fatigue, depression, hypothyroidism, woman, thyroid problem worse, tired all the time

There are too many possible causes of fatigue to offer a one-size-fits-all solution. Anemia due to inadequate iron or lack of B vitamins can make people feel worn out. So can many serious health problems such as chronic infection, problems with kidneys or liver, certain types of cancer and heart failure. One common problem that can make a person feel tired all the time is low thyroid function or hypothyroidism. In addition to fatigue, too little thyroid activity can lead to apathy, depression, weakness and other symptoms. Doctors usually treat this problem with a daily dose of synthetic thyroid hormone, but sometimes patients don’t feel quite well despite taking the medicine. What else might they do?

Reader Hates Feeling Tired All the Time:

Q. I had thyroid cancer, so my thyroid gland was removed. I’ve been on Synthroid ever since then, despite telling my endocrinologist that I’m tired all the time. When I wake up, I feel pretty good. Within an hour of taking my Synthroid, I’m ready to go back to sleep.

I’ve asked my doctor for either Armour Thyroid or Nature-Throid, but get nowhere. She is interested only in lab results, not how I feel. Is there any research that might convince her?

Research on T3 and T4:

A. Doctors treating people with underactive thyroid glands (or in your case, no gland at all) generally start by prescribing levothyroxine, also known as T4 because it contains four iodine atoms in the molecule. The physician then monitors the patient’s thyroid-stimulating hormone (TSH, also known as thyrotropin) to make sure it is within the normal range. The brain uses TSH as a messenger to tell the thyroid gland to make more or less hormone; when TSH is in the normal range, it suggests that the brain has determined that the right amount of thyroid hormone is circulating in the bloodstream.

While this works well for many patients, some people don’t find it helpful. They may report that they feel tired all the time–a symptom of low thyroid function–despite TSH tests within the normal range. To understand this, you should know that body tissues don’t use T4 directly. Instead, they use an enzyme to knock one iodine atom off the T4 molecule and convert it to the active thyroid hormone, T3 (aka triiodothyronine).

Trouble Converting T4 to T3:

Research shows that some people do not readily convert T4 (Synthroid or levothyroxine) to the active T3 hormone (Gereben et al, Nature Reviews. Endocrinology, Nov. 2015). Common genetic variations determine the activity of these converting enzymes known as deiodinases. According to recent research, people with genetic variants associated with lower enzyme activity are more likely to suffer from autoimmune diseases affecting the thyroid gland, such as Grave’s disease and Hashimoto’s disease (Inoue et al, Immunological Investigations, July 2018).

Such individuals may feel better when they take T3 with T4, although getting the dose right can be tricky. Our Guide to Thyroid Hormones and our one-hour radio show: Thyroid Mysteries, Controversies and the Latest Research (Show # 1015) may change your doctor’s mind. In the guide, you will also learn about common symptoms of too little or too much thyroid hormone.

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  1. Lynn

    My suggestion for those with thyroid and fatigue issues is to read the book “Stop the Thyroid Madness” by Janie A. Bowthorpe, M.Ed. I have no personal interest in promoting this book except that it is a very readable book about thyroid that is suitable for a regular non scientific person. It is eye opening. And right on target. I do not understand why some doctors are so adamant as to tell you that you don’t feel the way you do. Endocrinologist are no more enlightened and may be worse on thyroid prescribing than anyone which is really quite unbelievable. If you are having issues, take the time to read this and you will not be sorry.

  2. Marilyn

    I was told by my physician that I was hypothyroid. He prescribed Synthroid. I had no resolution of symptoms taking Synthroid. I went back to the same doctor and asked him if I could try another medication. He said he could prescribe Nature-Throid. Within a short period of time taking Nature-Throid I felt so much better. Nature-Throid is a natural thyroid hormone, not synthetic. It contains T3 and T4. If you cannot find a doctor to prescribe a natural thyroid hormone, ask the pharmacy which doctors prescribe natural thyroid. It can make a world of difference in your symptoms.

  3. Michael

    I’ve gotten tired easily recently, and I’ve suspected a metabolic syndrome T3/T4 problem for a few years, but nothing comes out wrong. T3 is 2.6 (ok), T4 1.21 (ok) and cortisol 18.6 (high end of ok). A year ago, I told my son’s friend, a post-doc in immunology, about some problems I’d had, and he suggested I get my cortisone (not cortisol) checked, but I just get told that cortisol is all there is to check. Anything you can see that’s missing?

  4. Susan

    I used to take Armour Thyroid and it worked very well for me, but when it tripled in price I began the synthetic Levothyroxine which did not work well at all. It was not converting T4 to T3 and I had the usual hypothyroid symptoms of fatigue and feeling cold. I didn’t like the idea of taking the synthetics anyway. Through some online research I found out about Acella’s new NP thyroid and good results it was getting.

    My doctor prescribed it and quickly my TSH, T4 and T3 readings become normal. I am no longer having any thyroid symptoms, and feeling great. I am also pleased how inexpensive it is at Costco. It’s important to get the correct dosage. For me it takes only 30mg of the NP whereas I used to take 90mg of the Armour and 75mg of Levothyroxine.

  5. Mike
    South Carolina

    How do you feel about Suzy Cohen’s thyroid studies and anylysis of thyroid disfunction and products she offers to help?

  6. Patricia
    Palm Harbor, FL

    I have been hypothyroid for a long time. I also am homozygous for the C677t) variant of the MTHFR gene. My lab report says that because of this, I am likely to have only 30% of the enzymes of a normal person. I am allergic to many things. I flunked Synthroid and other synthetic thyoid meds.

    The only thyroid meds that have ever worked for me are natural dessicated thyroid, such as Naturethroid or compounded T3/T4, which contain both T3 and T4. There is a PP podcast w/ Dr. Antonio Bianco, (former head of the endo dept at U Miami, and now at Rush University med school, in which he said that he thought about 15% of people who are hypo had a genetic reason that they need T3 in their thyroid meds. Dr. Bianco’s work can also be seen on the website deiodinase.org, more specifically at http://deiodinase.org/2013/05/14/deiodinase/ deiodinase .

    If you think you may be a poor converter of T4 to T3, the whole site is worth exploring.

  7. Linda
    Atlanta, Ga

    I take a compounded T3/T4 and it’s great. Over time, my Dr and I concluded I felt better being ‘high normal’ in the labs than ‘low normal.’ I tried everything and always feel best on something individually compounded made for me. It’s more expensive but worth it. If your Dr won’t switch, switch Dr! It’s your health and life. Take control.

  8. RENA M R

    My story is very similar. Ten year’s ago I was diagnosed with Graves Disease and given Radio-active Iodine to kill off my thyroid. Since then I have been to an Endocrinologist in the beginning and then several Internist since. Each time I have asked to try the T3 I have been told I don’t need it. One even said that it could make me hyperthyroid again.

    I’m no doctor but how could that happen with a dead thyroid. Not one out of perhaps six or so doctor’s were willing to give me T3. Even a local pharmacist said I needed to try it and that it would most assuredly make me feel better. I need nap’s daily just to get through the day. Thank you for the honest research and information that you make available to all people.

  9. Barbara

    I was fatigued all the time after taking my thyroid medicine when I got up. About 3 years ago, I started taking my thyroid medicine before I went to bed and it has made a big difference for me. I’m not fatigued through out the day anymore.

  10. Barbara
    Jackson, MS

    The brand Synthroid always makes me tired. I do much better with Levothyroxine.

  11. Barbara

    As I entered my 70s still in good health, I was so shocked at the change in medical providers’ treatment. All at once, I was not worth treatment and most important, courtesy, because of my age. I have been treated in numerous inconsiderate ways. Most recently, knee injection that I have been receiving for years, the doctor chose not to deaden my knee as usual, causing excruciating pain. Just a part of old age. I am determined to keep my busy schedule and reasonably good health in spite of the bad care I have received.

  12. Mary
    Fayetteville, NC

    My thyroid level fluctuated up and down until my endocrinologist added Cytomel to my Synthroid. Now my thyroid level has been stable for the past year.

    • Laura
      Raleigh nc

      Always ask for the deadening of the area first don’t let them skip that step I’ve gotten the novisic shot for years in both knees I’m 70. The pain is very bad if she does not inject the numbing part first. Stand strong.

  13. c

    There is another cause of fatigue which I discovered that happened to me. I use to come home from work tired but not overly so. When I walked into my front door I was so fatigued that all I could do was crash on the couch and sleep, waking up hours later still fatigued. Until one week-long camping out with heavy activity came about. I felt great. Slept like a log and was active all day.

    Then I walked into my home and the utter fatigue started again. Whatever it was was inside my home. After getting rid of all carpets and bed the problem was still not solved. So I went on internet and learned that health problems can be caused by “dirty electricity.” Learned about smart meters. Got rid of my cordless phones, microwave and laptop. Put cell phone on airplane mode or off when not using. Result. No more fatigue.

    Soon after that my electric company rolled up with a smart meter. OPTED OUT. If it was not for the fact I had health problems because of all the above, I would not have known about the rest of the story re: electrical.

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