The Connection Between Fatigue and Thyroid Disease

Why it happens, how to cope, and what else may be making you tired

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Fatigue is a common symptom of thyroid disease. And, if you've experienced it, you're intimately aware that this isn't the typical fatigue that many people experience after a night of poor sleep or during a stressful period. It's often a debilitating, relentless exhaustion that impairs your daily functioning. Whether you find yourself needing a nap every afternoon to make it to dinnertime or waking up unrefreshed and brain-fogged despite a full night's sleep, it may make you feel better to know that you're not alone.

Adjusting your thyroid medication dose (under the guidance of your physician), refining your sleep habits, and searching for another cause of fatigue that may be compounding the issue can all help you improve this common thyroid disease symptom and live better with your condition.

A Revealing Symptom

Fatigue and severe exhaustion can be key indications of undiagnosed or insufficiently treated thyroid conditions. Unfortunately, for some patients, fatigue persists even after treatment.

Hashimoto's Disease and Hypothyroidism

Fatigue is a nearly-universal symptom of hypothyroidism (an underactive thyroid), occurring as a result of the decrease in thyroid hormone production. One noticeable sign that your thyroid levels aren't properly regulated may be bone-numbing fatigue.

It can develop slowly or come on suddenly, leaving you barely able to lift your head off the pillow in the morning. You may feel like you can't get through a day without a nap, or you sleep more than usual but still feel completely exhausted. You may not have the energy to exercise, or you may fall asleep during the day or very quickly at night and find it difficult to get up in the morning.

If you're experiencing exhaustion, which is frequently seen along with other hypothyroidism symptoms, the problem may be that your hypothyroidism isn't sufficiently treated.

Graves' Disease and Hyperthyroidism

Fatigue is also a symptom of hyperthyroidism (an overactive thyroid), and it commonly results from insomnia, anxiety, or disrupted sleep patterns. Difficulty sleeping can be due to the stress hyperthyroidism puts on your body, including a rapid pulse, higher blood pressure, diarrhea, tremors, anxiety, and other symptoms of hyperthyroidism.

Treatment

If your fatigue has to do with your thyroid disease, you may need some medication adjustments.

For Hypothyroidism

When your treatment is optimized, meaning that your thyroid hormone levels are in specific narrow areas of the reference range, you may find that your fatigue improves or even goes away. Talk to your doctor about adjusting your thyroid hormone replacement medication dosage so that you can feel your best.

For Hyperthyroidism

If you're on an antithyroid drug and you're getting too much medication, this may shift your thyroid function into hypothyroidism, which can create worsening fatigue. And if you've had radioactive iodine (RAI) ablation or surgery to remove your thyroid and you're not taking thyroid hormone replacement medication, you may have become hypothyroid and need treatment.

Again here, if you're already on thyroid hormone replacement medication and you're still fatigued, you likely need an increased dosage in order to resolve your symptoms and get your thyroid hormone levels into the optimal range.

Other Causes

If your thyroid disease is treated and you're still experiencing persistent fatigue, there are other causes to consider with your doctor.

Depression

People with hypothyroidism and hyperthyroidism commonly have symptoms of depression. A 2018 systematic review found that patients with Hashimoto's disease are more likely to develop depression and anxiety than healthy people. In fact, around 24 percent of this population experiences depression and nearly 42 percent deals with anxiety.

Be sure to see your doctor if you're experiencing symptoms of depression. Treatment can be life-changing and often entails taking an antidepressant, seeing a mental health professional for psychotherapy, or a combination of the two.

Sleep Apnea

When you have sleep apnea, you experience brief periods when you stop breathing while you're sleeping, often accompanied by snoring. Because the amount of oxygen you're getting is reduced, frequent apnea can cause sleep disruption and contribute greatly to feelings of exhaustion. Besides snoring, fatigue, and grogginess, other common symptoms of sleep apnea include waking up gasping for air, a headache in the morning, and waking up at night to urinate.

Hypothyroidism is linked to sleep apnea since having low levels of thyroid hormone can impact your breathing. A 2016 systematic review of studies on sleep apnea and hypothyroidism found that 30 percent of adults newly diagnosed with overt hypothyroidism also had obstructive sleep apnea, which is a very common condition in the United States anyway.

Anemia

Anemia, indicated by a low red blood cell count, is common in hypothyroidism and sometimes it's even the first sign of thyroid disease. Along with fatigue, anemia may cause symptoms of dizziness, heart pounding, and shortness of breath.

Iron Deficiency

Though iron deficiency often leads to anemia, recently scientists have discovered that a large number of thyroid patients may have an iron deficiency that causes extreme fatigue without the presence of anemia. If this is the case for you, treating the iron deficiency can significantly improve your symptoms of fatigue.

Fibromyalgia

If you have long-term, debilitating fatigue and it's accompanied by other symptoms such as widespread muscle aches and pains, you may be experiencing fibromyalgia. In fact, research shows that 30 percent to 40 percent of patients with autoimmune thyroid disorders also have fibromyalgia.

Poor Sleep Habits

While insomnia and unrefreshing sleep may be associated with your underlying thyroid disease, engaging in poor sleep habits may be contributing to your fatigue, too. According to the National Sleep Foundation, adults need seven to eight hours of sleep per night, yet a substantial percentage aren't regularly getting this amount.

Additional Considerations

Besides the conditions listed above, there are many other potential causes of fatigue, such as other health problems like chronic kidney or liver disease, an infection, an anxiety disorder, or alcohol or drug abuse. There's also the possibility of medication side effects, getting too much or too little exercise, and not eating a consistently healthy diet.

How to Cope

Talking to your doctor and making some lifestyle changes to deal with your fatigue may help too, especially if your medication has been adjusted. Here are some tips to try:

  • Get more rest. If you're regularly fatigued even though your thyroid treatment is optimized, you may be tempted to continue blaming your thyroid. But here's a simple test: For a week, work to get at least eight hours of sleep each night. If you feel better and more energetic, your problem may be chronic sleep deprivation rather than a poorly-treated thyroid problem (or, at the very least, a lack of adequate sleep may be a significant contributing factor). Also, keep in mind that you may simply need more sleep than you used to, even when your thyroid treatment has been optimized.
  • Optimize your sleep. The quality of sleep you're getting is just as important as the quantity. You can start getting better quality sleep by taking steps to practice good sleep hygiene. If you simply can't get into a more healthful sleeping pattern, talk to your doctor about trying non-prescription sleep aids such as melatonin, Unisom (doxylamine), or herbs like valerian root, passion flower, or kava kava. For chronic sleep problems, your doctor may recommend antidepressants, anti-anxiety medications, or prescription sleep medications.
  • Keep a sleep diary. You may find it beneficial to keep a sleep diary for a couple weeks. The National Sleep Foundation has a printable one that can help you recognize patterns and spot factors that might be disturbing your sleep so you can make the necessary changes. Or you can look for an app for your smartphone or tablet that will help you track your sleep as well.
  • Change your diet. Some people report that altering their diet has improved their fatigue, whether that's eliminating gluten, sugar, or dairy, or just cutting out processed foods.
  • Get moving. Exercising at least several times a week can help you feel more tired at night and sleep more soundly, too. Just be sure you've finished your workout several hours before it's time for bed so your body has time to come down off of its endorphin high.
  • Make time to relax. Stress can have an extremely negative impact on both your quantity and quality of sleep. Be sure to take time out for yourself to do activities you enjoy and find relaxing so your stress doesn't pile up, leaving you missing stretches of sleep and even more stressed.
  • Stay on top of stress. When stress does threaten to get the best of you, try some stress-busting activities such as boxing, yoga, writing in a journal, painting, playing an instrument, getting a massage, going to coffee with a friend, or squeezing a stress ball.

A Word From Verywell

Ultimately, it's important to have your fatigue thoroughly evaluated by your doctor. Beyond the possibility that you need your medication tweaked, there's often more than one cause of fatigue, such as your thyroid disease and fibromyalgia or depression. If your fatigue can also be chalked up to lifestyle factors, the above lifestyle changes can help a lot. Getting adequate sleep is of particular importance to your overall thyroid management, as insufficient and/or poor quality rest can increase the risk of several issues already of concern to many thyroid patients, including reduced immune function and increased inflammation.

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