What Causes Thyroid Fatigue & How to treat it
Summary
TLDR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
😌 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。
🔬 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。
🤔 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。
Mindmap
Keywords
💡甲状腺
💡疲劳
💡甲状腺激素
💡维生素B12
💡自身免疫性甲状腺炎
💡代谢
💡T3和T4
💡皮质醇
💡瘦素
💡肾上腺适应原
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
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