Just tired or suffering from hypothyroidism?

Sometimes you can feel tired for no apparent reason. There are many possible causes, but we rarely think of hypothyroidism,

especially as blood tests are not well calibrated to detect it. Yet it is estimated that up to 15% of the population, mostly women, suffer from hypothyroidism.

What's it all about?

The thyroid is a small, butterfly-shaped gland located at the base of the neck. It produces hormones, especially T4 (thyroxine) and T3 (triiodothyronine), which control our metabolism through various mechanisms. Numerous bodily functions are affected: the speed at which calories are burned, growth, heat production, heart rate, digestion, etc.

The thyroid manufactures all T4 and around 20% of T3. The rest of T3 is manufactured by the body from T4. To produce both T4 and T3, the thyroid needs iodine, magnesium, iron, vitamin B and coQ10. To convert T4 to T3, the body needs selenium and zinc.

In some people, there may be a thyroid hormone deficiency, known as hypothyroidism. The metabolism is too slow, you feel tired for no apparent reason, you tend to put on weight, you're abnormally cold, with cold hands and feet, dry skin, and a low heart rate. Hair loss and other symptoms are also possible. There are many possible causes, including dietary deficiencies of iodine, magnesium, vitamin B, coQ10 and/or selenium.

Note that a person with hypothyroidism often has too much blood cholesterol, which increases the risk of atherosclerosis if this cholesterol is oxidized, since cholesterol needs T3 to enter the mitochondria of cells. The person also often has poor lipid regulation, which can lead to steatosis (accumulation of fat in the liver) and/or diabetes.

Hypothyroidism could be diagnosed by measuring T4 and T3 in the blood, but the values considered normal are too broad. Some practitioners therefore consider that a blood TSH above 2 mU/L can already be considered suspicious for hypothyroidism. If symptoms are present, it is advisable to also measure T3 and T4 in 24 h urine (to be considered normal, urinary T3 should be between 800 and 2500 pmol/L and urinary T4 24h between 550 and 3160 pmol/L). Anti-TSH receptor antibodies can also be measured in the blood: anti-TPO (anti-thyroperoxydase) and anti-TG (anti-thyroglobulin).

If hypothyroidism is confirmed, the standard treatment is to take T4 hormones. However, this does not solve the problem of T4 not being converted into T3. It may therefore be advisable to give T3 as well.

An alternative approach, which I prefer, is that of the diet, which must contain sufficient of the nutrients required for thyroid hormone production. There are specialized books on adapting diet to hypothyroidism.

In addition to hypothyroidism, unexplained fatigue can also be caused by:

  1. Hypochlorhydria, i.e., a lack of acidity in the stomach. If the abnormally tired person suffers from burping, digestive heaviness or bloating after meals, this cause may be suspected. To confirm this, you can take a betaine HCL tablet after a meal: if this improves digestion, there's a lack of acidity. If, on the other hand, it causes a sensation of heartburn, the acidity level is sufficient.

  2. A lack of pancreatic enzymes. Stool elastase can be measured for this diagnosis.

  3. An imbalance in the intestinal microbiota (dysbiosis). Here too, there are diagnostic techniques and, of course, solutions for restoring the microbiota.

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Sleeping lady picture by Abbie Bernet