Fatigue is a common symptom of thyroid disease. And, if you have experienced it, you will be intimately aware that this is not the typical fatigue that many people experience after a bad night’s sleep or during a stressful period.

It is often a relentless and debilitating exhaustion that impairs your daily functioning. Whether you need a nap every afternoon to make it to dinner time or you wake up un refused and brain clouded despite having slept through the night, you may feel better knowing you’re not alone.

Adjusting the dose of your thyroid medication (under the guidance of your doctor), refining your sleep habits, and looking for another cause of fatigue that may aggravate the problem, can help you improve this common symptom of thyroid disease and live better with your condition.

A telltale symptom of thyroid disease

Fatigue and severe exhaustion can be key indications of undiagnosed or under-treated thyroid conditions. Unfortunately, for some patients, fatigue persists even after treatment.

Hashimoto’s disease and hypothyroidism

Fatigue is an almost universal symptom of hypothyroidism (underactive thyroid), which occurs as a result of decreased thyroid hormone production. A notable sign that your thyroid levels are not properly regulated can be bone-numbing fatigue.

It can develop slowly or appear suddenly, leaving you barely able to lift your head from the pillow in the morning. You may feel like you can’t get through a day without a nap, or that you sleep more than usual but still feel completely drained. You may not have the energy to exercise or you may fall asleep during the day or very quickly at night and find it difficult to get up in the morning.

If you experience exhaustion that is seen frequently along with other symptoms of hypothyroidism, the problem may be that your hypothyroidism has not been treated enough.

Graves’ disease and hyperthyroidism

Fatigue is also a symptom of hyperthyroidism (overactive thyroid), and is commonly the result of insomnia, anxiety, or disturbed sleep patterns. Difficulty sleeping can be due to the stress that hyperthyroidism places on your body, including a rapid pulse, high blood pressure, diarrhea, tremors, anxiety, and other symptoms of hyperthyroidism.

Treatment for thyroid diseases

If your fatigue is related to your thyroid disease, you may need some adjustments in your medication.

For hypothyroidism: When your treatment is optimized, which means that your thyroid hormone levels are in specific narrow areas of the reference range, your fatigue may improve or even disappear. Talk to your doctor about how to adjust the dose of your thyroid hormone replacement medication so that you can feel better and the proper diet to keep you at an optimal level.

For hyperthyroidism: If you are taking an ant thyroid medication and are taking too many medications, this can change your thyroid function to hypothyroidism, which can make fatigue worse. And if you’ve had radioactive iodine ablation (RAI) or surgery to remove your thyroid and you’re not taking thyroid hormone replacement medications, you may have become hypothyroid and need treatment.


Here again, if you are already taking thyroid hormone replacement medications and are still fatigued, you will likely need a higher dose to resolve your symptoms and get your thyroid hormone levels in the optimal range. Remember, a proper diet can help you a lot to improve.

Other causes of thyroid disease

If you are being treated for your thyroid disease and you are still experiencing persistent fatigue, there are other causes that you should consider with your doctor.

Thyroid depression

The people with hypothyroidism and hyperthyroidism often have symptoms of depression. A 2018 systematic review found that Hashimoto’s disease patients are more likely to develop depression and anxiety than healthy people. Make sure to see your doctor if you experience symptoms of depression.

Sleep apnea

When you have sleep apnea, you experience brief periods where you stop breathing while you sleep, often accompanied by snoring. Because the amount of oxygen you are receiving is reduced, frequent apnea can cause sleep disturbances and contribute greatly to feelings of exhaustion.

In addition to snoring, fatigue, and lightheadedness, other common symptoms of sleep apnea include waking up with shortness of breath, a headache in the morning, and waking up at night to urinate.

The hypothyroidism is associated with sleep apnea because they have low levels of thyroid hormone can affect your breathing. A 2016 systematic review of studies on sleep apnea and hypothyroidism found that 30 percent of adults newly diagnosed with hypothyroidism also had obstructive sleep apnea, which is a very common condition.


Anemia, indicated by a low red blood cell count, is common in hypothyroidism and is sometimes even the first sign of thyroid disease. Along with fatigue, anemia can cause symptoms of dizziness, palpitations, and shortness of breath.

Lack of iron

Although iron deficiency often leads to anemia, scientists have recently discovered that a large number of patients with thyroid disease can have an iron deficiency that causes extreme fatigue without the presence of anemia. If this is the case for you, iron deficiency treatment can significantly improve your fatigue symptoms.


If you have long-term debilitating fatigue and it’s accompanied by other symptoms, such as general muscle aches and pains, you may be experiencing fibromyalgia. In fact, research shows that 30 to 40 percent of patients with autoimmune thyroid disorders also have fibromyalgia.

Bad sleep habits

While insomnia and restful sleep may be associated with your underlying thyroid disease, having poor sleep habits can also contribute to your fatigue. According to the National Sleep Foundation, adults need seven to eight hours of sleep per night, yet a substantial percentage do not receive this amount regularly.

Additional considerations

In addition to the conditions listed above, there are many other potential causes of fatigue, such as other health problems such as chronic kidney or liver disease, an infection, an anxiety disorder, or alcohol or drug abuse. There is also the possibility of drug side effects, exercising too much or too little, and not consistently eating a healthy diet.


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