What Causes Thyroid Fatigue & How to treat it

Summary

视频脚本由Dr Childs主讲，探讨了甲状腺患者常见的疲劳问题。他解释了疲劳的非特异性症状和多种可能的原因。特别指出，即使甲状腺激素水平得到补充，由于维生素B12缺乏、自身免疫性甲状腺炎引起的炎症、甲状腺激素对代谢的直接影响，以及甲状腺功能减退导致的激素变化，患者仍可能经历疲劳。Dr Childs强调，除了甲状腺荷尔蒙治疗外，还需要解决这些相关问题，如通过补充B12、使用肾上腺适应原和调整皮质醇水平等方法，以全面改善甲状腺患者的疲劳症状。

Takeaways

• 😪 甲状腺患者经常感到疲劳，这与多种因素有关，包括甲状腺激素水平、营养缺乏、炎症状态和代谢影响。
• 🩺 甲状腺功能减退（甲减）患者由于甲状腺激素不足，可能导致维生素B12等营养素缺乏，影响能量水平。
• 💊 即使补充了甲状腺激素，如服用左旋甲状腺素，也可能无法立即改善疲劳症状，因为还需要解决营养素缺乏等问题。
• 🔥 自身免疫性甲状腺炎是导致甲减的常见原因，它会引起炎症，从而影响能量产生和身体的整体效率。
• ⚡️ 甲状腺激素直接影响新陈代谢，特别是通过T3来调节线粒体能量产生，而T4需要转化为T3才能发挥作用。
• 🌡️ 甲状腺功能减退会导致各种激素变化，如皮质醇和瘦素，这些激素的变化可能进一步加剧疲劳感。
• ☕ 疲劳、睡眠问题、对压力的耐受性降低、体重变化和对咖啡因的依赖都可能是肾上腺功能不全的迹象。
• 🌿 支持肾上腺功能和皮质醇水平对于改善甲状腺患者的疲劳症状很重要，可以考虑使用适应原等补充剂。
• 📊 评估皮质醇水平有助于确定疲劳的原因和治疗方法，包括使用肾上腺适应原、肾上腺提取物或磷脂酰丝氨酸等补充剂。
• 🔄 治疗甲状腺患者的疲劳不仅仅是补充甲状腺激素，还需要综合考虑营养、炎症、代谢和激素平衡等多方面因素。

Q & A

为什么甲状腺患者经常感到疲劳？

甲状腺患者经常感到疲劳是因为甲状腺激素水平不足，这影响了能量产生和代谢率，还可能与其他因素如营养缺乏、炎症状态和激素失衡有关。

甲状腺激素不足如何导致营养缺乏？

甲状腺激素不足可能导致维生素B12等营养素的吸收不足，因为足够的甲状腺激素水平是维生素B12吸收所必需的。

为什么甲状腺激素替代治疗后，一些患者仍然感到疲劳？

即使进行了甲状腺激素替代治疗，如果甲状腺激素（T4）没有正确转化为活性形式（T3），或者存在炎症、营养缺乏和激素失衡等问题没有得到解决，患者可能仍然会感到疲劳。

自身免疫性甲状腺炎如何影响能量水平？

自身免疫性甲状腺炎导致的炎症状态可以减缓身体的系统效率，从而影响能量产生，使身体像是以低于最佳状态的效率运行。

甲状腺激素如何直接影响新陈代谢？

甲状腺激素通过介导线粒体能量产生来直接影响基础代谢率，特别是T3形式的甲状腺激素。如果T4未能有效转化为T3，那么线粒体功能将不会得到改善。

甲状腺功能减退如何导致激素变化，进而影响疲劳感？

甲状腺功能减退会导致TSH水平上升，这可能间接影响其他激素，如皮质醇和瘦素，这些激素的变化会影响能量水平和代谢。

为什么甲状腺患者需要特别关注肾上腺功能？

甲状腺患者可能存在HPA轴（下丘脑-垂体-肾上腺轴）的失调，这可能导致皮质醇水平变化，影响能量水平和应对压力的能力。

如何判断是否存在HPA轴失调？

HPA轴失调的一些症状包括早晨醒来时的疲劳、一天中能量水平的异常波动、对压力的耐受性降低、体重增加或减重困难等。

甲状腺患者如何处理HPA轴失调？

甲状腺患者可以通过使用肾上腺适应原（如阿什瓦根或者人参）和肾上腺补充剂来支持肾上腺功能，同时可能需要调整生活方式和饮食习惯。

为什么甲状腺患者需要特别注意B12的补充？

由于甲状腺激素不足可能导致B12吸收不足，而B12是能量产生的关键营养素，因此甲状腺患者需要特别注意B12的补充，以改善能量水平。

甲状腺患者如何评估和管理自己的疲劳问题？

甲状腺患者可以通过评估自己的激素水平、营养状况和炎症状态来管理疲劳问题，并可能需要与医生合作，采取综合的治疗策略，包括药物治疗、营养补充和生活方式调整。

Outlines

00:00

😌 甲状腺患者为何易感疲劳

Dr. Childs在本段中讨论了甲状腺患者常见的疲劳问题。他指出疲劳是一个非特异性症状，可能由多种因素引起，因此需要深入了解其原因。对于已知患有甲状腺功能减退症的患者，治疗过程相对简单，因为已经知道问题所在。Dr. Childs解释说，甲状腺激素的缺乏会导致营养缺乏，尤其是维生素B12，这对能量产生至关重要。然而，仅仅补充甲状腺激素并不能立即解决维生素B12的缺乏问题。

05:01

🔬 甲状腺功能减退症的多重影响

第二段中，Dr. Childs进一步探讨了甲状腺功能减退症对患者的影响。他提到，大多数甲状腺功能减退症是由自身免疫性甲状腺炎引起的，这会导致炎症和能量产生效率下降。此外，甲状腺激素直接影响新陈代谢，特别是通过T3来调节线粒体能量产生。然而，如果患者正在服用T4药物，如左甲状腺素，它必须转化为T3才能激活。Dr. Childs还提到了甲状腺功能减退症导致的激素变化，这些变化可能会加剧疲劳感，例如TSH水平上升时，皮质醇水平也会发生变化。

10:02

🤔 如何解决甲状腺功能减退症患者的疲劳问题

在第三段中，Dr. Childs讨论了解决甲状腺功能减退症患者疲劳问题的方法。他强调，仅仅补充甲状腺激素并不足以解决所有问题，还需要解决其他相关问题，如B12缺乏、自身免疫性甲状腺炎引起的炎症、代谢问题和激素失衡。他建议，除了甲状腺药物，患者可能还需要补充B12，特别是通过注射形式，以及使用肾上腺适应原来支持肾上腺功能和皮质醇水平。此外，他还提到了HPA轴失调的症状，如早晨醒来时感到疲劳、一天中能量水平异常波动、对压力的耐受性降低、体重增加或减重困难、对咖啡因和其他兴奋剂的依赖等，并建议根据皮质醇水平选择合适的肾上腺补充剂。

Keywords

💡甲状腺

甲状腺是位于人体颈部的一个腺体，负责分泌甲状腺激素，这些激素对调节新陈代谢和能量水平至关重要。在视频中，甲状腺功能减退（甲减）是导致疲劳和能量水平低下的主要原因之一。

💡疲劳

疲劳是一种主观感受，表现为身体或精神上的乏力和能量不足。视频中讨论了甲状腺患者为何经常感到疲劳，以及疲劳的多种可能原因，包括甲状腺激素水平不足、营养缺乏和炎症状态等。

💡甲状腺激素

甲状腺激素是调节新陈代谢和能量消耗的关键激素。视频中提到，甲状腺激素的缺乏会导致营养吸收不良，进而影响能量水平。此外，甲状腺激素的适当水平对维生素B12的吸收至关重要。

💡维生素B12

维生素B12是参与能量代谢的重要营养素，被称为“能量维生素”。视频中指出，甲状腺激素水平不足会影响维生素B12的吸收，从而导致能量水平下降。

💡自身免疫性甲状腺炎

自身免疫性甲状腺炎是一种常见的甲状腺疾病，由免疫系统错误地攻击甲状腺组织引起。视频中提到，这种状况会导致炎症，进而影响能量产生和甲状腺激素的正常功能。

💡代谢

代谢是指身体内进行的化学过程，用于维持生命活动。视频中解释了甲状腺激素如何通过调节代谢率来影响能量水平，特别是通过促进线粒体能量产生。

💡T3和T4

T3和T4是两种主要的甲状腺激素。T4是主要的甲状腺激素形式，但需要转化为T3才能激活。视频中提到，T4必须转化为T3才能通过线粒体产生能量，而这一转化过程可能受到影响。

💡皮质醇

皮质醇是一种重要的应激激素，对能量水平和应对压力的能力有显著影响。视频中讨论了甲状腺功能减退如何影响皮质醇水平，进而影响能量水平和应对压力的能力。

💡瘦素

瘦素是一种由脂肪细胞分泌的激素，它影响食欲和能量消耗。视频中提到，甲状腺功能减退可能导致瘦素水平失衡，从而影响能量水平和体重管理。

💡肾上腺适应原

肾上腺适应原是一类可以帮助身体应对压力并支持肾上腺功能的草药或补充剂。视频中提到，使用肾上腺适应原如阿什瓦根或者人参，可以帮助改善甲状腺患者的疲劳症状。

Highlights

甲状腺患者经常感到疲劳的原因与多种因素有关。

低能量或疲劳是一个非特异性症状，可能由多种因素引起。

已知甲状腺功能减退（甲减）的患者更容易出现疲劳。

甲状腺激素不足可能导致维生素B12等营养素缺乏，影响能量水平。

甲状腺激素对于维生素B12的最佳吸收至关重要。

即使补充了甲状腺激素，维生素B12的储备不会立即恢复。

大多数甲状腺功能减退是由自身免疫性甲状腺炎引起的，这会导致炎症。

炎症状态本身可以减缓能量产生，影响身体效率。

甲状腺激素直接影响新陈代谢和静息能量消耗，主要是通过T3发挥作用。

甲状腺功能减退会导致多种激素变化，这些变化可能加剧疲劳。

补充甲状腺激素并不能解决所有导致疲劳的问题。

甲状腺患者可能需要额外补充B12和其他营养素。

自身免疫性甲状腺炎患者可能需要支持肾上腺功能和皮质醇水平。

HPA轴失调或肾上腺疲劳的症状包括早晨醒来时疲劳、日间能量水平异常等。

评估皮质醇水平对于确定肾上腺功能和选择合适的补充剂至关重要。

肾上腺适应原和肾上腺提取物是支持肾上腺功能的一些选择。

治疗甲状腺疲劳需要综合考虑多种因素，而不仅仅是补充甲状腺激素。

Transcripts

hey guys it's Dr Childs today I want to

talk about uh thyroid patients and

energy levels or um why thyroid patients

uh deal with fatigue so frequently so um

in order to have this discussion we kind

of need to lay down some um uh some

framework here um because you need to

understand why people experience the

subjective symptom of fatigue or low

energy um and it turns out that uh

fatigue or you know having low energy is

really a

non-specific symptom um it it's

something that could be caused by

multiple factors and so it's kind of

nebulous if you go into a a physician or

a provider and you say look I'm I'm

dealing with low energy there it's kind

of like you have to do some digging in

order to even understand where to start

now if you have hypothyroidism or or

known hypothyroidism I should say um the

digging becomes a lot easier okay and

that's actually a really good thing so

presumably if you're listening to this

you probably know that you have a

diagnosis of hypothyroidism which means

we already have some we already know

where we need to be looking so um

basically why does why why do thyroid

patients um why are they more prone to

developing this fatigue and why is it

kind of why is it so difficult to treat

why is it that um when you replace the

thyroid hormone that's supposed to be

deficient in your body with something

like level thyroxin why then do you

still experience the this fatigue um and

to answer that we need to talk about all

the the various causes that um various

causes of fatigue in in hypothyroid

patients so so number one is thyroid

hormone um or I should say a deficiency

in thyroid hormone causes nutrient

deficiencies like vitamin B12 and so you

probably know um or at least very

familiar with the fact that vitamin B12

is felt to be one of the um quote

unquote um energy vitamins right that

there's a reason that vitamin B12 is is

in all sorts of energy drinks it's in um

all sorts of energy supplements and the

reason is because B12 well I mean I

could talk to I mean there's a lot of

reasons but probably one of the main

reasons is its role in mitochondrial

energy production and if you listen to

my other videos you know why that's

important so thyroid hormone how it fits

in here is adequate levels of thyroid

hormone is required for optimal B12

absorption so if you're hypothyroid

you're going to be B12 deficient period

okay now the interesting thing is here

if you simply replace um thyroid hormone

in your body with like level thyroxin

that doesn't magically replete your

vitamin B12 stores right it's it doesn't

work that way so um for some things it

does and now yes okay yes you might

start absorbing a little bit more of it

but generally speaking you're still

going to have whatever deficiency you

you um you started with prior to taking

the medication okay so that's number one

um number two is that most causes of

hypothyroidism um are at least in the

United States I can't speak to other

other countries but most cases of

hypothyroidism are caused by autoimmune

thyroiditis okay and these conditions uh

result in inflammation and inflammatory

States themselves can produce energy

production they can kind of slow I I

want you to think of it sort of like as

a slowing down of the system and so I

know that's a very unscientific word but

what it's meant to mean is that um if

you think of your body as a machine um a

and one that has it has uh uh various

degrees of efficiency so what I mean by

that is is an optimal machine runs at

100% right um but but a lot of us are

probably really running at 90%

efficiency or 80% uh efficiency or even

70% % efficiency so any factor that

reduces the efficiency of the system is

going to reduce the amount of energy

production that that that um um is being

produced yeah it's going to reduce um

it's going to change enzymatic

production it's going to change a lot of

different factors which just sort of

Gunk up that system so that's what I

want you to think of it as and one of

the things that reduces or reduces the

efficiency of the entire system is

inflammation and autoimmune States and

autoimmune conditions are driven by

inflammation they're PR I mean right

like you this should be um this should

be clicking to you because autoimmune

immunity is in there um I mean

inflammation and the immune system are

go hand inand so that's why this kind of

goes together now yeah this this concept

is welln exactly why it happens is not

really welln because we know that for

instance we know that um

enzymes that certain things can

upregulate the efficiency of an enzyme

or down regulate the efficiency of an

enzyme so and this can happen in your

mitochondria it can happen from

inflammation it can happen from nutrient

deficiency Etc but let's just bypass all

that and just just think of it as the

efficiency system that I described

previously so that was number two number

three is that thyroid hormone directly

influences your metabolism and what I

mean by metabolism is your basil me

metabolic rate um and or your resting

energy expenditure and it does this by

mediating mitochondrial energy

production we've talked about this

before but the thyroid hormone that that

mediates this is is T3 not T4 so T4 if

you're taking level thyroxin as a T4

medication it must be converted to T3 in

order to be activated and if you're not

converting T4 to T3 then you're not

getting the benefit of that

mitochondrial um function because it's

mediated through T3 right hopefully

that's making sense hopefully you

understand about um hopefully you

understand about thyroid conversion um

and then the other thing is and this is

maybe maybe even more important than the

other three but again these are all kind

of they all go together um this one

would be that hypothyroidism results in

various hormonal changes that worsen

fatigue um and let's see do I talk about

these things I don't talk about them all

at least not here so I'll just make a

quick mention of these so for instance

one of them and probably the most

obvious would be there are studies that

link the um your TSH which is a you know

it can be uh or at least somewhat

correlated with your um um the amount of

thyroid hormone that's being produced in

your body there are studies that show as

TSH Rises which means you're in a

hypothyroid State um your cortisol will

change as well so that's one instance

where um your thyroid horm hormone

directly influences or at least

indirectly through some way uh changes

other hormones in your body this isn't

even the only one another example would

be leptin um so leptin is is a hormone

that's secreted from your fat cells

which uh feed feeds back to your brain

and and help set your metabolism help

set your appetite helps set kind of the

energy level of your body how much

energy you're going to produce how much

you're going to consume and it kind of

balances that system out and so

obviously if there's any disregulation

in that system it's going to manifest as

a change in energy because you're you're

you're you as an organism you as a human

or you as an efficient machine you're

not going to want to consume or you're

not going to want to um uh use more

energy than is necessary so your body's

going to match those things and that's

how this this all kind of fits together

so bottom line is at least through four

different mechanisms thyroid hormone

results in low energy levels all right

and so the like I said before and I

mentioned this in the very beginning one

of the most important aspects of this is

not that this occurs we know that this

occurs the more important aspect is just

giving you thyroid hormone doesn't

change these things it doesn't increase

your B12 right it doesn't reduce the

inflammation associated with autoimmune

thyroiditis it doesn't fix your

metabolism right it doesn't unless

you're converting correctly and it does

not reverse any hormone imbalance that

existed so you have the situation in

which I can give you this T4 this T4

thyroid hormone or whatever I mean this

could even this is even true of natural

desicated thyroid and I you know kind of

I sit back in my chair and I you know

kind of wash my hands I'm like you're

fixed well no not exact not that's

that's so far from the truth and that

explains why so many well at least in

part why probably so many hypothyroid

patients are unhappy with their

treatment because they're they're kind

of left to believe that that's it right

take the thyroid hormone and boom you're

done well that that's not the truth you

got to fix these other problems so in

cases where you're this would be related

to B12 you have to fix you have to give

back B12 and predom well usually and I

do think I I talk about this in in this

and I don't want to go over this in this

video otherwise it'll be really long but

um in my opinion replacing things

replacing p12 that's loss with B12 shots

is superior to that of oral or

sublingual forms and so there's kind of

there's little nuances like that which

make a big difference in in helping

patients get um to where they need to be

now I do want to talk about um support

your adrenals and cortisol levels here

uh at least real quick and and the

reason for this is I I don't know that I

have ever met a thyro a hypothyroid or

patient or a patient with hasimoto

thyroiditis or another autoimmune

thyroiditis condition who had sufficient

energy levels um which means that this

is this is a really good opportunity and

I I I don't I don't mean to say that

this is the most important um I don't

think that's true but I do think you're

doing yourself a disservice if you're

not at least addressing um adrenal

function with an adaptogen okay and I

will talk just briefly about the

symptoms of HPA disregulation or this is

sometimes referred to as uh adrenal

fatigue I don't use that term because um

I just don't think it's an accurate term

really to be honest with you um because

I think it's it's better to look at

what's happening at the level of

cortisol and then treat that condition

but however you want to however you feel

is best to describe it this is kind of

the this um it's kind of on the Spectrum

so what what symptoms uh what are the

symptoms that may indicate that there's

some HPA disregulation in your body so

let's go over those so number one would

be fatigue especially upon Awakening in

the morning that's not normal especially

if you get a good night's sleep you

shouldn't wake up and feel tired I mean

that kind of goes without saying but

we'll say it anyway uh the second and

that's actually fairly common among

hypothyroid patients um second is you

get abnormal energy levels throughout

the day especially at weird times so um

I like to describe this as having a

second wind at night right before sleep

and I'll be I'll talk to patients and

and I'm I'm you know I'm kind of like I

just have heard enough of these stories

that I kind of have an idea of how

people are going to present so I'll say

you know I just started asking them and

I'm like well you know what's your

energy like oh it's really low you know

it's it's low all day and I'm like okay

well you know do do you have a crash in

the middle of the day sometime yeah yeah

I have a crash like 2 to 3 p.m. I'm like

okay well how's your energy at night

does it does it go up yeah yeah it goes

up I mean this is very common among

among people and and this is felt to be

at least in part due to this H HPA

disregulation so along with that so

obviously if you're going to have your

second way if you're going to have more

energy at night it's going to be

difficult to sleep so difficulty with

sleep or insomnia and this this vicious

cycle occurs in which patients will be

super fatigued in the morning they will

rely upon caffeine to get them through

the day at least through the morning

they'll crash about 2: to 3: p.m. and

I'm just like midf afternoon they'll

crash they'll go for another cup of

coffee or an energy drink or something

like that they'll kind of rally they'll

be really fatigued around 600 700 p.m.

they'll eat then 8 9 10 p.m. rolls

around and boom their energy is back up

and so guess what happens and they don't

go to bed until 1 or 2: a.m. and then

they get back up at 6 a.m. repeat rinse

and repeat over and over and over again

that's not a good thing that's not a

good cycle to be in um so another

another big thing is the inability to

tolerate stressful situations you know

if you're in that because well you know

how you're bodies handle stress over

time if if previously you were able to

tolerate stress better than you are now

well then that's a pretty good pretty um

good good sign that you're not

tolerating it very well now um the next

one another one would be weight gain or

the inability to lose weight this this

is kind of non-specific but it does go

with cortisol um disregulation increase

cravings for certain foods especially

carbs and refined sugars yeah this this

is I wouldn't say it's specific but

people do experience this and then this

one's this one is probably a little more

specific but it's the Reliance upon

caffeine or other stimulants as uh

pickme up and by the way this this can

include um uh prescription medications

like ADD medication right so there's a

lot of patients who who take it and that

that's a that's an even worse cycle so

let's say you get you know you have this

insomnia you have this the fatigue that

I talked about that that um um that

cycle that we were talking about before

and not only are you using fat you're

using caffeine to boost your energy but

you're now you're also using ad

medication that's a that's a recipe for

um disaster down the road you are

definitely going to crash at some point

you can't sustain that indefinitely so

what do you do um and and attempt to try

and keep this a little bit shorter I

I'll talk about some of the ways that

you want to look at this but we'll go

into this in a little more detail

probably some future um videos here but

really what you want to do is you need

to assess your cortisol um so you can

figure out what it is and and the way I

kind of break it up is into three main

categories you have low normal cortisol

right so these is all this is all

variations of um the cortisol spectrum

because I believe just kind of winging

it off the top of my head here but

usually serum cortisol levels anyways

range from something like 8 8 to 24 um

and so you kind of have to doctors

aren't really impressed unless your

cortisol is basically zero or unless

it's like 50 right there's there they

don't really care if it's anywhere in

between there but the truth is it

matters so if you want to look at this

you want to look at um you want to

determine if it's a low normal a normal

and still symptomatic or or high normal

so the way that we would break that up

is anything like I would consider kind

of a normal 8 A.M cortisol serum anyway

this is different if we start going into

urinary tests and such but somewhere

between the range of 14 to 16 anything

less than a you know 12 or so and

anything greater than than 18 to 20 is

would be that low normal or high normal

so you have to figure out where you lie

on that Spectrum now the way and then

then you can kind of identify how which

adrenal supplements to take now I I

generally would recommend at least for

hypothyroid patients um adrenal

supplements of some sort now I tend to

be a fan of adrenal adaptogens and you

can kind of determine where to go from

there so if the cortisol this is kind of

a baseline you're going to want some

adrenal adaptogens and you know that

would be something like ashwaganda or

riola those type of things you've

probably heard about those before and

they need to be in a high enough dose by

the way um and we'll talk about those

later uh the other thing is uh you can

consider the use of adrenal glandulars

um usually for more severe cases and

then the other thing you want to

consider is and this so this would be

like if your cortisol is actually low

and then if your cortisol is quite High

then you you want to do things to bring

it back down to normal and there's very

few things that do that but one of those

things is phosph vital searing um so you

can get so soyf free versions of this

supplement um to kind of manage your

cortisol now there are a lot of other

things but these are probably the most

important so I'll kind of I'll kind of

end that here but um we can talk about a

bunch of other um um treatments for uh

thyroid fatigue but um we we'll kind of

stop here so hopefully this was helpful

to you if you have any questions

regarding you know how to assess your

fatigue or you know what to do about it

leave them in the comments below um I'll

try to get to any questions that you

have but just know that it is it is more

complex than most people probably

realize and that's not a bad thing it

just means that it's going to take a

little bit more than probably just

taking your thyroid medication although

I will say that is an important aspect

as well so anyways hope you guys found

this uh helpful and I'll talk to you

guys again uh probably tomorrow