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I’m Tired All the Time—Is That Normal?

More than just run-of-the-mill sleepiness, thyroid fatigue can leave you feeling drained—but there is a solution.

Do you often feel exhausted with more than your run-of-the-mill fatigue? Hypothyroidism, an underactive thyroid, may be to blame. We talked to endocrinologist Parveen K Verma, DO, FACE, of Our Lady of Lourdes Medical Center in Camden, New Jersey, to learn more about hypothyroidism and how it’s treated.  

What is hypothyroidism? 
Dr. Verma: Hypothyroidism … is a problem with the thyroid gland, a gland in the base of your neck that controls metabolism. Someone with hypothyroidism does not make enough thyroid hormone. It can be caused by an infection and may be a transient problem … that gets better without treatment. It may also be the result of an autoimmune disease, more commonly known as Hashimoto's disease, where the thyroid doesn't make enough thyroid hormone. 

What are symptoms of hypothyroidism? 
Dr. Verma: Typical symptoms of hypothyroidism include fatigue, weight gain, decreased energy, depression, dry skin and hair and constipation. ... A lot of people just feel like everything has closed down. For women, they may have fertility issues or abnormal menstrual cycles. 

If I am extremely tired all the time, when should I see my healthcare provider? 
Dr. Verma: If common things that cause fatigue (not getting enough sleep, nutritional issues, multitasking) have been ruled out and you don’t feel better after a few weeks, then you should seek a medical evaluation from a primary care doctor. … An initial workup may include a discussion about sleep habits, nutrition, work schedule, personal stressors and blood work that looks for things like anemia or other metabolic problems, such as hypothyroidism. 

How is hypothyroidism treated? 
Dr. Verma: The typical treatment for hypothyroidism is to use a form of thyroid hormone called levothyroxine. … There are some other formulations that are considered more natural, such as Armour Thyroid. To decide which would be an appropriate choice for you, discuss your options with your primary care doctor or endocrinologist. 

Are there lifestyle modifications I can make to improve my symptoms? 
Dr. Verma: Everyone should engage in regular physical activity, a minimum of 30 minutes a day, five days a week. In terms of diet, our typical recommendation is to follow a well-balanced diet that includes a variety of fruits and vegetables. Overall, maintaining a well-balanced diet and exercise regimen can improve some of the symptoms that result from hypothyroidism, but there is no diet or exercise plan that works better than another to stimulate the thyroid. Also, it's important to look at [your sleep]. Are you sleeping enough? Is your sleep restful sleep? Are you waking up multiple times at night? Some of us feel that we slept for nine hours, but if we have other diseases like sleep apnea, it's not a restful sleep. If you have a lot of stress or you're not eating well, these are all other things that can contribute to fatigue. 

What should I do if I continue to feel excessively tired all the time, despite treatment? 
Dr. Verma: It's important that when symptoms persist or if you don't improve, that you follow up with your doctor. He or she will repeat blood work, most commonly measuring TSH (thyroid stimulating hormone), which is the best marker of thyroid function. Your doctor may do additional testing … to make sure there's not something else contributing. 

What else should I know about hypothyroidism treatment? 
Dr. Verma: When you are treated for hypothyroidism it's very important that you take your thyroid hormone replacement at approximately the same time every day so you get a consistent and stable level. That would be the reason to have a regular schedule of sleeping at approximately the same time, with the appropriate amount of sleep—seven to nine hours for adults—and proper nutrition. 

Medically reviewed in October 2018. Updated in March 2021. 

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