Tired all the time?

Feeling tired all the time so much so that you’re unable to perform daily activities? Has this been going on for a long time? Then there are chances you might be suffering from Chronic Fatigue Syndrome (CFS). Previously, it was mistakenly assumed to be a psychological issue, when it’s very real and could be caused by having low levels of thyroid hormones, as per a new study. We asked experts for their take...

The study

A new Dutch research, conducted on 197 adults, backs up claims that CFS is a physical problem and not made up in the head of sufferers. Scientists hope to find the root cause of the condition, which may allow doctors to move away from treatments that involve psychologists. There is no cure and current treatments include Cognitive Behavioural Therapy (CBT), graded exercise therapy and medications such as antidepressants.  

Researchers compared thyroid function between 98 CFS patients and 97 healthy adults. The results showed that the former had lower serum levels of two key hormones, triiodothyronine (T3) and thyroxine (T4). Having low levels of these two hormones, can cause weakness and fatigue, like that of CFS. However, they did not show signs of hypothyroidism, where the thyroid gland does not produce enough thyroid-stimulating hormone.

Expert speak

So is CFS psychological or a real thing? Clinical psychologist, psychotherapist and tobacco treatment specialist, Mansi Hasan says that almost all of her clients who complain of “feeling tired” are assessed psychologically as well as blood tests are administered. “There are many cases in which the T3 and T4 levels are lower. The average would be six out of 10 cases. Vitamin deficiencies are also observed which cause ‘feeling of tiredness’. In case of low T3, T4 levels, they are referred to an endocrinologist,” she recounts.

Lower T3, T4 levels are found to be more prevalent in women, with the common age group being 15-25 and 35-40 years. Women with hormonal conditions are more prone to it. Pregnant women and women with postpartum depression is another population which is most prone. Heredity is  another factor. Stress, unhealthy eating habits and lack of sleep can accentuate low thyroid levels, explains Hasan.

More tests required for diagnosis

Dr Sudhindra Kulkarni, consultant endocrinologist, Fortis Hospital, says that low thyroid hormones can manifest as fatigue and lethargy. However, she says, “In a certain subset of patients, the reports need to be interpreted accordingly, as there are various reasons for low T3 and T4. So, a test has to be conducted to differentiate between primary and secondary type of thyroid disease.”

She too, has observed patients suffering from chronic fatigue do get detected among the group of thyroid patients, although uncommonly. It is seen predominantly amongst females, and is common in middle-aged patients. “If thyroid issue is confirmed in such patients, which can be on the basis of further tests, thyroid medication can be started. Vitamin supplements can be of help especially Vitamin D3, as it can aid in improving muscle and bone strength,” she says.

Dr Vikrant Shah, internal medicine expert, Zen Multispecialty Hospital, agrees with the study, saying that not only CFS but also fibromyalgia (a long-term condition that causes pain all over the body) are correlated to abnormal thyroid function, which he has seen amongst patients. However, it’s not necessary that if one is experiencing CFS and fibromylgia, then one has hypothyroidism. “It’s the clinician’s judgement to further investigate and rule out pituitary abnormalities,” he says adding that in the case of CFS and fibromyalgia, T3 and T4 levels are low whereas TSH is normal and in the case of hyperthyroidism, there’s low levels of T3 and T4 and an increased level of TSH.  

What should you do?

If a person is experiencing chronic fatigue, should they do a thyroid test? What else should they do? Dr Kulkarni says that certainly, in such patients it would be worth testing for thyroid problems. Once confirmed, consultation with an endocrinologist for further advice and long-term management, is a must. Identifying other conditions in consultation with a rheumatologist can also be helpful.