Dr. Izabella Wentz, Thyroid Pharmacist
Hashimoto’s Thyroid Fatigue Steps To Heal
Fatigue was the most debilitating symptom I experienced with Hashimoto’s.
It actually started 8 years before I was finally diagnosed in 2009, after I got Mono (Epstein-Barr Virus) in college. I needed to sleep for 12 hours each night to be able to function, and by “function” I mean after hitting the snooze button on my alarm clock for two hours (ask my poor husband), I would drag myself out of bed and then had to drink 4-6 cups of caffeine everyday to keep myself awake. I often had Red Bull and Pepsi for breakfast, and was the epitome of “wired but tired”.
I saw numerous doctors and I was offered antidepressants, stimulant medications used for narcolepsy and ADHD, but no one though to check my poor little thyroid. I came across “chronic fatigue syndrome” , and was discouraged that there was “no cure”, and so I slept half of my early twenties away thinking that I better just deal with it since no one could help me anyway.
When I was finally diagnosed with Hashimoto’s, part of me was relieved. I thought that I would finally get more energy. But this was not the case, sure the thyroid medication helped- instead of sleeping for 12 hours, I only needed 11 hours of sleep after starting medications. But I didn’t give up. At the time of my diagnosis, I was working as a consultant pharmacist and had become accustomed to researching emerging healthcare information.
Finding a way to get myself better became my mission.
It took me almost three years after my Hashimoto’s diagnosis to get my energy back, and I hope that some of the strategies that I used will help you get yours back too.
Here are some of my strategies to address fatigue:
1. TSH – One major symptom of hypothyroidism is low energy. 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.
For more on TSH and how to talk to your doctor about adjusting your medications, read my article here.
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, such as adding Cytomel to levothyroxine, or switching to Armour, Nature-Throid or Compounded T4/T3. You can read my article about thyroid medications here.
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. I 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. You can read more about B12 here.
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. You can read more about Ferritin here.
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 food sensitivities 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.