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Suggested mechanisms for fatigue include imbalances in energy production caused by increased energy requirement (e.g., caused by tumor growth, infection, fever, or surgical procedures), reduced availability of substrates (e.g., due to anorexia, nausea, or vomiting), atypical generation of compounds that disrupt metabolic homeostasis or regular functions of muscles (e.g., cytokines and proteolysis inducers), anemia, and hypoxemia

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[72] As a best practice with all interventions used for Hashimotos, I recommend tracking symptoms, testing thyroid hormone levels, and testing thyroid antibodies after starting new therapies