Surprising Reasons You're Always Tired


By: , – By Winnie Yu, of Woman's Day
  :  18 comments   :  30,970 Views

In 2001, Kim Rhyne gained 20 pounds in six weeks. Normally an energetic women’s ministry leader in Cleveland, she was suddenly so exhausted that she could barely drag herself out of bed. “I wasn’t eating a lot more or doing anything any differently than I had been before,” says Kim. “I had no idea what was going on with my body.”

Knowing that an underactive thyroid often causes these symptoms, Kim’s doctor gave her a blood test to check her thyroid function. When the results came back within the normal range—though just barely—he diagnosed her with depression and started her on antidepressants.

Nine months later and not feeling any better, Kim had her thyroid levels rechecked. This time her levels were higher, so her doctor diagnosed her with hypothyroidism and started her on the medication Synthroid, which is commonly used to treat the condition. The drug pushed her test results back into the normal range, but Kim still didn’t feel well. She even struggled to muster up the energy to go grocery shopping or chat with the congregants who frequently stopped by her home. “I would end up in bed before guests even left the house,” she recalls. Meanwhile, she was more irritable than ever, snapping at her husband for the littlest things.

Kim told her doctor how bad she was feeling but he wouldn’t raise her medication dosage, citing her normal test numbers. Then, earlier this year—nine years after she was first diagnosed—Kim started chatting with a woman at church who happened to be an endocrinologist (a doctor trained in the treatment of hormone disorders). The woman suggested that Kim come see her for a workup. Her findings: Kim needed a slightly higher dose of Synthroid. A few weeks later, Kim started to feel like her old self again. “I couldn’t believe that I had spent years feeling tired and irritated when the solution was as simple as taking a little more medication,” says Kim, now 41.

Unfortunately, Kim’s struggle to get the right treatment is not that uncommon. Nearly 13 million people in the U.S. are not correctly diagnosed with hypothyroidism, and experts think that the number is probably climbing. “One in eight Americans is now age 65 or over, and you’re more likely to develop thyroid problems when you get older,” explains E. Chester Ridgway, MD, a professor of medicine at the University of Colorado School of Medicine. “That 13 million may just be the tip of the iceberg,” he says.

Why are thyroid disorders so hard to detect? For one thing, doctors don’t agree on how to interpret screening tests. There are also several tests that check thyroid function, but many doctors use just one. And in some cases, like when test results are borderline “normal,” symptoms should be given extra weight when deciding on treatment.

One Test, Many Interpretations

Your thyroid gland plays a crucial role in regulating just about everything, including your heart rate, metabolism, muscles and mood. If your thyroid is underactive (hypothyroidism), it’s not making enough thyroid hormone, so your body starts pumping out extra thyroid-stimulating hormone (TSH), which makes your TSH levels high. Insufficient amounts of thyroid hormone can cause symptoms like weight gain, fatigue, chills, and dry skin, hair and nails. On the other hand, when your thyroid is making too much thyroid hormone, you’ve got an overactive thyroid (hyperthyroidism), which causes weight loss, insomnia and anxiety.

Although most experts agree that measuring TSH levels with a simple blood test is the best way to detect a thyroid issue, they differ on what should be considered normal. Most primary care doctors use one standard range (0.5 mIU/L to 5.0 mIU/L), but many endocrinologists narrow that range (0.3 mIU/L to 3.0 IU/L), meaning that a larger group of people fall outside it. Kim’s internist considered her TSH levels normal, but her endocrinologist found them high.

It’s also worth noting that the TSH screening isn’t the only one. Doctors can also test for antibodies that show up in Hashimoto’s disease, an autoimmune condition that causes up to 95% of all hypothyroidism cases. It’s possible to have normal TSH levels but high levels of these antibodies, says Theodore C. Friedman, MD, PhD, chief of endocrinology at Charles R. Drew University and a professor of medicine at UCLA. But not all doctors order this additional blood test. Some doctors also believe in measuring two forms of thyroid hormone (T3 and T4).

Click here to find out when symptoms matter more and how to be your own advocate!

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Have you had to be your own advocate to get the proper care and diagnosis? Have you dealt with thyroid issues? If so, do you have any other suggestions to add?

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    I wonder if i should get my thyroid check. - 11/10/2011   12:03:26 AM
    It can't be stressed enough that especially in America medicine is treated as a "one size fits all", along with everything else. We are individuals! I diagnosed myself in the 90s after reading an article in Natural Health. It actually saved my life, although it was too late to reverse some of the more serious ramifications of my 7 year long bout with low thyroid. Fortunately, I had a nurse practitioner who listened to me and worked with me and then a doctor who was willing to do the same.

    Prior to that, I was just considered fat and lazy, despite being at least a 4th generation sufferer of low thyroid problems. My daughter works with her doctor and takes thyroid meds as needed. She is lucky enough not to need it all the time. By eliminating grains from my diet, I've recently been able to reduce my dosage. So who knew? I've never heard any connection between eating grains and low thyroid, but all grains are extremely toxic to my individual system and it's made a world of difference all around.

    Thanks for the great article. - 11/8/2011   7:13:31 AM
  • 16
    I follow Roby Mitchell, M.D./PhD on YouTube who is DrFittt as he treats many patients for thyroid illness. Dr. Atkins in "The New Diet Revolution" said that many people have low thyroid even thought it doesn't show up on a STANDARD thyroid test. That book is well worth reading. - 11/7/2011   5:19:35 PM
  • 15
    It took a long time for my doctor to finally acknowledge my thyroid problems. I'm still not at the proper dosage yet, but I still feel better than I did before! - 11/7/2011   2:25:54 PM
  • 14
    I had abnormally dried and broken skin, so my doctor prescribed a prescription strength hydrocortisone ointment. After a while, I noticed weight gain and puffiness in my face. After reading the literature in the ointment container and checking Web Md, I determined that I was leaning towards Cushing Syndrome. The doctors even today, continue to deny to a topical ointment on broken skin could be blamed. After I discontinued using the ointment, my face and weight returned to normal. Just a conincidence, really? You are your best advocate. - 11/7/2011   1:45:56 PM
  • 13
    so far, all of my issues have been diagnose-able.
    this was a great article. - 11/7/2011   12:43:03 PM
  • 12
    so, my endocrinologist tests my TSH every 6 months and it is always in the normal range, yet i am still exhausted every morning (no matter how much sleep i get each night. between 8-11 hrs). I know that an anti-anxiety med that i am on causes some tiredness, but i think it is something more. do i go to a different endocrinologist, or just suck it up and be tired all the time? - 11/7/2011   12:15:10 PM
  • BABYGIRL383236
    Good article. This reminded me I need to have my throid checked again. - 11/7/2011   11:06:52 AM
  • 10
    EVERY ONE of these comments describes my struggle being affected by Hashimotos thyroiditis. It makes me sooooo angry that it took me literally almost DYING (heart rate in the 40's, foggy brain syndrome, numbness/tingling in extremities to the point where I could do NOTHING, horrible coordination to the point where I really literally had to "relearn" walking and just feeling plain HORRIBLE) before a Dr. listened to me! Within two weeks of being started on the right meds I was getting a little healthier again! At least I could take care of my (at the time) young children! That was in 1998. During the time from 1998 to 2010 I packed on the weight (4 ft 10-1/2 in and weighed . . . gulp! . . . 192 lbs.) I KNEW something was just wrong, because I wasn't eating unhealthy foods (but now I know it wasn't in the right portions . . . still . . . ) and my health was sliding. Dx'd with high blood pressure in Nov. 2009 and type 2 diabetes in Jan. 2010 it was time to take charge of my health again1 I found a new Dr. willing to handle my thyroid, B/P and diabetes (wonderful woman!!) Flash forward to today. Yes, I do get tired, but it's from being active! I have gone from 192 lbs. in Nov. 2009 to 100 lbs. now. Perfect for my bone structure and height. I feel better than I have in 13 yrs. I LOOK better than I have in 13 yrs. I have more energy than I ever had. No, I am not exactly the enerhgizer bunny, but sure a lot closer than I was years ago!

    All I can say to those of you out there suffering and getting nowhere . . . FIND A DR. WHO WILL WORK WITH YOU . . . NOT your numbers . . . with YOU! My #'s were "normal" according to my initial Dr. But I found out I was hanging with a TSH of 4.9 (out of 5.0), and because the #'s "fell within parameters" (even though I felt like CRAP . . . sorry!).

    It really is important to know your #'s and realize that the guidelines now are .3 to 3.0 for the TSH and women generally feel best no higher than 1.0)

    Keep advocating for yourself and learning. Thanks for this very important article. - 11/7/2011   11:03:10 AM
  • 9
    Great article! Thanks! - 11/7/2011   10:56:46 AM
    I have had to fight to get the proper medication. I was diagnosed with Hashimoto's in mid-2007 but the doctor who diagnosed it refused to prescribe Synthroid because she said my labs were normal (although outside the new range of .3-3). I sure didn't feel normal! I'd been gaining .5-1 pound per month for about 18 months, and I was falling asleep over dinner. I also had a lot of other low thyroid symptoms. When I moved back to the US, I asked both my new GP and an endocrinologist to test me again. The endocrinologist said my labs were normal, that I was my mid-40s and that I should just try eating less. Both times, the doctors didn't do the full range of tests. My GP was more open-minded. Initially, he asked me to try a couple of other approaches to tackle my energy levels (including reducing my caffeine intake, increasing vitamin D, etc). When these didn't work, he agreed to start me on a small dose of meds. After a few months, when the meds showed a slight but not significant improvement, he increased the dose slightly and almost immediately, it was like I got my life back. I think that one of the problems I have is is poor conversion of T4 to T3. Unless tests are done to check for free T4 and free T3, the poor conversion isn't apparent. I seem to have close to normal T4, but that's not translating into proper levels of T3.

    Even though my GP is willing to prescribe meds, I still have to remind him every time I have labwork done to have the full set of tests done. I even have to remind him twice. I ask him to do the free T4 and free T3 during the appointment, and then I check the instructions he writes out for the lab. And half the time I have to remind him which tests he agreed to do ... - 11/7/2011   9:45:32 AM
    I recently change doctors and as a result have now been diagnosed witha thyroid disorder. I am very grateful this doctor has been so thorough and has me on the right track. It's only been a couple of weeks and I am starting to feel much better and have more energy. - 11/7/2011   9:45:31 AM
  • 6
    I went for over 3 years with mystery symptoms, I was Dx'ed with everything under the sun. Last December my thyroid came up wacky in the brief thyroid, I was put on meds and 6 months later my thyroid looked normal BUT I was still having symptoms. I changed dr's....she order a FULL thyroid panel and told me to take my body temp every morning (the old fashion way to dx thyroid). My body temp was never above 94.5 degrees most of the time it was 93.6. I would check it a few times a day, even after working out and sweating really hard by temp never was above 94.7. When I went back for the extended lab results, my body makes all the hormones checked in the brief panel (T3, T4, and TSH) but the extended panel showed my body no longer makes the T3 Uptake hormone, so my body makes the hormones but is unable to use it. The new dr increased my meds (I take Armour because it supports both the T3 and T4 as well as the uptake hormones). I feel like a new person and I even lost weight. My new dr said my issue is common but often overlooked and left untreated thyroid issue can cause so much damage in the body because the thyroid controls just about everything. Educate youself on thyroid problems (there are some great resources and user's groups on the web) and like TREESA57 said don't let the lab work control how you feel or your treatment!!!! - 11/7/2011   9:42:35 AM
  • 5
    Several years ago, I saw a specialist who put me on sythroid. I stupidly stopped the meds because I was feeling better (and in college with a hectic schedule). I started to feel bad again and went to see a different specialist who said my levels were normal. I'm still feeling off and I am trying to get back to Specialist #1 who seemed to get it right the first time. This is definitely a story/problem I am hearing about more and more... get checked and be your own advocate! - 11/7/2011   7:57:16 AM
  • 4
    This is a great article thank you for much for sharing. - 11/7/2011   7:53:53 AM
  • 3
    I have fought for years to get doctors to pay any attention to my symptoms, yet no matter how bad my condition is, they still have no interest in helping. Too many doctors have been trained to rely soley on statistical probabilities and algorithms instead of listening to their patients. Doctors interrupt their patient's story after an average of only 18 seconds!

    Check out the books How Doctor's Think by Jerome Groopman and Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders to read how difficult it is becoming for patients to find a doctor who will listen. I know the doctors I've seen are forcing me to suffer with starvation, serious pain, extreme fatigue, episodes of losing consiousness, and several dozen more symptoms without offering anything except that it must be a mental health problem. - 11/7/2011   7:42:52 AM
  • 2
    I too had this problem. One doctor said normal and another said on no. I am glad I changed doctors. I now feel great and tell others do not let the lab results tell YOU how to feel. You tell the dr how you feel about your lab results.Most doctors want you to be involved in your care of thyroid problems. If they dont, switch Doctors! - 11/7/2011   7:33:47 AM
  • MAHONEY_09
    W when I was first diagnosed with panic disorder and depression, my therapist had me get blood work to check on these things...I'm now done with therapy for almost two years and off my meds and just had my blood work done again through my levels came back normal but it is interesting that so many people go undiagnosed despite doing the right thing getting checked out... - 11/7/2011   6:56:35 AM

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