The chronic fatigue culprit that most doctors are missing

How to get an accurate diagnosis—and effective treatment

Chronic fatigue syndrome (CFS) has been a source of frustration among patients and doctors for decades.

It’s a common disease—characterized by unrelenting weakness, fatigue, and depression. But the problem lies in the fact that conventional medicine has yet to determine a clear cause.

The diagnosis, for the most part, is a process of elimination. And that’s only if your doctor decides to diagnose it at all, rather than dismiss it as a figment of your imagination—which was the norm up until very recently.

Luckily, the medical establishment has finally started to see CFS as the legitimate medical condition that it is. And along with that mainstream acknowledgement has come a welcomed increase in research on the disease’s origins…and its cures.

I’ve shared a number of potential causes with you over the years—from adrenal fatigue to an unhealthy microbiome. But new research indicates another common culprit has been hiding in plain sight all along.

Too many patients slip through the cracks

It turns out, your thyroid can trigger chronic fatigue. Which probably won’t come as a surprise to anyone familiar with the havoc the thyroid can wreak in the body if it’s not operating up to par. But it’s been awhile since I’ve written about it, so here’s a quick refresher…

Your thyroid is a tiny butterfly-shaped gland located in your neck. It generates two main hormones—thyroxine (T4) and triiodothyronine (T3). These hormones influence metabolism, body temperature, heart rate, protein production, and more.

Maintaining optimal levels of T4 and T3 requires thyroid-stimulating hormone, or TSH. Your brain’s pituitary gland generates TSH when levels of either T4 or T3 are too low.

So if your thyroid isn’t generating enough T4 or T3, your body produces more TSH to stimulate your thyroid. That’s why high TSH levels will often be one of your very first signs of hypothyroidism.

Unfortunately, most conventional doctors tend to treat this as the only sign—ordering a TSH test for patients and nothing more. And when those results come back normal, they consider it case closed.

As a result, tons of patients with thyroid dysfunction are slipping through the cracks. And as new research shows, we may be able to add chronic fatigue to the many devastating consequences of this oversight.

The common imbalance behind chronic fatigue

This study appeared last year in Frontiers in Endocrinology. A team of Dutch researchers compared inflammation and thyroid markers of nearly 100 chronic fatigue patients to a similarly-sized group of matched controls.

Among the findings, researchers discovered that CFS patients have lower levels of key thyroid hormones T3 and T4…but normal levels of TSH.

This hormone deficiency was especially pronounced in the case of T3. At the same time, chronic fatigue patients’ levels of reverse T3—an inactive form of the hormone—were notably elevated.

So what’s behind this anomaly? The short explanation is that your body needs to convert inactive T4 into T3 in order to use it. And as you may have guessed, this conversion rate isn’t always so great in those with hypothyroidism.

The results above suggest an issue converting T4 into T3—or “low-T3 syndrome”—which could be responsible for CFS, too. This may explain why the disease bears a striking resemblance to hypothyroidism, minus the “typical” telltale sign of high TSH levels.

It’s a bit complicated, but here’s the bottom line: If you’re “tired all the time,” there’s a pretty good chance that unbalanced thyroid hormones are at least partially to blame. But without a doctor who knows how to properly test for and treat them, you’ll never know for sure.

So let’s take a closer look at what comprehensive thyroid testing should entail.

Proper thyroid testing is crucial

It should be clear by now that you simply can’t go on one number alone—and that even in cases where TSH levels are perfectly normal, there could still be trouble brewing behind the scenes. Part of the problem is what mainstream doctors consider to be “normal.”

And needless to say, their criteria on TSH levels are different from mine.

That’s because most clinical laboratories use an overly broad, out-of-date “normal” range. The standard normal range goes all the way up to 5.0 milli-international units per litre (mIU/L). And in my opinion, this misses too many people who suffer from subclinical hypothyroidism (when TSH levels are elevated, yet free T4 levels are normal).

There are countless people who have all of the symptoms, but their TSH results don’t indicate a problem. Which is proof that the numbering system is all wrong. That’s why I always treat every patient whose TSH is greater than 2.0 mIU/L.

But once again, a comprehensive thyroid panel should look for more than just TSH levels, anyway. It should also include free T4, T3, reverse T3, thyroid autoantibodies, and TBG (or thyroxine binding globulin—a protein that moves thyroid hormones through the body).

Free T3 and free T4 tests will tell you how much available thyroid hormone is circulating in your body. A reverse T3 test will tell you if your body is storing T3 or if it’s using it properly. Any results that show levels that are out of range are big red flags.

But of course, getting the right tests is just half the battle. Because getting the right treatment can be just as difficult when you’re dealing with conventional doctors.

Why bioidentical replacement is always best

I prescribe Nature-Throid®, Armour® Thyroid, or a compounded version of thyroid hormone for my patients. These products are derived from the animal thyroids—most commonly, pigs. So if that makes you squeamish, then this type of hormone therapy may not be for you.

But that would be a real shame, and let me explain why.

Levothyroxine, or Synthroid®—a synthetic form of T4—is the main drug doctors prescribe for an underactive thyroid. But I’ve found that many of my patients don’t like the way they feel when they take it. And this is likely due to the conversion problems we talked about above.

That’s why I always prescribe a natural thyroid preparation that has both T3 and T4 in it—and I’ve found that my hypothyroid patients respond very well to it.

But unfortunately, most conventional doctors hate using this combination. They’ve been brainwashed into thinking that all you need is T4—which is far from the case.

Even worse, in addition to questioning the necessity of combination treatment, mainstream medicine will also plant fears about cardiovascular risks with natural thyroid replacement therapy.

Better results, with no added risks

Needless to say, these “concerns” are unsubstantiated. And it’s my hope that a recent study on the effects of long-term T4 and T3 combination therapy will silence those naysayers once and for all.

Researchers assessed the benefit of six years’ worth of combination therapy on quality of life, as well as its effect on TSH levels.

Quality of life questionnaires showed that more than 92 percent of subjects reported feeling “excellent, very good, or good” in comparison to subjects on levothyroxine monotherapy alone.

Furthermore, there was no added risk of atrial fibrillation, heart disease or death among these patients.

So please, next time a doctor suggests that natural thyroid replacement is unsafe or unproven, show them this newsletter. Then show yourself out the door, and into the office of a doctor who actually knows what they’re doing.

The fact is, we’re still learning about CFS. And if you’re suffering from it, thyroid dysfunction may or may not be the cause. But when it comes to getting an accurate diagnosis—and effective treatment—it’s critical not to leave any stones unturned.


  1. “Higher Prevalence of “Low T3 Syndrome” in Patients with Chronic Fatigue Syndrome: A Case-Control Study.” Front Endocrinol (Lausanne). 2018 Mar 20;9:97. doi: 10.3389/fendo.2018.00097.
  2. “Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life.” South Med J. 2018 Jun;111(6):363-369. doi: 10.14423/SMJ.0000000000000823.