Has anyone tried Cognitive behavioral therapy to combat tiredness ?

[Suzc16355]

Firstly I would like to say how comforting it is to have this site to ask questions and see others experiences. I live in The Netherlands and have had an under active thyroid for 27 years. If I sit down to read a book, I fall asleep and my husband laughs at how many TV programs I sleep thru. I have over the years had many blood tests, which discovered low Calcium and vitamin D, so I take tablets. I also take a multi vitamin tablet for 50 plus ladies and spray my aching limbs with magnesium oil.

My local health center seems unable to retain doctors, so as soon as I build any relationship with them, they leave and another takes their place. I must say some seem very disinterested in my ongoing quest to feel less tired and reduce my daily aches / stiffness . If the blood tests look OK, they would like me to accept one blood test per year and stop complaining. Thanks to your ongoing advice I reject both.

Seven weeks ago I saw a doctor and asked for an increase in my levothyroxine as I was really sluggish, as he signed the paperwork he announced it was his last day at the surgery. I insisted that he increase my levothyroxine dose from 175 to 200 seven weeks ago and had the blood tests last week. Yesterday, I saw yet another doctor who told me that my thyroid test results were in the correct range, after a big fight I even got them to measure my T3, which he said was also normal . The doctor told me that fatigue can be a common complaint for under active thyroid patients, doctors do not know why it happens and that maybe CBT could help me cope with the feeling of tiredness.

He also asked if I was active, I showed him my Samsung Health tracker to prove i am not a couch potato ( I am in the top 2% of my age group) so that killed off the idea I am not active enough. I also showed him my sleep tracker, I admit I could try to go to bed earlier. He did not see my heart beat ranging from 42 minimum, 59 Average and maximum 142 (if I have been cycling ) as unusual.

I also eat well, being allergic to garlic ensures that I do not eat ready meals or often eat out at restaurants as it always a fight to exclude garlic. I try to eat a wide range for food types and eat my 5 a day.

So my question is has anyone tried CBT and if so did it help ? I am fed up of feeling tired, aching and I am sleeping my life away.

[Nanaedake]

When thyroid disease is correctly treated you will not be tired. I'm not tired. I wish doctors would stop assuming thyroid patients should expect to be tired. Ask for a copy of blood test results along with lab ranges and post them here. Also ask doctor to test Vitamin D, folate, ferritin and B12, being low in any of these will make you tired.

[greygoose]

It sounds to me as if you have a conversion problem. But, we would need to see an FT4 and FT3 result tested at the same time. It's low T3 that causes symptoms like fatigue, and just saying oh, they're all in range is meaningless. The FT4 could very well be at the top of the range, and the FT3 at the bottom, and that would signify a conversion problem. Sounds like doctors in The Netherlands are as ignorant as they are everywhere else!

Do you have your calcium tested regularly? Taking calcium supplements is not a good thing to do because it's not easily absorbed. Plus taking vit D will increase your absorption of calcium from food, so you could easily be taking too much. And, when taking vit D, you should also take vit K2 to make sure the extra calcium goes into the teeth and bones, and doesn't build up in the soft tissues, which can cause lots of problems.

And taking a multi-vit is a very bad idea. At best you won't get much out of it. At worst you will be taking things you don't want like more calcium, iodine and/or copper. Much better to do as Nanaedake says and do the tests, and just take what you need in the correct quantities according to the results.

Oh, and in answer to your question, I very much doubt anyone has found CBT helpful for fatigue caused by low T3. You cannot replace hormones with exercise. You can only replace hormones with hormones. Pity a few more doctors don't understand that!

[Wildbird]

CBT is a psychological therapy which focuses on negative thoughts and behaviour change. You are tired because you are not optimally treated. There are two very good replies below. It is insulting to a thyroid patient to suggest that their symptoms must be psychological. I wish you better health, keep questioning and preferably get hold of your test results.

[humanbean]

If a thyroid patient is tired it is most likely caused by one or more of the following :

1) Thyroid hormone levels, Free T4 and more importantly Free T3, not being right for the patient. Just getting these into the reference range is not sufficient. I might like my Free T3 to be 60% of the way through the range, you might feel best when yours is 80% of the way through the range. If we are both treated to a level where Free T3 is only 20% of the way through the range we will both feel awful. Our doctors will feel great though - they have done their job of ignoring symptoms and paying attention only to the blood test results. Note that TSH doesn't make people feel anything, whether it is below range, in range or above range. The measure most correlated with feelings of well-being is Free T3 level - and this is the thing that doctors rarely measure.

2) Both hyperthyroidism and hypothyroidism patients frequently end up with low levels of nutrients. In the case of hypothyroidism it is because the patient is likely to produce too little stomach acid so they can't extract nutrients from their food very well. Many symptoms of nutrient deficiencies can be mistaken for hypothyroidism symptoms. Just like thyroid hormone levels, nutrient levels need to be optimal for the patient. Just getting levels into the reference range is not sufficient for the patient to feel well.

3) Adrenal issues - the body needs the right amount of cortisol and adrenaline. If the level is wrong it has a huge impact on the body. If the level of cortisol is too high or too low the patient will probably have difficulties tolerating thyroid hormones at the right level for them. Some of the symptoms of cortisol being too high or too low - anxiety, feeling jittery, internal tremors, sweating profusely, panic attacks, insomnia, very low energy.

[SeasideSusie Remembering]

Suzc16355

I was offered CBT by my GP many years ago. After 20+ years of being on Levo I had taken a turn for the worse. I left the surgery muttering something about not needing psychobabble, but needing my thyroid properly treated.

Years later, after discovering this site and doing lots of reading and research and private testing, I discovered nutritional deficiencies including severe Vit D deficiency, and poor conversion of T4 to T3. If any doctor had bothered to investigate properly back then, I might not be in the place I am today - still unwell despite optimising everything, a lot of damage was done in my opinion, by doctors being a slave to TSH and not thinking outside the box.

[Suzc16355]

Thank you everyone, I was not keen on the CTB theory.

I forgot to mention that I take 150 mg rantitidine tablet in the evening as I have a Hiatus hernia and avoid anything that set off acid production. Perhaps this ties into your comments about stomach acid, could I be reducing even more by it by taking this medication to lower acid reflu?

I have to really push for extra tests, even though we are all paying for health care via private insurance. I think the last time my vitamin D3 and calcium were tested was about 12 months ago. Maybe a test kit sent to a UK address might be the solution.

Here are the test results for my T4 & T3 completed on 14 -8 -2018

T4 17.800 Dutch lab range is measured from 12.00 -22.00

TSH 0.610 Dutch lab range is measured from 0.27 - 4.2

T3 4.400 Dutch lab range is measured from 3.1 - 6.8

All your comments are very gratefully received, like others I am made to feel like a hypochondriac or someone who likes seeing doctors for nothing.

[HighlandMo in reply to Suzc16355]

I used to take ranitidine and have now stopped. I feel it will be contributing to your problems. I now take apple cider vinegar for digestive problems if I have eaten something which disagrees with me. Take a look at this website. drmyhill.co.uk It has a lot of very useful (and different) information. She is very against CBT.

[Suzc16355 in reply to HighlandMo]

Thank you for your support and I will look at the link.

[humanbean in reply to Suzc16355]

Ranitidine will lower your stomach acid. If your stomach acid is already low then it will make it even lower.

I take ranitidine to protect my stomach from the effects of Naproxen, an NSAID painkiller I have no choice about taking because I'm in too much pain without it. Ranitidine may make taking Naproxen "safer" but I hate having to take it. I'm sure it will shorten my life.

[Jompy]

Hi I had nearly a year of cbt for fatigue and anxiety caused by hypothroidism it helped very much in 2 ways 1 I learnt many coping strategies that hav changed my life and secondly but most importantly she wrote to my gp and said after extensive work by me i had done everything I could and now had no symptoms of anxiety/depression but my physical problem of fatigue (and headaches) etc were still a cause for concern and my gp needed to address them , which my gp

is following up and is now genuinely interested

[Eazybiker]

Sorry to hear a physical problem being handled as mental/emotional. Like if a person was sleeping 4 hours a day, CBT wouldn't help, they would need to get more sleep. Thyroid sufferers need optimal hormone and vitamin levels yet for some reason this eludes many medical professionals. I think we are living in an age of checklists and protocols instead of genuine application of knowledge.