Testing and treatment for hypothyroidism may be the answer to a patient’s fatigue

One in every 5-10 patients seeing a family physician complains of fatigue, and one in every 10-20 Americans has hypothyroidism. Since the thyroid gland has an important role in metabolism, it’s reasonable to suspect that hypothyroidism might be responsible for fatigue.

A physician might order a screening blood test for hypothyroidism if a patient’s symptoms (such as fatigue) suggest that diagnosis; if there is a family history of hypothyroidism, an enlarged thyroid gland, high cholesterol, Type 1 diabetes, pituitary gland disease, other autoimmune diseases; or if the patient takes medications know to affect thyroid levels.

Doctors measure thyroid-stimulating hormone (TSH) in the blood as the hormone that controls how much thyroid hormone is released. If elevated, it serves as a sign that this master hormone is trying to get the thyroid gland to make more thyroid hormone.

If the test suggests hypothyroidism, a trial of thyroid hormone is the only way to determine if the fatigue is caused by hypothyroidism. If thyroid hormone levels normalize and fatigue continues, that means there is another cause. Patients with worse measures of TSH and thyroid hormone are the most likely to benefit from thyroid replacement; those with mild disease on blood tests are less likely to benefit.

The most common cause of hypothyroidism is Hashimoto’s disease, in which 1 in 9 adults have anti-thyroid antibodies in the blood. In the absence of low thyroid hormone, such patients develop hypothyroidism — and fatigue — at a rate of 3-5 percent per year, so they need to be seen for regular follow-up to catch hypothyroidism before it gets severe.

One might think that if a little thyroid hormone doesn’t fix fatigue that a higher dose would do it. Sadly, that is not the case. Excess thyroid hormone can cause problems such as bone loss and the irregular heart rhythm known as atrial fibrillation. This heart disorder can create blood clots that can cause stroke, heart attack, pulmonary embolism, or deep venous thrombosis.

While many people think of the thyroid gland first if they have fatigue, other factors such as sleep disorders, depression, and psychosocial stress are the main causes of fatigue. Other common causes include anemia, medication side e[1]ects, depression, anxiety, diabetes, and an inactive lifestyle. Emotional, family, and spiritual stressors can also contribute to fatigue. A physician should do a thorough evaluation looking for other causes of fatigue if symptoms persist despite appropriate treatment for hypothyroidism.

Hope for improving fatigue lies in identifying the cause and treating it. If thyroid hormone replacement does not improve it in patients diagnosed with hypothyroidism, other measures such as improved sleep hygiene, treating sleep apnea, or changing medications that cause fatigue can be provided by your doctor based on their findings in a thorough examination.

THOMAS MORAGHAN, M.D., trained at Mayo Clinic and is board certified in endocrinology. He loves the Catholic faith and teaching, and he believes in the power of prayer in medicine.

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