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 very aware that this isn't the typical fatigue that many people experience after a night of poor sleep or during a stressful time.

It's often extreme exhaustion that interferes with daily life. 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 healthcare provider), improving your sleep habits, and addressing other factors that may be making the issue worse, can all help you improve this common thyroid disease symptom and live better with your condition.

Keep reading to learn more about how thyroid disease can make you feel exhausted. This article will also discuss treatment for thyroid disease and ways to find more energy.

thyroid sleep problems

Verywell / Emily Roberts

A Revealing Symptom

Fatigue or severe exhaustion can be a key sign of undiagnosed or insufficiently treated thyroid conditions. Unfortunately, some patients continue to experience fatigue even after treatment.

Hypothyroidism

Fatigue is a nearly universal symptom of hypothyroidism (an underactive thyroid). This medical condition occurs as a result of a decrease in thyroid hormone production.

Bone-numbing fatigue may be one noticeable sign that your thyroid levels aren't properly regulated. The fatigue 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. You may sleep more than usual but still feel completely exhausted. You may not even have the energy to exercise. At times, you may fall asleep during the day or very quickly at night. In the morning, you may find it difficult to get out of bed.

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.

Hyperthyroidism

Fatigue can also be a symptom of hyperthyroidism (an overactive thyroid), because the condition commonly causes:

Difficulty sleeping can be due to the stress hyperthyroidism puts on your body, including:

Treatment

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

For Hypothyroidism

When your treatment is working, you may find that your fatigue improves or even goes away. This may involve increasing your thyroid hormone replacement medication dosage.

Talk to your healthcare provider about whether you need to adjust your dose so that you can feel your best. Don't try to make these changes on your own.

For Hyperthyroidism

If you're on an antithyroid drug and you're getting too much medication, this may shift your thyroid function into hypothyroidism. It 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.

If you're already on thyroid hormone replacement medication and you're still fatigued, you probably need an increased dosage in order to help your symptoms. This will get your thyroid hormone levels into the optimal range.

Other Causes

If your thyroid disease is well treated and you're still experiencing persistent fatigue, there are other causes to explore with your healthcare provider.

Depression

People with hypothyroidism and hyperthyroidism often have symptoms of depression. A 2018 systematic review found that patients with Hashimoto's disease, a condition that causes hypothyroidism, are more likely to develop depression and anxiety than those without the condition. In fact, around 24% of this population experiences depression and nearly 42% deals with anxiety.

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

Sleep Apnea

If you have sleep apnea, you experience brief periods when you stop breathing while you're sleeping. It's often accompanied by snoring.

Because the amount of oxygen you're getting is reduced, frequent apnea can wake you up and interrupt your sleep. It can also make you feel exhausted.

Besides snoring, fatigue, and grogginess, other common symptoms of sleep apnea include:

  • Waking up gasping for air
  • Experiencing a headache in the morning
  • Waking up at night to urinate

Hypothyroidism is linked to sleep apnea since having low levels of thyroid hormone can affect your breathing. A 2016 systematic review of studies found that 30% of adults newly diagnosed with hypothyroidism also had obstructive sleep apnea.

Anemia

Anemia, indicated by a low red blood cell count, is common in hypothyroidism. Sometimes it's even the first sign of thyroid disease. Along with fatigue, anemia may cause symptoms of:

Iron Deficiency

Though iron deficiency often leads to anemia, 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 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% to 40% 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, poor sleep habits may be contributing to your fatigue, too. According to the National Sleep Foundation, adults need seven to nine hours of sleep per night. But a large 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:

There's also the possibility of medication side effects, getting too much or too little exercise, and not eating a consistently healthy diet.

Coping with thyroid disease.

Verywell / Brooke Pelcynzski

Coping

Talking to your healthcare provider about 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 exhausted even though your thyroid treatment is optimized, you may be tempted to continue blaming your thyroid. But try this 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.

At the very least, a lack of adequate sleep may be a huge reason why you have fatigue. Also, keep in mind that you may simply need more sleep than you used to.

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 healthier sleeping pattern, talk to your healthcare provider about trying non-prescription sleep aids such as:

For chronic sleep problems, your healthcare provider 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 of 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.

Change Your Diet

Some people report that changing 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 settle down for sleep.

Make Time to Relax

Stress can have an extremely negative effect on both your quantity and quality of sleep. Be sure to take time out for yourself to do enjoyable, relaxing activities. If you do this, your stress won't pile up. You'll also sleep better.

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 get a coffee with a friend, or squeezing a stress ball.

Summary

When you have thyroid disease, it can make you feel exhausted all of the time. Unfortunately, you may continue to experience fatigue even after a healthcare provider provides treatment for your thyroid condition.

Your healthcare provider may need to adjust your thyroid medication to help with your exhaustion. Making lifestyle changes may also help, such as getting more rest, keeping a sleep diary, eating a healthier diet, managing stress, and taking time to relax.

A Word From Verywell

Ultimately, it's important to have your healthcare provider provide you with a complete checkup to evaluate your fatigue. Beyond the possibility that you need your medication tweaked, there's often more than one cause of fatigue. You could be tired because of 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. It's important to get enough quality sleep to manage your thyroid. Sufficient rest will help boost your immune system and overall health.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Siegmann E-M, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of depression and anxiety disorders with autoimmune thyroiditis: a systematic review and meta-analysisJAMA Psychiatry. 2018;75(6):577. doi:10.1001/jamapsychiatry.2018.0190

  2. Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory manifestations of hypothyroidism: A systematic review. Thyroid. 2016 Nov;26(11):1519–1527. doi:10.1089/thy.2015.0642.

  3. National Heart Lung and Blood Institute. Sleep apnea.

  4. Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory manifestations of hypothyroidism: a systematic reviewThyroid. 2016;26(11):1519-1527. doi:10.1089/thy.2015.0642

  5. Haliloglu S, Ekinci B, Uzkeser H, Sevimli H, Carlioglu A, Macit PM. Fibromyalgia in patients with thyroid autoimmunity: prevalence and relationship with disease activity. Clinical Rheumatology. 2017 Jul;36(7):1617–1621. doi:10.1007/s10067-017-3556-2.

  6. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's sleep time duration recommendations: Methodology and results summary. Sleep Health. 2015 Mar;1(1):40–43. doi:10.1016/j.sleh.2014.12.010.

  7. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summarySleep Health. 2015;1(1):40-43. doi:10.1016/j.sleh.2014.12.010

  8. Eunice Kennedy Shriver National Institute of Child Health and Human Development. How is the body affected by sleep deprivation? Updated December 1, 2016.