Overcoming Fatigue in Thyroid Problems

17 Jun, 2014

Have thyroid issues and struggle with fatigue even on thyroid medication? Here are some of the strategies to help overcome this debilitating symptom.


1. TSH

Make sure that your TSH is within the range of a healthy person without thyroid disease, not within the range of an elderly person or someone with subclinical thyroid disease.

In recent years, The National Academy of Clinical Biochemists indicated that 95% of individuals without thyroid disease have TSH concentrations below 2.5 μIU/L, and a new normal reference range was defined by the American College of Clinical Endocrinologists to be between 0.3- 3.0 μIU/ml.

However, most labs have not adjusted that range in the reports they provide to physicians, and have kept ranges as lax as 0.2-8.0 μIU/ml. Most physicians only look for values outside of the “normal” reference range provided by the labs, and may not be familiar with the new guidelines. Thus many physicians may miss the patients who are showing an elevated TSH. This is one reason why patients should always ask their physicians for a copy of any lab results. Despite some lab tests stating that a TSH of 8, or 5 is “normal”, most people feel best with a TSH between 0.5-2 μIU/L.

2. Low T3/high reverse T3

T3 is our main “energy” hormone produced by the thyroid. When our cells see T3, they produce more energy.  Reverse T3 is a molecule that looks like T3, but has slowing down effects. When cells see this molecule, they slow down energy production. Levothyroxine is the most commonly prescribed thyroid medication, but only contains T4, a precursor to T3, our main “energy” hormone.  T4 is converted to T3 in the body, but in many people, due to stress, nutrient deficiencies and other factors, this doesn’t always happen, and we can continue to feel exhausted despite normal T4 levels.

If you continue to be fatigued while on medications, you can have your doctor test your free T3 levels, (and reverse T3, although sometimes it’s not necessary) and may benefit from a T4/T3 combination medication.

3. Anemia is an energy thief

People often think of iron deficiency as anemia, but there are three types of nutrient deficiencies that can lead to anemia that are common in those with Hashimoto’s; Iron, B12, and folic acid. Your doctor will usually run a blood test to check for hemoglobin and hematocrit. While helpful for advanced cases of anemia, this test may miss some subtle cases of anemia that can make us exhausted. We recommend doing a test for ferritin, B12 levels, and folic acid. Always be sure to get a copy of your lab tests. As is the with the “normal” range for TSH, the “normal” lab values for B12, ferritin and folic acid are not often correct. For example, normal levels of B12 are between 200-900 pg/mL, yet levels under 350 are associated with neurological symptoms. If your levels are below 800, you may still benefit form a supplement. For B12, be sure to get a methylcobalamin version rather than a cyanocobalamin version of B12. The methylcobalamin absorbs better.

Normal ferritin levels for women are between 12 and 150 ng/mL. According to some experts, the optimal ferritin level for thyroid function is between 90-110 ng/ml.

4. Food sensitivities

Food sensitivities are different from food allergies and eating a food one is sensitive to may result in fatigue. People with Hashimoto’s often present with gluten, dairy, soy, egg, corn and nut sensitivities. Undertaking an elimination diet, or food sensitivity testing can give you a tremendous amount of your energy back. You can read more about the food sensitivity testing we do here. 

5. Blood sugar imbalances 

Blood sugar imbalances can wreak havoc on our energy levels as well as cause anxiety. Some people will test blood sugar when feeling tired and will note that it is low. Opt to eat more protein and fat with each meals rather than carbohydrates.

6. Optimize digestion

The digestive process takes a lot of energy. Poor gut function is always a factor with Hashimoto’s and autoimmunity. Anything you can do to aid the process of digestion will help you get some energy back. Green smoothies with digestive enzymes are a great place to start and you can talk to one of our Naturopaths to find out which enzymes are best for you.

7. Check your Vitamin D levels

Low levels of vitamin D can be associated with fatigue, hypothyroidism and autoimmunity in general. Be sure to get enough Vitamin D through sunshine, foods or supplements. Your goal should be to get your Vitamin D levels between 60-80 ng/dl.

8. MTHFR gene

Up to 50% of people have a gene variation that prevents them from properly converting synthetic folic acid. These individuals may benefit from increased green veggies and the activated form of folic acid: methylfolate as well as additional substances that aid with breaking down homocysteine.

9. Adrenals 

Adrenal fatigue can make you feel like you are dragging yourself around the place, especially in the later phases of adrenal fatigue when our cortisol becomes depleted. Cortisol spikes in the morning to give us a natural jolt to get us out of bed. Those without sufficient cortisol levels may become dependent on caffeine. Coffee may seem like it’s helping, but only weakens the adrenals in the long term. Adrenal fatigue is one of the major reasons we feel exhausted despite taking thyroid  medications. Natural therapies like herbs, supplements and even acupuncture can really help with adrenal fatigue and you can read more about that here.

10. Is your liver congested? 

Some of us may be exhausted because we do not have the ability to process the toxins our body is dealing with. The toxins may be external such as molds, or internal, such as the ones caused by an imbalance of gut bacteria or pathogens. The toxins saturate the liver enzymes and we feel exhausted. There are many supplements that support the liver’s detox capacities and your natural health practitioner will prescribe the most effective one for your condition.

In Addition…

Many people often don’t know which brand of supplements are best to take. As natural health professionals, we are very picky about our supplements. We make it a priority to only stock brands in our clinic that have extremely tight quality control and manufacturing guidelines and ones we have experienced both first-hand and through the results in our clients to really work. We never recommend self-prescribing. All herbs and supplements should always be cleared by a natural health practitioner first.

Call us on 3369 0045 so we can assist you in getting back your energy in the quickest way possible.