10 Things to Know About Thyroid Disease and Fatigue

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Are you tired of being tired? Whatever you call it—exhaustion, weakness, lethargy, or feeling run down, sluggish, overtired, or just plain pooped out—fatigue is a common symptom of thyroid problems.

We're not talking about normal fatigue after a late night. This is a debilitating fatigue. You may find yourself needing a nap in the afternoon just to survive until dinnertime. Or you sleep ten to twelve hours a night and still wake up exhausted.

Or you are less able to exercise, and your endurance is low because you are weak and lethargic. Or you may just walk around tired and brain-fogged out on the same amount of sleep that used to leave you feeling refreshed.

There are a number of important things to know about the connections between fatigue and thyroid conditions, and ten of the most important things to know about improving your energy and fighting fatigue are explored here.

1. Fatigue and Hypothyroidism

Fatigue is a very common symptom of hypothyroidism, an underactive or low thyroid, in many patients. When the treatment for hypothyroidism is optimized, many patients report that their fatigue is lessened or even fully resolved.

2. Fatigue and Hyperthyroidism

Fatigue is a symptom of hyperthyroidism, an overactive or high thyroid, in some patients. In some cases, fatigue is present even after you've gotten a sufficient amount of sleep.

In other cases, fatigue in hyperthyroidism may result from insomnia, anxiety, or disrupted sleep patterns. Typically, appropriate treatment for Graves' disease and hyperthyroidism will help resolve the fatigue associated with an overactive thyroid.

3. Fatigue and Autoimmune Thyroid Disease

Even when thyroid function tests show that the thyroid is "normal" and hormone levels fall within the reference range, the presence of elevated thyroid antibodies, which can indicate autoimmune Hashimoto's disease or Graves' disease, may cause fatigue as a symptom in some patients.

4. Dietary Changes

Some thyroid patients, including those who do not have celiac disease or gluten intolerance, have reported a reduction in fatigue when they switch to a gluten-free diet. A gluten-free diet is a diet free of wheat and gluten products. Others have reported similar effects by eliminating sugar, dairy, or other inflammatory and allergenic foods from the diet.

5. Unrefreshing Sleep

Some people experience fatigue due to what's known as unrefreshing sleep. This means you've had enough sleep, usually seven or more hours, but you wake up and still feel tired, because the sleep was of poor quality, interrupted, or did not reach restorative levels. Unrefreshing sleep may be associated with adrenal dysfunction, as well as chronic fatigue syndrome and fibromyalgia.

6. Iron

Some thyroid patients experiencing fatigue may be low in iron, in particular, the stored form of iron known as ferritin. It's worth having ferritin levels checked by your physician, and if they are not optimal ( in the upper end of the reference range), talk to your doctor about supplementing with iron, or adding more iron to your diet through foods.

An excess of iron, in particular, a hereditary condition known as hemochromatosis, can also be associated with fatigue.

There is a link between thyroid conditions and an increased risk of hemochromatosis.

7. Chronic Fatigue Syndrome and Fibromyalgia

If you have long-term, debilitating fatigue, and the fatigue is accompanied by other symptoms such as enlarged lymph nodes, a chronic sore throat, and/or body/muscle aches pains, you may have other conditions such as chronic fatigue syndrome and/or fibromyalgia. these conditions are more common in thyroid patients than in the general population.

8. T3 and Natural Thyroid

Some thyroid patients on thyroid hormone replacement have reported an improvement in their fatigue levels when switching from a T4 only treatment (i.e., levothyroxine), to a T4/T3 treatment--for example, the addition of synthetic T3--or use of a natural desiccated thyroid drug.

9. Sleep Apnea

Thyroid patients are at greater risk of sleep apnea, where breathing stops for short periods during sleep. Sleep apnea can contribute greatly to fatigue, due to reduced oxygen intake. Thyroid patients experiencing fatigue should talk to a physician about having a sleep study or evaluation done to determine if sleep abnormalities, including apnea, may be contributing to the fatigue.

10. Get More and Better Sleep

Make sure you get optimal treatment for your thyroid condition and address any sleep disorders, food sensitivities, and imbalances in your iron levels. 

Also, make sure you get enough sleep. According to the National Sleep Foundation, most adults need a minimum of seven to eight hours per night, and a substantial percentage of us are not getting this amount of sleep on a regular basis.

A Word from Verywell

Here are some tips to help get to sleep, and get more and better sleep:

  • Try to keep the same sleep schedule weekdays and weekends
  • Keep your bedroom cool
  • Don't watch television or work in your bedroom
  • Avoid caffeine and alcohol in the afternoon, and before bedtime
  • Don't take naps.
  • Don't exercise after dinner time
  • Take a hot shower or bath before bedtime
  • Use a sound conditioner or earplugs to block noise
  • Avoid large meals before bedtime
  • Increase light exposure during the day
  • Minimize light in your bedroom by using blinds or blackout curtains, turn off television and computer at night, avoid illuminated clocks, and don't read from or look at backlit devices or smart phones at night
  • Listen to relaxation or guided imagery audios to help fall asleep. (One recommended program is the Thyroid Meditation.) 
  • Don't drink too much liquid in the evening
  • Limit changes in your work shifts
  • Drink an herbal or relaxation tea at bedtime
  • Have a bedtime snack with protein


Dayana, Colin. "Hypothyroidism and Depression." Eur Thyroid J. 2013 Sep; 2(3): 168–179.

Husson, Olga et al. "Fatigue Among Short- and Long-Term Thyroid Cancer Survivors: Results from the Population-Based PROFILES Registry" Thyroid. 2013 Oct; 23(10): 1247–1255.