Hashimoto's and Dizziness: What Could Be Causing It?

Perhaps you recognise this.

You stand up and suddenly feel as though you might faint.

Or you are walking through a shop and notice that you feel lightheaded. Maybe the room is not actually spinning, but you feel unsteady, weak or unsure on your feet.

If you have Hashimoto's, it is understandable to wonder:

“Is this dizziness part of my Hashimoto's?”

The short answer is:

dizziness can occur in someone with Hashimoto's or hypothyroidism, but it is not a symptom that should automatically be attributed to Hashimoto's.

Dizziness has many possible causes.

That is why it is important to ask not only whether you are dizzy, but also:

what exactly do you mean by dizziness?

When does it happen?

How long does it last?

And do you have other symptoms at the same time?

What does “dizziness” actually mean?

Dizziness can describe several different sensations.

One person means:

“The room feels like it is spinning.”

Another means:

“I feel lightheaded when I stand up.”

Someone else may say:

“I feel unsteady when I walk.”

These are not necessarily the same problem and they can have different causes.

It can therefore help to distinguish between:

a spinning sensation;

feeling lightheaded;

feeling as though you may faint;

problems with balance;

or a vague floating or unsteady feeling.

That distinction can provide useful information for your healthcare professional.

Can hypothyroidism cause dizziness?

Hypothyroidism can affect several processes in the body.

When thyroid hormone levels are clearly too low, symptoms can include:

fatigue;

slowness;

muscle weakness;

a slower heart rate;

feeling cold;

difficulty concentrating;

and sometimes changes involving blood pressure or heart function.

Some of these changes may contribute to feeling weak or lightheaded.

But dizziness is not specific enough to conclude:

“My thyroid levels must be wrong.”

The same symptom can occur for reasons that have nothing to do with your thyroid.

What if your thyroid levels are normal?

If your TSH and FT4 are appropriate but you continue to experience dizziness, it is important not to automatically assume that Hashimoto's is responsible.

There are many other possible explanations.

Depending on the type of dizziness and your other symptoms, a healthcare professional may consider possibilities such as:

low blood pressure;

anaemia or iron deficiency;

vitamin B12 deficiency;

dehydration;

medication side effects;

inner-ear or balance disorders;

heart rhythm problems;

blood sugar problems;

migraine;

infections;

or other medical conditions.

This does not mean that you necessarily have any of these conditions.

It simply shows why there is no single Hashimoto's explanation for dizziness.

Dizziness when you stand up

Do you mainly become dizzy when you get up from bed or stand up from a chair?

That is useful information to mention specifically.

In some people, blood pressure temporarily falls when they stand. This is known as orthostatic or postural hypotension.

You may notice:

your vision going dark;

feeling lightheaded;

needing to stand still for a moment before moving;

or feeling as though you may faint.

Dehydration, certain medications and various medical conditions can contribute.

If rapid changes in position trigger symptoms, standing up more gradually may help.

If it happens regularly or you actually faint, discuss it with your healthcare professional.

Could iron deficiency play a role?

Yes.

Iron deficiency and anaemia can cause symptoms such as:

fatigue;

weakness;

shortness of breath during activity;

palpitations;

headaches;

and dizziness.

This may be particularly relevant if you have heavy menstrual bleeding or another reason to be at increased risk of iron deficiency.

But do not take long-term iron supplements simply because you feel dizzy.

Blood tests can help determine whether a deficiency is actually present.

If you take both levothyroxine and iron supplements, timing also matters because iron can reduce levothyroxine absorption when they are taken too close together.

Can vitamin B12 deficiency cause dizziness?

Vitamin B12 deficiency can also cause a range of neurological and general symptoms.

These can include:

fatigue;

weakness;

tingling;

changes in sensation;

balance problems;

and cognitive symptoms.

Hashimoto's can also occur alongside other autoimmune conditions, including autoimmune gastritis and pernicious anaemia, which can affect vitamin B12 absorption.

That does not mean everyone with Hashimoto's needs to take vitamin B12.

But when symptoms and risk factors fit, it may be worth discussing testing with your healthcare professional.

What about dehydration?

This is an easy cause to overlook.

If you do not drink enough or lose a lot of fluid, you may feel weak or lightheaded.

This can happen during:

hot weather;

fever;

vomiting or diarrhoea;

heavy sweating;

or simply not drinking enough.

Busy days can also make it easy to postpone eating and drinking until you suddenly feel unwell.

That does not necessarily make it a Hashimoto's symptom.

Regular meals and adequate fluids are therefore simple factors to consider when trying to understand when your dizziness occurs.

Can levothyroxine cause dizziness?

If you take levothyroxine and develop new symptoms, it is understandable to wonder whether your medication is responsible.

Levothyroxine replaces thyroid hormone that your body does not produce in sufficient amounts.

If the dose is too high, symptoms associated with excess thyroid hormone can occur.

These may include:

palpitations;

a fast heart rate;

tremor;

sweating;

restlessness;

and difficulty sleeping.

Some people may also feel lightheaded or dizzy.

But dizziness alone cannot tell you whether your dose is too high or too low.

Your symptoms, TSH and FT4 results and individual circumstances all matter.

Do not change your levothyroxine dose yourself because of dizziness.

Discuss new or persistent symptoms with your healthcare professional.

What if the room is spinning?

A clear spinning sensation is often described as vertigo.

It may feel as though:

the room is spinning;

you are moving even though you are still;

or your balance suddenly disappears.

This type of dizziness often has different possible causes from feeling lightheaded when you stand up.

Problems involving the inner ear and balance system are well-known causes of vertigo.

For that reason, new or recurrent spinning sensations should not automatically be attributed to Hashimoto's.

Describe as precisely as possible what you feel and when it occurs.

Can stress cause dizziness?

Stress and anxiety can produce physical symptoms.

During periods of tension, you may breathe differently or more quickly, develop muscle tension, experience palpitations or feel lightheaded.

But again:

do not automatically assume that new, severe or recurrent dizziness is caused by stress.

Immediately deciding that “it must be stress” can mean another cause is overlooked.

If other causes have been assessed and you notice a clear connection with anxiety or stressful situations, stress may of course be part of the overall picture.

What can you track yourself?

Because dizziness can mean so many different things, keeping a small record can be useful.

For example, note:

what the dizziness feels like;

when it happens;

how long it lasts;

whether it occurs when standing up;

whether you have recently eaten;

whether you have had enough fluids;

which medications and supplements you use;

whether you experience palpitations;

whether you have a headache;

and whether other symptoms occur at the same time.

You do not need to monitor every symptom all day.

A few concrete details can help reveal a pattern and make it easier to explain the problem to your healthcare professional.

When should you contact a healthcare professional?

Recurrent, unexplained or worsening dizziness deserves medical assessment.

You should also seek medical advice if you actually faint or if dizziness occurs together with other concerning symptoms.

Sudden severe dizziness accompanied by symptoms such as:

difficulty speaking;

facial drooping;

weakness or numbness on one side;

sudden severe problems walking or coordinating movements;

a new and very severe headache;

chest pain;

severe shortness of breath;

or loss of consciousness

requires urgent medical assessment.

Do not wait because you assume it is probably related to Hashimoto's.

What should you remember?

Dizziness can occur when you have Hashimoto's, but Hashimoto's is not automatically the cause.

The type of dizziness makes a major difference.

A spinning room is different from becoming lightheaded when you stand.

And feeling unsteady may mean something different again.

For someone with Hashimoto's, thyroid levels may be part of the assessment, but sometimes the explanation lies elsewhere.

Possibilities can include:

blood pressure;

iron deficiency or anaemia;

vitamin B12 deficiency;

dehydration;

medication;

the inner ear and balance system;

or another medical condition.

If dizziness keeps returning, try not to guess which Hashimoto's mechanism might be responsible.

Describe as clearly as possible what you feel, when it happens and which other symptoms occur with it.

That gives your healthcare professional much more useful information for finding the cause.