Is fatigue a sign of thyroid problems?

Located just at the front of the neck beneath the skin, the thyroid gland helps to regulate how your body uses energy by releasing certain hormones at certain times as part of your endocrine system. Many signs of thyroid problems can be difficult to pin down, and treatment options ranging from daily medication to surgical removal may be needed to treat your symptoms and restore your quality of life.

Endocrinologist Maximilien Rappaport, DO, explained signs of thyroid problems to watch out for and what to expect during treatment.

What are the most common thyroid conditions?

“One of the most common disorders of the thyroid gland is a thyroid nodule,” said Dr. Rappaport. “These are masses within the thyroid gland, and don’t necessarily indicate cancer. It could be as simple as a single cyst or include multiple nodules. While cancer is sometimes the cause, most nodules found within the thyroid are non-cancerous.”

Other common thyroid conditions include:

• Hyperthyroidism: Occurs when your thyroid overproduces thyroid hormones beyond what your body needs. This can be caused by autoimmune diseases like Graves’ disease, autonomous nodules (a localized lesion that produces thyroid hormones independently of the larger thyroid gland) or thyroiditis, an inflammation of the thyroid which can be caused by an upper respiratory virus or medication.
  
• Hypothyroidism: Happens when the thyroid gland isn’t producing enough hormones, due to an autoimmune disease like Hashimoto’s or prior thyroid surgery.

What are some symptoms of thyroid problems?

“Many patients show no symptoms at all,” said Dr. Rappaport. “In these cases, the nodules are found through examination by a medical provider or incidentally on imaging such as CT performed for completely unrelated reasons.”

A person with thyroid problems may notice a lump in their neck, difficulty swallowing or a change in their voice. However, since the hormones the thyroid produces and regulates involve metabolism, heart rate, energy level, mood and more, the symptoms might not be immediately obvious as being caused by a thyroid problem. Hyperthyroidism and hypothyroidism can also have very different sets of symptoms.

Signs of hypothyroidism include:

• Fatigue and general weakness
• Unexplained weight gain
• Sensitivity to cold
• “Brain fog,” feeling like your thoughts are slow, or noticing memory problems (especially in people over 65)
• Depression or a loss of sex drive
• Physical changes like dry skin, brittle nails and thinning hair
• Muscle aches, cramping or pain and tingling in the hands and fingers
• Sudden digestive problems, specifically constipation
• Irregular or unusually heavy menstrual periods

Signs of hyperthyroidism include:

• Sudden digestive problems, specifically frequent bowel movements
• Irregular or unusually light menstrual periods
• Unexplained weight loss
• Rapid heartbeat
• Feeling unusually anxious and jittery

These symptoms are known as “non-specific” as they are difficult to directly pinpoint to the thyroid or any specific illness and frequently are due to non-thyroid issues such as sleep apnea, poor sleep quality, poor diet, stress, anxiety, medication side effects, anemia or a combination of factors.

How are thyroid problems treated?

“In some cases, all that’s really needed is observation and treatment of symptoms,” said Dr. Rappaport. “Thyroiditis, for example, tends to resolve on its own. Other conditions like hypothyroidism can be treated with thyroid hormone replacement therapy. When dealing with thyroid nodules, most can be monitored with ultrasound, however surgical treatment is sometimes recommended for cancerous nodules, indeterminate nodules or symptomatic nodules.”

Surgical treatment for thyroid problems might involve a thyroid lobectomy or total thyroidectomy, which would mean removing either the nodule and a portion of the thyroid gland or a total removal of the gland. These surgeries may be outpatient, where the patient can head home afterward, or involve a short stay overnight in the hospital for observation.

“When the thyroid is removed like this, there’s no more production of thyroid hormone within the body,” said Dr. Rappaport. “After a thyroidectomy, medication to replace that hormone, along with regular testing to ensure you have the right amount, will help you stay healthy.”

While fatigue and brain fog can easily be blamed on the stress of everyday life, that doesn’t mean you have to live with those feelings permanently. If you suspect your thyroid is the culprit, a simple conversation and a blood test with your primary care clinician can be the first step toward uncovering the root cause of your issue and getting your energy, and your life, back on track.