A Daily Routine to Fight Hypothyroidism Fatigue

Fatigue is one of the most common symptoms of hypothyroidism, or an underactive thyroid. Medication can help you feel better, but a few tweaks to your daily routine can also help you keep your energy up throughout the day when you have hypothyroidism fatigue.

“It’s all about the lifestyle,” says Beatriz Olson, MD, an endocrinologist in Middlebury, Connecticut, who has worked with the Yale School of Medicine and the National Institutes of Health. “You are what you eat, what you do, and what you think.”

Regardless of the cause of your hypothyroidism — the autoimmune Hashimoto’s thyroiditis, having had your thyroid surgically removed, or a less common type of the condition — here’s your plan for all-day energy to relieve your thyroid fatigue.

Morning

Wake up around the same time every day. Give yourself a good start. “The body does better when you sleep in a regular pattern, so for anyone with hypothyroidism — or not — waking up at nearly the same time can be helpful,” says Rachel Abrams, MD, MHS, director of Santa Cruz Integrative Medicine in California. “That doesn’t mean that you should wake yourself up at 7 a.m. even if you’re sleep deprived and went to bed at 2 in the morning. It’s more important to be well-rested than to get up at the same time, but it can be helpful in sleeping more regularly and more deeply.”

Take your thyroid medication bright and early. The best time to take your thyroid hormone medication is first thing in the morning, on an empty stomach, says Dr. Olson, then wait for about an hour before you eat. Certain foods and medications can interfere with the absorption of thyroid hormone.

If you don’t follow the ideal routine, it’s critical to at least be consistent, says Dr. Abrams. “If someone can’t remember to take their medication unless they’re eating at the same time, or they’re rushing out of the house and they don’t have breakfast, I’d honestly rather they take it with food as long as they do it on a regular basis,” she says. “The reason being that if you always take it with food, you won’t absorb as much of it, but we will adjust your dose for that circumstance.”

Eat a breakfast that fuels your body. A morning meal isn’t mandatory, but a healthy breakfast can be helpful, says Abrams. “Having a doughnut or other simple carb with sugar and white flour will spike your blood sugar, and it will drop back down and just exacerbate whatever energy issues you have from hypothyroidism,” she says. Instead, pair protein-rich foods like almond butter with whole grains like oatmeal, she suggests. You’ll digest it more slowly than the oatmeal alone, so your blood sugar and energy levels can stay steadier, she says.

Be smart about caffeine. A bit of caffeine is perfectly fine for many people with hypothyroidism, but not for those with severe anxiety, insomnia, or panic disorder, says Abrams. Just don’t go overboard. “The major issue with caffeine is that people use it to make up for not getting enough sleep, [which] is actually very harmful to your health,” she says.

Choose natural caffeine sources like coffee or tea (as opposed to soda or energy drinks), and pay attention to how it affects you. “Some people can drink caffeine before bed because their metabolism is such that it doesn’t affect them; other people can’t drink caffeine after noon,” Abrams says. “You need to know what your own limits are. The average person probably shouldn’t drink it after 2 or 3 p.m.” Green tea, which has a lower caffeine content than coffee and other teas, has anti-inflammatory benefits and can be a particularly good choice for some people with fatigue, she says.

Midafternoon

Break for a healthy lunch. Ham and cheese on white bread isn’t doing your energy any favors. Like breakfast, avoid simple carbs like white bread at lunch to help prevent fatigue. “Most people are eating too many processed carbohydrates,” says Olson. “I tell people to focus on proteins, nonstarchy carbohydrates like vegetables, and good fats.” Eggs, avocados, and Greek yogurt are good examples. Some organic complex carbohydrates, such as whole grains, can help you keep up your levels of the brain chemical serotonin, says Abrams, but some people with hypothyroidism, such as those who also have diabetes, may need especially low-carb diets. Talk to your doctor about a meal plan that works best for you.

Reenergize in the afternoon. Looking for a quick fix for your afternoon energy dip? Take a nap. “Napping in the afternoon is a natural human thing because we have a dip in our energy levels in the afternoon as part of our normal daily cycle,” says Abrams. If you limit your sleep to just 20 to 25 minutes, you won’t enter a deep sleep cycle, which means you won’t wake up groggy. If napping isn’t an option, get up from your chair, walk around outside, and repeat. “Set a timer to take a break for five minutes every hour to sort of stretch and stand and leave whatever you’re doing,” says Olson. Doing something fun for even just a moment can make you feel energized.

Get some exercise. “It is essential for people with hypothyroidism to exercise because it keeps their metabolism up and helps reduce symptoms that can be associated with hypothyroidism, such as depression, low energy, and constipation,” says Abrams. Do what you can: If you’re feeling very tired, a gentle walk around the block is a good start; if you’re highly active already, a game of soccer could be a good choice, she says. Exercise is helpful for many reasons. It helps increase blood flow to the brain, clear toxicities, and develop muscle mass, which increases production of mitochondria, the energy units in our cells, says Olson.

Take time for your mind. Sadness, depression, and anxiety can reduce your bandwidth and sap your energy, says Olson, but meditation can help counter stress-related spikes in nervous system activity that can otherwise leave you exhausted. Take a course in mindfulness-based stress reduction, offered at many hospitals and health centers around the country, she suggests. Talking with a mental health professional can also be helpful.

Keep water nearby. Dehydration can make you feel tired or give you a headache, says Olson. You want to keep your urine relatively diluted, not dark brown or dark orange, she says, and everyone has different needs. You’ll need a couple of liters a day, she says, and if you’re working outside and sweating, you’ll need to drink more than if you’re in an air-conditioned space. Keep a 16-ounce bottle of water at your desk to help you hit your target.

Evening

Don’t overeat at dinner. A full belly can make you feel sluggish. Bonus: “Eating lightly in the evening and eating more of your calories earlier in the day can help you maintain a normal weight, which is a real issue for many people with hypothyroidism,” says Abrams.

Be careful about alcohol. Drinking alcohol can make you drowsy but also interfere with your quality of sleep, leaving you fatigued the next day. It can also pack a lot of calories. “I tell my patients it’s just like eating a slice of chocolate cake every night if you have two glasses of wine, so if you’re trying to lose weight, manage diabetes, or keep your energy high, you probably want to limit the amount of alcohol that you drink,” says Abrams. If you do drink, stick to no more than one drink per night for women or two for men. A drink is one 1.5-ounce shot, one 12-ounce beer, or 5 ounces of wine, she says. It’s also important to consider why you are imbibing. “People who are very stressed and anxious in their jobs and are coming home and drinking to help with that stress and anxiety are not necessarily helping themselves, because that’s an addictive use of alcohol,” she says.

Relax and unwind before bed. Turn off your TV, computer, and tablet, and don’t look at your phone for an hour before bedtime, says Olson. The blue light from screens suppresses the sleep hormone melatonin and interferes with slumber, according to a study. Instead of staring at a screen, do something you find relaxing, whether it’s reading a paperback, making art, or something else, says Abrams. Or take a hot bath. Research suggests a hot bath is helpful because it increases your body temperature, she says, and then your temperature drops “just as it does when you sleep during the night, [which] seems to increase onset of sleep and deep sleep.” Sniffing lavender oil can also help you relax, she says.

Go to bed at the same time every night. Sticking to a routine bedtime can help you fall asleep and stay asleep. Sleeping enough hours and sleeping soundly play an important role in managing autoimmune diseases, says Abrams. “It also helps balance the endocrine hormonal system, of which hypothyroidism is a part,” she says. You need at least seven hours per night, says Olson, so if you need to get up at 6 a.m., start going to bed at 10 p.m. so you fall asleep by 11. Turn out the lights, keep your room cool, dark, and quiet, and get some z’s.

If your medication and healthy habits aren’t curbing your fatigue, talk with your doctor to make sure anemia, an undiagnosed autoimmune disease, or adrenal insufficiency isn’t contributing to your problems, says Olson. People with Hashimoto’s thyroiditis have an elevated risk of developing a second autoimmune disease, according to a study.

If you're living with hypothyroidism fatigue, there are simple adjustments you can make to feel more energized. Waking up at the same time daily, eating breakfast foods that release energy slowly, and taking thyroid medication early on can help you maintain steady energy levels until lunch. Taking a nap or short walk after a healthy lunch can support a mid-afternoon energy kick, and people with hypothyroidism should look after water intake and stress management throughout the day to reduce the energy drain of dehydration and anxiety.

Come dinnertime, doctors recommend eating lightly and focusing more calorie intake on an earlier time in the day, as well as limiting alcohol consumption, and going to bed at the same time every day. If energy levels remain low enough to interfere with daily life despite taking steps to manage them through lifestyle changes, speak to an endocrinologist about the next steps.