What does Hashimotos fatigue feel like?

A Daily Routine to Fight Hypothyroidism Fatigue

Use this all-day plan to keep your energy levels up, even when you’re feeling drained.

By Julie Stewart Medically Reviewed by Sanjai Sinha, MD
Reviewed: October 31, 2018

Fatigue is one of the most common symptoms of hypothyroidism, or an underactive thyroid. Medication can help you feel better, but a few tweaks to your daily routine can also help you keep your energy up throughout the day. “It’s all about the lifestyle,” says Beatriz Olson, MD, an assistant clinical professor of endocrinology and metabolism at Yale School of Medicine in New Haven, Connecticut. “You are what you eat, what you do, and what you think.” Regardless of the cause of your hypothyroidism — the autoimmune Hashimoto’s disease, having had your thyroid surgically removed, or a less common type of the condition — here’s your plan for all-day energy.

Morning

Wake up around the same time every day. Give yourself a good start. “The body does better when you sleep in a regular pattern, so for anyone with hypothyroidism — or not — waking up at nearly the same time can be helpful,” says Rachel Abrams, MD, MHS, director of Santa Cruz Integrative Medicine in California. “That doesn’t mean that you should wake yourself up at 7 a.m. even if you’re sleep deprived and went to bed at 2 in the morning. It’s more important to be well-rested than to get up at the same time, but it can be helpful in sleeping more regularly and more deeply.” Take your thyroid medication bright and early. The best time to take your thyroid hormone medication is first thing in the morning, on an empty stomach, says Dr. Olson, “then wait for about an hour before you eat.” Certain foods and medications can interfere with the absorption of thyroid hormone. If you don’t follow the ideal routine, it’s critical to at least be consistent, says Dr. Abrams. “If someone can’t remember to take that medication unless they’re eating at the same time, or they’re rushing out of the house and they don’t have breakfast, I’d honestly rather they take it with food as long as they do it on a regular basis, the reason being that if you always take it with food, you won’t absorb as much of it, but we will adjust your dose for that circumstance,” she says. Eat a breakfast that fuels your body. A morning meal isn’t mandatory, but a healthy breakfast can be helpful, says Abrams. “Having a doughnut or other simple carb with sugar and white flour will spike your blood sugar, and it will drop back down and just exacerbate whatever energy issues you have from hypothyroidism,” she says. Instead, pair protein-rich foods like almond butter with whole grains like oatmeal, she suggests. You’ll digest it more slowly than the oatmeal alone, so your blood sugar and energy levels can stay steadier, she says. Be smart about caffeine. A bit of caffeine is perfectly fine for many people with hypothyroidism, but not for those with severe anxiety, insomnia, or panic disorder, says Abrams. Just don’t go overboard. “The major issue with caffeine is that people use it to make up for not getting enough sleep, [which] is actually very harmful to your health,” she says.

Choose natural caffeine sources like coffee or tea (as opposed to soda or energy drinks), and pay attention to how it affects you. “Some people can drink caffeine before bed because their metabolism is such that it doesn’t affect them; other people can’t drink caffeine after noon,” she says. “You need to know what your own limits are. The average person probably shouldn’t drink it after 2 or 3 p.m.” Green tea, which has a lower caffeine content than coffee and other teas, has anti-inflammatory benefits and can be a particularly good choice for some people with fatigue, she says.

Midafternoon

Break for a healthy lunch. Ham and cheese on white bread isn’t doing your energy any favors. Like breakfast, lunch should not be rich in simple carbs like white bread. “Most people are eating too many processed carbohydrates,” says Olson. “I tell people to focus on proteins, nonstarchy carbohydrates like vegetables, and good fats.” Eggs, avocados, and Greek yogurt are good examples. Some organic complex carbohydrates, such as whole grains, can help you keep up your levels of the brain chemical serotonin, says Abrams, but some people with hypothyroidism, such as those who also have diabetes, may need especially low-carb diets. Talk to your doctor about a meal plan that works best for you. Reenergize in the afternoon. Looking for a quick fix for your afternoon energy dip? Take a nap. “Napping in the afternoon is a natural human thing because we have a dip in our energy levels in the afternoon as part of our normal daily cycle,” says Abrams. If you limit your sleep to just 20 to 25 minutes, you won’t enter a deep sleep cycle, which means you won’t wake up groggy. If napping isn’t an option, get up from your chair and walk around outside, and repeat. “Set a timer to take a break for five minutes every hour to sort of stretch and stand and leave whatever you’re doing,” says Olson. Doing something fun for even just a moment can make you feel energized. Get some exercise. “It is essential for people with hypothyroidism to exercise because it keeps their metabolism up and helps reduce symptoms that can be associated with hypothyroidism, such as depression, low energy, and constipation,” says Abrams. Do what you can: If you’re feeling very tired, a gentle walk around the block is a good start; if you’re highly active already, a game of soccer could be a good choice, she says. Exercise is helpful for many reasons. It helps increase blood flow to the brain, clear toxicities, and develop muscle mass, which increases production of mitochondria, the energy units in our cells, says Olson. Take time for your mind. Sadness, depression, and anxiety can reduce your bandwidth and sap your energy, says Olson, but meditation can help counter stress-related spikes in nervous system activity that can otherwise leave you exhausted. Take a course in mindfulness-based stress reduction, offered at many hospitals and health centers around the country, she suggests. Talking with a mental health professional can also be helpful. Keep water nearby. Dehydration can make you feel tired or give you a headache, says Olson. You want to keep your urine relatively diluted, not dark brown or dark orange, she says, and everyone has different needs. You’ll need a couple of liters a day, she says, and if you’re working outside and sweating, you’ll need to drink more than if you’re in an air-conditioned space. Keep a 16-ounce bottle of water at your desk to help you hit your target.

Evening

Don’t overeat at dinner. A full belly can make you feel sluggish. Bonus: “Eating lightly in the evening and eating more of your calories earlier in the day can help you maintain a normal weight, which is a real issue for many people with hypothyroidism,” says Abrams. Be careful about alcohol. Drinking alcohol can make you drowsy but also interfere with your quality of sleep, leaving you fatigued the next day. It can also pack a lot of calories. “I tell my patients it’s just like eating a slice of chocolate cake every night if you have two glasses of wine, so if you’re trying to lose weight, manage diabetes, or keep your energy high, you probably want to limit the amount of alcohol that you drink,” says Abrams. If you do drink, stick to no more than one drink per night for women or two for men. A drink is one 1.5-ounce shot, one 12-ounce beer, or five ounces of wine, she says. It’s also important to consider why you are imbibing. “People who are very stressed and anxious in their jobs and are coming home and drinking to help with that stress and anxiety are not necessarily helping themselves, because that’s an addictive use of alcohol,” she says. Relax and unwind before bed. Turn off your TV, computer, and tablet and don’t look at your phone for an hour before bedtime, says Olson. The blue light from screens suppresses the sleep hormone melatonin and interferes with slumber, according to a study published in January 2015 in the journal Proceedings of the National Academy of Sciences of the United States of America. Instead of staring at a screen, do something you find relaxing, whether it’s reading a paperback, making art, or something else, says Abrams. Or take a hot bath. Research suggests a hot bath is helpful because it increases your body temperature, she says, and then your temperature drops “just as it does when you sleep during the night, [which] seems to increase onset of sleep and deep sleep.” Sniffing lavender oil can also help you relax, she says. Go to bed at the same time every night. Sticking to a routine bedtime can help you fall asleep and stay asleep. Sleeping enough hours and sleeping soundly play an important role in managing autoimmune diseases, says Abrams. “It also helps balance the endocrine hormonal system, of which hypothyroidism is a part,” she says. You need at least seven hours per night, says Olson, so if you need to get up at 6 a.m., start going to bed at 10 p.m. so you fall asleep by 11. Turn out the lights, keep your room cool, dark, and quiet, and get some z’s. If your medication and healthy habits aren’t curbing your fatigue, talk with your doctor to make sure anemia, an undiagnosed autoimmune disease, or adrenal insufficiency isn’t contributing to your problems, says Olson. People with Hashimoto’s disease have an elevated risk of developing a second autoimmune disease, according to a study published in February 2010 in The American Journal of Medicine.

Thyroid fatigue: key points to know

Medically reviewed on January 7, 2022. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

What is your thyroid?
Understanding thyroid problems
Understanding thyroid fatigue
What is fatigue?
Dealing with thyroid fatigue
Related content

It’s normal for the average person to feel physically exhausted every so often. Whether you had a long day or exerted extra energy during your workout, feeling tired or fatigued is generally nothing to worry about. However, suppose you feel physical fatigue consistently and on a regular basis. In that case, that can seriously undermine your quality of life, and you may be dealing with a more serious, underlying issue.

Ongoing fatigue can be rooted in numerous different health conditions and disorders. One of the most common is thyroid disease. Thyroid problems can have a considerable impact on all components of health. Learn more about thyroid fatigue and how to manage it below.

Check if your thyroid hormones are balanced from the convenience of home with the Everlywell at-home Thyroid Test.

What is your thyroid?

Your thyroid gland is located at the front of your neck wrapped around your windpipe. This small, butterfly-shaped gland is responsible for producing the thyroid hormones thyroxine (T4) and triiodothyronine (T3). These hormones are primarily involved with regulating your metabolism, which comprises all the processes involved with turning the food you eat and beverages you drink into usable energy [1].

Outside of metabolism, thyroid hormones also play a role in:

Supporting heart and muscle function
Controlling digestive functions
Maintaining bone health [1]

Understanding thyroid problems

Learning how to understand thyroid levels is important. Thyroid hormone levels are carefully controlled by your body’s pituitary gland and hypothalamus. However, even with these glands working properly, the thyroid can malfunction, causing problems with thyroid hormone levels. These malfunctions can be caused by numerous factors, including autoimmune diseases and certain medications. Therefore, it is important to learn the early signs of thyroid problems [1].

A thyroid disorder can manifest in several different ways. While it is well-known for controlling metabolism, it’s worth understanding how your metabolism is involved with basically every process within the body. Furthermore, imbalances in any of the body’s hormones can cause fluctuations in other hormones, which can then lead to health issues [1].

Exact symptoms of thyroid imbalances will vary from person to person, and an overactive thyroid (hyperthyroidism) may present different symptoms from an underactive thyroid (hypothyroidism). General symptoms of an imbalanced thyroid can include sudden weight fluctuations, changes in mood (often resulting in depression and/or anxiety), sleep problems, and irregular menstrual periods. One of the most common symptoms of thyroid disease is intense fatigue [1].

Understanding thyroid fatigue

While hyperthyroidism can potentially contribute to fatigue, this symptom is more common among those with hypothyroidism, particularly for those with Hashimoto’s disease. Hashimoto’s disease is an autoimmune disease wherein the immune system mistakenly attacks the thyroid gland, resulting in reduced thyroid function [1].

Your thyroid hormones are involved with metabolism, which is how you get energy for the day. Without enough hormones, your metabolism slows down, causing weight gain, which means less energy throughout the day. Less energy equates to more intense fatigue. This can occur suddenly or can develop over time [2].

Hypothyroidism can also contribute to symptoms that can then lead to fatigue. For example, an underactive thyroid commonly contributes to depression. While depression is typically associated with extreme sadness and a lack of motivation, it can also give way to physical symptoms, like aching muscles and joints, muscle weakness, frequent headaches, and fatigue [2].

With hyperthyroidism, fatigue can present as a product of other symptoms. An overactive thyroid commonly leads to insomnia and general sleep problems. This comes because of the excess thyroid hormone, which can increase your blood pressure and heart rate and cause anxiety. Left untreated, those sleepless nights can easily add up, resulting in fatigue in your waking hours [2].

What is fatigue?

There is a difference between feeling tired and sleepy and feeling fatigued. Fatigue is like feeling tired with the dial cranked all the way up to 100. That overtired feeling can have a huge negative impact on your everyday life. You may have trouble getting up in the morning, going to work, performing your usual tasks, and simply getting through the day [3].

This can be noted by an intense sleepiness that doesn’t go away even after going to sleep and sometimes goes even beyond that. Your muscles can feel weak, and your limbs might feel unnaturally heavy. Basic movement can feel sluggish, and you may feel physically uncomfortable more easily. You may have no energy to exercise regularly, and doing something as simple as climbing stairs can feel like an impossible task [3].

That fatigue can eventually catch up to your mental health and basic cognitive processes. Fatigue may keep you from concentrating or focusing on tasks. You may have memory problems, both in the short and long term. You may lack motivation to do anything, even the activities you like. You may also feel nervous, irritable, or anxious [3].

Dealing with thyroid fatigue

The best way to manage your thyroid fatigue is to get a proper diagnosis and receive treatment for the thyroid disorder. This may involve a form of prescribed medication. For many people, even with thyroid medication, fatigue can persist, but it’s important to keep up with your prescription. Take your medication consistently as directed. If you miss a dose, take it as soon as you remember. Wait at least four hours to take your medication after taking iron, calcium, or cholesterol-lowering supplements. These can interfere with the absorption of the medication for the thyroid condition [4].

Those feeling the effects of fatigue will typically reach for sugar and caffeine to give them an extra energy boost. Although sugar can give you a slight boost, that energy is temporary and usually followed by a crash that can make you feel even worse than before. Caffeine is generally okay when taken in moderation, but too much caffeine can interfere with sleep, which can make you feel more tired [4].

While there is no singular diet that will increase your energy levels, it’s always a good idea to maintain a balanced diet that includes plenty of fruit and vegetables, lean sources of protein, and whole grains in lieu of sugary snacks [4].

Exercise can seem impossible and counterintuitive. After all, why would you tire yourself out even more? However, a regular exercise routine can help manage your mood, energy levels, stress, and blood sugar. You don’t need too vigorous of activity. Yoga, cycling, and walking can all help you relax while remaining active [4].

Maintaining a sleep routine sets the foundation for good quality sleep every night. Keep a bedtime routine that introduces a low-level activity that gets your mind relaxed and ready for bed. This can include taking a bath, meditating, or reading a book. Things like exercising, playing games, or watching TV can over-excite your brain, even after you close your eyes [3].

As you’ve probably heard before: avoid electronics before bed. Anything with a screen should be put away at least an hour before bedtime. Move your phone away from your bed to prevent the temptation of checking it.

Literally, hundreds of conditions and diseases aside from thyroid problems cause fatigue. The only way to know your health status is to get tested, like with the Everlywell at-home thyroid test, or get an official diagnosis from your healthcare provider. This can provide peace of mind and help you start your journey to better health.

20 Signs Your Thyroid Isn’t Working Right

The thyroid gland is an integral part of the endocrine system. This butterfly-shaped organ regulates important hormones that influence many functions in your body. These hormones also affect how well your body performs physically and mentally. So, if you’re feeling unwell with no explanation, your body might be showing signs of a thyroid problem.

Remember that your body is a complicated and intricate system with many performance levels. However, over time many factors can build up and disrupt the balance of your body. Specifically, your systems can become overactive or underactive to compensate for or respond to these factors. Those with a family history of thyroid disorders are especially at risk.

Thyroid function problems, in particular, occur when the thyroid either becomes under or overused. These conditions are called hypothyroidism and hyperthyroidism, respectively. Both of these conditions can cause several problems. To explore twenty signs of thyroid problems, our Nashville, TN surgeons have divided them into ten signs for each condition.

10 Signs of Hyperthyroidism

As we mentioned, hyperthyroidism comes from an overactive thyroid gland. When this happens, your body produces an excess of thyroid hormones, such as triiodothyronine (T3) and thyroxine (T4). T4 is specifically produced when the pituitary gland secretes the thyroid-stimulating hormone (TSH). Here are the signs that your thyroid is off when it has abnormally high levels of thyroid hormones.

1. Nervousness and Anxiousness

When your thyroid gland works overtime, the hormones tell the body to work in overdrive. As you’ll see, this leads to several symptoms that can make you feel nervous and anxious. But before that, these hormones lead to mood swings and hyperactive thoughts.

2. Increased Heart Rate (Plus Palpitations)

Next, as one of the physical symptoms of high hormone levels, your heart rate increases. The increase in heart activity can also lead to heart palpitations. So, if you feel your heart is off or moving too fast, you should ask your doctor about investigating your thyroid health.

3. Increased Sweating

Because the thyroid hormones tell your body to become more active, naturally, it will try to cool itself off by sweating, even in less active situations when you’re not physically exerting yourself.

4. Weight Loss

Depending on where you are in life, this may not be unwanted. But, the abundance of thyroid hormones will increase your metabolism and appetite. While you may welcome a little unexplained weight loss, unexpected weight loss can lead to dramatic and unwanted changes. On its own, however, sudden weight loss indicates other conditions.

5. More Bowel Movements

The changes in hormone levels can even influence your digestive system. More frequent bowel movements can indicate other conditions, such as Crohn’s disease; however, hyperthyroidism can even cause rapidly changing patterns.

6. Goiter

A goiter occurs when the thyroid gland begins to swell due to the overproduction of hormones. Typically, the thyroid needs adequate levels of iodine. However, if you don’t have enough iodine, your body will try to compensate for what’s missing, and the thyroid swells. If you develop a goiter, you must take iodine supplements and possibly consider surgery.

Goiter symptoms include a tight feeling around your throat, hoarseness, coughing, and trouble swallowing.

You should also note that Hashimoto’s thyroiditis often causes goiters. This condition is an autoimmune disorder that affects millions of Americans. Specifically, this disorder causes inflammation and damage to the thyroid. As a result, the body tries to compensate by causing the thyroid gland to grow.

Hashimoto’s disease can also lead to symptoms of hypothyroidism, but more on that later.

7. Weak Nails and Thinning Hair

Your hair and nails are constantly growing. This is because a critical function of the thyroid gland is sending hormone signals to trigger hair and nail growth. With hyperthyroidism, the extra hormones tell your body to increase the growth of your hair follicles and nails in a shorter time.

While it would seem that rapid nail growth would be a positive side effect of thyroid dysfunction, that isn’t the case. This forced growth is too fast. As a result, your body has to stretch its natural resources, which can lead to thin and brittle hair and nails.

8. Sensitive Skin and Skin Discoloration

Thyroid hormones also influence the quality of your skin in various ways. For example, with hyperthyroidism, you may notice itchy and dry patches of skin.

Your face may feel softer and swollen. You may even notice swelling around your fingertips. Other symptoms include skin darkening, rashes, lumps, and reddish spots.

9. Difficulty Sleeping

You may find sleeping difficult with more hormones telling your body to be active. For instance, hormonal changes can make your nervous system hyperactive. Therefore, you may notice difficulty sleeping by no fault of your own. Also, as we’ve discussed, you may experience nervousness and anxiety due to thyroid problems, which also affect sleep.

10. Changes in Menstrual Periods

Because hyperthyroidism tells your body to move faster, the menstrual cycle can become lighter and shorter. You may also notice the time between your periods increasing.

On their own, these symptoms may indicate other medical problems. However, when you or your doctor identify more than one of these symptoms at a time, there is a good chance it’s due to thyroid problems.

Thankfully, most thyroid disorders are treatable and are not life-threatening. However, you should call your doctor immediately if you notice a rapid heart rate and experience a fever or deliriousness. These are signs of a hyperthyroid complication called a thyrotoxic crisis.

10 Signs of Hypothyroidism

Now that we’ve covered the signs of an overactive thyroid let’s look at what happens with an underactive thyroid gland.

1. Fatigue

First, when you develop hypothyroidism, your body produces fewer thyroid hormones, making it harder to recover from day-to-day stress. As a result, you’ll start feeling tired more often and more frequently. It also becomes more challenging for your body to get moving each day. Your thoughts become more sluggish and slow, and you may have difficulty concentrating as mental fatigue sets in.

2. Sensitivity to Cold

The hormones secreted by your thyroid gland also regulate your body’s temperature. With fewer hormones, your body has more difficulty heating itself because your metabolism slows down. Therefore, you’ll feel more sensitive to the Nashville winter cold.

3. Constipation

While hyperthyroidism speeds up your digestive process, hypothyroidism slows it down. Constipation often occurs as a result of these slowed processes. If you notice days pass without a bowel movement, you should talk to your doctor.

4. Dry and Itchy Skin

Just as the overproduction of thyroid hormones leads to skin problems, the lack of these hormones also impacts your skin’s health. The skin tends to become dry, itchy, and scaly. Your skin may even wrinkle or become pale. These symptoms can also cause other skin conditions.

5. Weight Gain

Thyroid problems cause your metabolism to slow down significantly. As a result, your body begins burning less energy and consequently stores more fat. It can even be hard to exercise because of the fatigue that comes with hypothyroidism.

6. Muscle Weakness

Without the stimulation from thyroid hormones, your muscles begin to lose their strength. They may even atrophy or become permanently relaxed.

7. Muscle Aches, Pains, and Soreness

Similarly, your muscles can feel sore, tired, and heavy. Also, with a lower metabolism, your body uses catabolism to create energy. Catabolism is a process that breaks down muscle and other tissue, thus leading to weakness, soreness, and pain.

8. Joint Pain, Stiffness, and Swelling

Catabolism also affects the joints, contributing to fatigue, aches, and pains from thyroid problems.

9. Heavy or Irregular Periods

In contrast to hyperthyroidism, hypothyroidism causes the menstrual cycle to become slower and heavier. Cycles can also become less frequent.

10. Depression and Brain Fog

Finally, your nervous system slows down because your body can’t use energy as efficiently. Combined with the feelings of fatigue, you can feel sluggish, experience mood swings, and see signs of depression. Patients, who receive hormone replacement therapy, usually report improvement in depressive symptoms.

How to Treat Thyroid Problems

Now that you know more about the problems that indicate thyroid problems, what should you do? Of course, the first thing you should do is ask your doctor about your symptoms. Depending on your symptoms, you may have another condition that needs treatment.

However, if you are experiencing several of these symptoms at a time, you most likely have a thyroid condition.

List of Thyroid Disorders

Hyperthyroidism
Hypothyroidism
Hashimoto’s Thyroiditis
Thyroid Tumors
Thyroid Cancer
Postpartum Thyroiditis

Before you start receiving treatments, you’ll need to work with your doctor to get tested. Typically this will include blood tests to check the levels of T4 and T3 in your blood. Your doctor will help you know what to do when the tests return.

Usually, treatments include hormone replacement therapy. Additionally, your doctor may prescribe Iodine supplements to treat goiters.

However, if your symptoms are severe, it can be a sign of thyroid cancer. In this case, you must visit a thyroid surgeon to remove the cancerous cells. Chemotherapy and radiation oncology are also viable options.