Hypothyroidism and Fatigue

Fatigue is a common symptom associated with hypothyroid, but many people still experience fatigue even after their hypothyroidism has been treated.  Did you know that over 20% of people with Hashimoto’s thyroid autoimmunity may also have difficulty absorbing certain vitamins, which can then cause anemia, which then causes fatigue.  Lets discuss this issue and what you can do about it.

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Hypothyroidism and Fatigue

Dr. Michael Ruscio: Hypothyroidism and Fatigue. Hi, this is Dr. Ruscio. And if you’re suffering with Hashimoto’s hypothyroidism and still have fatigue, there may be a reason why you’re fatigued outside of having to do with your thyroid. And it may have to do with an anemia, specifically a megaloblastic or pernicious anemia. This is an anemia caused by deficiencies in B12.

Now, how does this happen? Well, some of the studies are showing that about 25% of the people who have Hashimoto’s, which is the most common cause of hypothyroidism, will also form antibodies that damage a part of your stomach that releases a factor called intrinsic factor that allows you to absorb vitamin B12. So even if you are eating foods that are high in B12 or taking vitamin B12 supplements, you may not actually be able to absorb the B12 because of a lack of your stomach cells’ ability to release this intrinsic factor, which actually enables you to absorb and utilize B12.

Now, you may be able to see this on lab work. Oftentimes, it will appear as an elevated MCV—mean corpuscular volume— or MCH—mean corpuscular hemoglobin—, which essentially means that your blood cells are getting larger because of a lack of this DNA cell replication stimulation ability that B12 can cause.

So the take home is that if you have Hashimoto’s, and it’s being somewhat successfully managed, and again, that’s really up for interpretation what that term means, but if you’re working with someone who practices functional medicine and you’re having a very holistic and comprehensive look at your thyroid, and all your thyroid markers look normal, not just TSH and T4, but TSH, T4, free T4, T3, free T3, reverse T3, and your thyroid antibodies are all starting to normalize, but you’re still fatigued, it may be because of one of these pernicious or B12 anemias, which can cause some pretty significant fatigue.

And you can put yourself with certain lab tests. You can test for the vitamin deficiency and for the autoimmune attack against the stomach cells. And these patients will need to either take a sublingual, or under the tongue, absorbing form of B12 with intrinsic factor or vitamin B12 injections. I don’t think everyone can get there with the sublingual B12 alone. And some people will ultimately need B12 injections to be able to feel good energy again.

So if you have Hashimoto’s, you have about a 20% to 25% chance of having this problem occur. So I’d strongly encourage you to have a close look at your blood work and make sure that you rule out a pernicious anemia if you’re still fatigued after successful and comprehensive treatment for your thyroid.

This is Dr. Ruscio. If you have any questions, just let me know.


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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.


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