Thyroid: Why am I so Tired All the Time?
If your normal response to the question, “How are you?” is “I’m so tired,” you may want to have your thyroid checked. Suboptimal thyroid symptoms rear their ugly heads in many ways, but one of the most common and debilitating symptoms is a constant feeling of lethargy and exhaustion.
What is the Thyroid and What Does It Do?
The thyroid is a small endocrine gland that sits at the front of your neck just under your larynx. Once triggered by TSH (thyroid-stimulating hormone), which is sent from the pituitary gland in your brain, the thyroid produces two critical hormones, thyroxine (T4) and triiodothyronine (T3). These hormones are essential to the function and processes of all cells within your body. When secreted into the bloodstream, T4 is converted into T3, the biologically active hormone. This hormone regulates the body’s metabolic rate controlling heart, muscle and digestive function, brain development and bone maintenance.
There is a delicate balance of having too much thyroid or having too little and TSH levels rise and fall depending on your body’s needs to produce more or less thyroid hormones. If you suffer too high of levels, hyperthyroidism, the cells are triggered to work faster which is why people experience quickening of heart rate or frequent bowel motions, like diarrhea. If you suffer too low of levels, hypothyroidism, the cells and organs slow down, and basically so does the rest of you.
According to the American Thyroid Association, an estimated 20 million Americans have some form of thyroid disease. Up to 60 percent of those with thyroid disease are unaware of their condition. Women are five to eight times more likely than men to have thyroid problems, with one in eight developing a thyroid disorder during her lifetime. Most startling is that many of these thyroid deficiencies go undiagnosed, which can lead to symptoms of fatigue, weight gain, hair loss, poor concentration, brittle nails, depression, and feeling cold. On top of these bothersome and oftentimes unbearable symptoms, are more serious conditions like cardiovascular disease and osteoporosis.
Is it Aging or is it Your Thyroid?
Many of the symptoms described above are also attributed to aging. The complaints of fatigue, weight gain, thinning hair and dry skin are common to the aging process and therefore are often overlooked as normal conditions of the aging process. At the same time, a slowing down of thyroid production is also common to the aging process. Although this is a well-known fact, suboptimal thyroid symptoms are often attributed to aging, the thyroid is often overlooked as the main culprit, and therefore left ignored and untreated.
What Are Your Treatment Options?
If you’re lucky enough to have your thyroid tested and supplemented, most doctors will prescribe only levothyroxine (also known by the brand name Synthroid). The idea behind this strategy is that levothyroxine (T4) should be transformed by the body into the more active liothyronine (T3), thus providing appropriate thyroid replacement. Unfortunately, this is not always how it works. For many people, part of the problem they face is that their body cannot transform the T4 into T3 at all, or does so incorrectly by turning the T4 into something called “reverse T3” which is completely inactive in the body. As was mentioned before, T3 is the form of thyroid hormone that is most active in the body, that our cells and brain recognize and use. If our body has trouble converting T4 into T3, this one dimensional treatment option is not going to get us very far. For so many people supplementing with T4 and T3 is essential for optimizing thyroid hormone treatment.
One of the best options to ensure that you are getting both T4 and T3 with one simple tablet or capsule, is a desiccated porcine thyroid extract (found in prescription products like NP Thyroid, Nature Throid, Armour Thyroid, or a compounded thyroid capsule). Desiccated thyroid is considered the “natural” option for thyroid treatment, and contains not only T4 and T3, but also contains small amounts of thyroid co-factors T1, T2, calcitonin and iodine. Many patients prefer this form of thyroid for symptom resolution.
This was illustrated in an American Thyroid Association online survey for hypothyroid patients. It found that a subset of patients with hypothyroidism were not satisfied with their current therapy or their physicians. However, patients on a T4/T3 combination therapy reported a higher satisfaction with both the treatment and their physicians.
Another study, featured in the Journal of Endocrinology, Diabetes & Obesity, found that of 154 women and men who didn’t experience beneficial outcomes while taking levothyroxine alone, 78% who switched to a thyroid extract said they preferred it. Side effects were minor.
While desiccated thyroid extracts are an excellent option, It is important to know that this type of thyroid comes from pork, so for patients who prefer to avoid animal products, there are still options. Liothyronine is available as a prescription product as well, allowing you to take separate T3 and T4 tablets. You also have the option of working with a compounding pharmacy who can simplify this routine by combining the T3 and T4 into one capsule. In addition, having your T3 and T4 compounded by the pharmacy gives you the flexibility to have your medication adjusted specifically to meet your needs with doses that may not be available commercially.
You have found a provider who is well-versed in treating suboptimal levels of thyroid. Not only will you be treated with the more natural formulation of thyroid, and will also continue to titrate your dosage to achieve ideal blood levels, while working to resolve your symptoms.
Peterson SJ, et al. An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction. Thyroid. 2018: 28: 707-722. DOI: 10.1089/thy.2017.0681.
Slater S. “The discovery of thyroid replacement therapy. Part 1: In the beginning.” Journal of the Royal Society of Medicine, 2011: 104: 15–18. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014555/