Fatigue was the most debilitating symptom I experienced with Hashimoto’s. It actually started 8 years before I was finally diagnosed in 2009, after I got Mono (Epstein-Barr Virus) in college. I needed to sleep for 12 hours each night to be able to function, and by “function” I mean after hitting the snooze button on my alarm clock for two hours (ask my poor husband), I would drag myself out of bed and then had to drink 4-6 cups of caffeine everyday to keep myself awake. I often had Red Bull and Pepsi for breakfast, and was the epitome of “wired but tired”.

I saw numerous doctors and I was offered antidepressants, stimulant medications used for narcolepsy and ADHD, but no one though to check my poor little thyroid. I came across “chronic fatigue syndrome” , and was discouraged that there was “no cure”, and so I slept half of my early twenties away thinking that I better just deal with it since no one could help me anyway.

When I was finally diagnosed with Hashimoto’s, part of me was relieved. I thought that I would finally get more energy. But this was not the case, sure the thyroid medication helped- instead of sleeping for 12 hours, I only needed 11 hours of sleep after starting medications. But I didn’t give up. At the time of my diagnosis, I was working as a consultant pharmacist and had become accustomed to researching emerging healthcare information. Finding a way to get myself better became my mission.

It took me almost three years after my Hashimoto’s diagnosis to get my energy back, and I hope that some of the strategies that I used will help you get yours back too, a lot sooner!

Here are some of my strategies to address fatigue

1. TSH- One major symptoms of hypothyroidism is low energy. Make sure that your TSH is within the range of a healthy person without thyroid disease, not within the range of an elderly person or someone with subclinical thyroid disease.

In recent years, The National Academy of Clinical Biochemists indicated that 95% of individuals without thyroid disease have TSH concentrations below 2.5 μIU/L, and a new normal reference range was defined by the American College of Clinical Endocrinologists to be between 0.3- 3.0 μIU/ml.

However, most labs have not adjusted that range in the reports they provide to physicians, and have kept ranges as lax as 0.2-8.0 μIU/ml. Most physicians only look for values outside of the “normal” reference range provided by the labs, and may not be familiar with the new guidelines. Thus many physicians may miss the patients who are showing an elevated TSH. This is one reason why patients should always ask their physicians for a copy of any lab results. Despite some lab tests stating that a TSH of 8, or 5 is “normal”, most people feel best with a TSH between 0.5-2 μIU/L.

For more on TSH and how to talk to your doctor about adjusting your medications, read my article here: http://www.thyroidpharmacist.com/1/post/2013/09/what-to-do-if-your-tsh-is-normal-and-you-are-anything-but.html

2. Low T3/high reverse T3- T3 is our main “energy” hormone produced by the thyroid. When our cells see T3, they produce more energy. Reverse T3 is a molecule that looks like T3, but has slowing down effects. When cells see this molecule, they slow down energy production. Levothyroxine is the most commonly prescribed thyroid medication, but only contains T4, a precursor to T3, our main “energy” hormone. T4 is converted to T3 in the body, but in many people, due to stress, nutrient deficiencies and other factors, this doesn’t always happen, and we can continue to feel exhausted despite normal T4 levels.

If you continue to be fatigued while on medications, you can have your doctor test your free T3 levels, (and reverse T3, although sometimes it’s not necessary) and may benefit from a T4/T3 combination medication, such as adding Cytomel to levothyroxine, or switching to Armour, Nature-Throid or Compounded T4/T3.

You can read my article about thyroid medications here: http://www.thyroidpharmacist.com/1/post/2013/06/which-thyroid-medication-is-best.html

3. Anemia is an energy thief- People often think of iron deficiency as anemia, but there are three types of nutrient deficiencies that can lead to anemia that are common in those with Hashimoto’s; Iron, B12, and folic acid. Your doctor will usually run a blood test to check for hemoglobin and hematocrit. While helpful for advanced cases of anemia, this test may miss some subtle cases of anemia that can make us exhausted.

I recommend doing a test for ferritin, B12 levels, and folic acid. Always be sure to get a copy of your lab tests. As is the with the “normal” range for TSH, the “normal” lab values for B12, ferritin and folic acid are not often correct.

For example, normal levels of B12 are between 200-900 pg/mL, yet levels under 350 are associated with neurological symptoms. If your levels are below 800, you may still benefit form a supplement. For B12, be sure to get a methylcobalamin version rather than a cyanocobalamin version of B12. The methylcobalamin absorbs better.

You can read more about B12 here:

Normal ferritin levels for women are between 12 and 150 ng/mL. According to some experts, the optimal ferritin level for thyroid function is between 90-110 ng/ml.

You can read more about Ferritin here: http://www.thyroidpharmacist.com/1/post/2013/06/hair-loss-and-thyroid.html

4. Food sensitivities – food sensitivities are different from food allergies and eating a food one is sensitive to may result in fatigue. People with Hashimoto’s often present with gluten, dairy, soy, egg, corn and nut sensitivities. Undertaking an elimination diet, or food sensitivity testing can give you a tremendous amount of your energy back.

You can read more about food sensitivities here: http://www.thyroidpharmacist.com/1/post/2013/06/got-hashimotos-you-may-want-to-reconsider-milk.html

5. Blood sugar imbalances- blood sugar imbalances can wreak havoc on our energy levels as well as cause anxiety. Some people will test blood sugar when feeling tired and will note that it is low. Opt to eat more protein and fat with each meals rather than carbohydrates.

6. Optimize digestion- the digestive process takes a lot of energy. As those of you that have read my book will know, poor gut function is always a factor with Hashimoto’s and autoimmunity. Anything you can do to aid the process of digestion will help you get some energy back.

My favorites? Green smoothies and digestive enzymes like Betaine with Pepsin. I felt like Bradley Cooper in “Limitless” after I started taking Betaine with Pepsin.

You can learn more about Betaine with Pepsin here:

and find my green smoothie recipe here: http://www.thyroidpharmacist.com/2/post/2013/05/thyroid-smoothie.html

7. Check your Vitamin D levels. Low levels of vitamin D can be associated with fatigue, hypothyroidism and autoimmunity in general. Be sure to get enough Vitamin D through sunshine, foods or supplements. Your goal should be to get your Vitamin D levels between 60-80 ng/dl.

This is especially true for those who have a history of mono. The fighter cells that keep the mono virus are dependent on Vitamin D! If you are someone that tends feel better in the summer, and not so good in the winter, I’m talking to you!

Read more about Vitamin D here: http://www.thyroidpharmacist.com/1/post/2013/10/get-some-sunshine-for-your-thyroid.html

8. MTHFR gene- up to 50% of people have a gene variation that prevents them from properly converting synthetic folic acid. These individuals may benefit from increased green veggies and the activated form of folic acid: methylfolate as well as additional substances that aid with breaking down homocysteine. Read more about MTHFR here: http://www.thyroidpharmacist.com/1/post/2013/07/mthfr-hashimotos-and-nutrients.html

9. Adrenals- Adrenal fatigue can make you feel like you are dragging yourself around the place, especially in the later phases of adrenal fatigue when our cortisol becomes depleted. Cortisol spikes in the morning to give us a natural jolt to get us out of bed. Those without sufficient cortisol levels may become dependent on caffeine like I did. Coffee may seem like it’s helping, but only weakens the adrenals in the long term. Adrenal fatigue is one of the major reasons we feel exhausted despite taking thyroid medications.

Adrenals are no quick fix, and I have an entire long chapter dedicated to them in my book, but to get started on the right track, I recommend adaptogens like Daily Stress Formula from Pure Encapsulations, and adrenal saliva testing with your health care professional to determine an appropriate course of action.

You can learn more about adrenals here: http://www.thyroidpharmacist.com/1/post/2013/09/are-your-adrenals-sabotaging-your-health.html

10. Is your liver congested? Some of us may be exhausted because we do not have the ability to process the toxins our body is dealing with. The toxins may be external such as molds, or internal, such as the ones caused by an imbalance of gut bacteria or pathogens. The toxins saturate the liver enzymes and we feel exhausted. N-Acetyl-Cysteine is a supplement that supports the liver’s detox capacities. I also have a whole chapter on detoxification in my book, and will be writing about it at some point in the future.


Many people often ask me which brand of vitamins/supplements I recommend. As as a pharmacist I’m very picky about my supplements. Pure Encapsulations is a pharmaceutical grade brand that has extremely tight quality control and manufacturing guidelines. Each product undergoes rigorous testing by a third party laboratory to verify label claims, potency and purity.

All the products sold by Pure Encapsulations are free of gluten, dairy, and additives that may impair absorption.

The supplements are available through your healthcare professionals and through the shop here: http://www.purecapspro.com/thyroidrootcause/pe/home.asp

I hope that these strategies help you get your energy back soon

Be sure to follow Thyroid Pharmacist, Dr. Izabella Wentz

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