Published October 31 2016
Although experiencing dizziness and lightheadedness isn’t considered to be a classic symptom of either hypothyroidism or hyperthyroidism, it’s common for people with these conditions to have these symptoms. In some cases the symptoms are mild, but in other cases they can be severe, and even debilitating. And so I thought it would be beneficial to discuss some of the common factors which can cause dizziness and/or lightheadedness in people with hypothyroidism/Hashimoto’s and those with hyperthyroidism/Graves’ Disease. Keep in mind that these causes aren’t necessarily listed in any specific order.
Cause #1: Food Allergies. Having food allergies or sensitivities can lead to dizziness and/or lightheadedness. Of course not everyone who has a food allergy or food sensitivity experiences dizziness or lightheadedness, but it’s still something to look into. Elevated histamine levels might be responsible for the symptoms, and as a result, sometimes antihistamines are used (1) (2).
Treatment options: If you suspect a possible food allergy or sensitivity, one of the first things you can do is to try following an elimination diet and see if this helps. Just keep in mind that it’s possible to have a food sensitivity to the “allowed” foods on an elimination diet, and if this happens to be the case then it can be challenging to determine what food you’re sensitive to. For example, while most people do fine eating broccoli, over the years I have had a few patients who were sensitive to broccoli. The point I’m trying to make here is if you are experiencing dizziness and/or lightheadedness, and if there is a food you eat on a regular basis, even if it’s a healthy food, it might be a good idea to take a break from that food. If histamine is an issue then you can not only try to minimize the consumption of foods that are higher in histamine, but you can also take something such as quercetin, which can stabilize mast cells and prevent the release of histamine. Another option is to take diamine oxidase (DAO), which is the main enzyme that degrades histamine.
Cause #2: Benign paroxysmal positional vertigo. This is the most common cause of vertigo, and it most often occurs spontaneously in the 50 to 70-year age group (3). In younger individuals it is the commonest cause of vertigo following head injury (3). It is induced by a change in head position, and so the person might develop vertigo when getting out of bed or tilting their head back, and the person may experience postural instability, lightheadedness, and nausea (4). Many times this condition will self-resolve within a few days or a few weeks, although this isn’t always the case.
Treatment options: Something called the “canalith repositioning maneuver” (also known as the Epley maneuver) is commonly used to treat benign paroxysmal positional vertigo of the posterior and anterior semicircular canals (5). The “roll maneuver” is commonly used to treat benign paroxysmal positional vertigo of the horizontal canal (5).
Cause #3: Dehydration. Remember that our body is mostly made up of water, and so it’s important for you to keep well hydrated. While many of my patients do an excellent job of drinking water throughout the day, others don’t drink enough water. Other factors can also lead to dehydration, such as severe cases of diarrhea. And it doesn’t take severe dehydration to produce dizziness or lightheadedness. There are usually other symptoms present as well, such as a feeling of thirst, dry skin and mouth, constipation, muscle cramps, and sometimes headaches.
Treatment options: Of course the main goal should be to address the cause of the dehydration. If the person simply isn’t drinking enough water then they need to increase their fluid intake. If they have a condition such as chronic diarrhea then this obviously needs to be addressed.
Cause #4: Hypoglycemia. Hypoglycemia is a condition where the blood glucose levels are low, and this can lead to symptoms such as hunger, shakiness, dizziness or light-headedness, as well as numerous other symptoms. One study showed that 81.4% of patients with hypoglycemia experienced dizziness (6).
Treatment options: Hypoglycemia can be challenging to deal with at times. Although many times eating a healthy diet consisting of whole healthy foods while avoiding refined foods and sugars will greatly help, along with having regular meals, at other times this isn’t sufficient. I spoke more about hypoglycemia in this article.
Cause #5: Orthostatic (Postural) Hypotension. Orthostatic hypotension is diagnosed when a fall in systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing is recorded (7). A number of different factors can influence blood pressure regulation during orthostatic hypotension, including autonomic nervous system function, intravascular volume, duration of erect posture, time of day, postprandial state, and ambient temperature (7) (8). Dizziness is one of the main symptoms of orthostatic hypotension, along with syncope (a temporary loss of consciousness). A few different orthostatic stress tests are commonly used to diagnose this condition. Ragland’s test involves checking the blood pressure when the person is sitting down. Then the person stands up and their blood pressure is immediately checked again. As I described earlier, if the blood pressure taken while standing is the same or lower than the blood pressure in the sitting person, then this indicates orthostatic hypotension, and is typically caused by adrenal imbalances.
Treatment options: The goal of treating orthostatic hypotension is to try to increase the person’s blood pressure while standing, while not increasing their blood pressure while in a sitting or supine position. There is no medication that accomplishes this, as for example, if someone takes a vasoconstriction medication it will probably help to increase the person’s blood pressure while standing, but it also will increase the patient’s blood pressure when in other positions. There is evidence that the herb licorice might help with orthostatic hypertension (9), which makes sense since this can support the adrenals by raising cortisol levels, and I mentioned earlier how adrenal issues are usually a factor. And so I definitely would recommend ordering an adrenal saliva panel and addressing any imbalances that are found.
Cause #6: Inner ear problems/Labyrinthitis. Having inner ear problems can cause dizziness and/or lightheadedness. One example is labyrinthitis, which is an inflammatory condition of the inner ear. It is often preceded by an upper respiratory infection. This disorder occurs when infectious microorganisms or inflammatory mediators invade the membranous labyrinth, and it can cause damage to the vestibular and auditory end organs (10). With labyrinthitis, vertigo presents suddenly and can result in hearing loss (10).
Treatment options: Since labyrinthitis involves an infection of the inner ear, the goal of treatment is to eradicate the infection that is causing the condition. Conventional medicine usually tries to accomplish this by giving antibiotics. The problem is that infections of the inner ear can also be viral, and when this is the case, giving antibiotics won’t help. From a natural perspective you want to do things to improve the health of the immune system, and perhaps take some natural antimicrobials such as oregano oil, berberine, and garlic. Chiropractic care is also something to consider, as many times receiving chiropractic adjustments can help with inner ear problems.
Cause #7: Other infections. In addition to labyrinthitis, other types of infections can also result in dizziness or lightheadedness. We normally don’t think of infections causing neurological disturbances, and to be fair, most infections don’t cause these types of problems. But certain bacteria (11), viruses (12), parasites (13), and mold (14) can also lead to vertigo and other neurological symptoms.
Treatment options: Of course the main challenge with infections is determining what infection someone has. Unfortunately there isn’t a single test that detects all infections, and as a result, someone might need to do a combination of blood and stool tests, and even then the infection might not be detected. And sometimes specialty labs need to be considered, especially with regards to infections such as Lyme disease and mold toxicity. But the obvious goal should be to detect and then eradicate the infection. Sometimes conventional medical treatment such as antibiotics is necessary to accomplish this, although many times natural antimicrobials can be effective.
Cause #8: Medications. Certain medications can result in dizziness or lightheadedness. Some of the drugs which can lead to dizziness or lightheadedness include anti-convulsants, anti-hypertensives, antibiotics, anti-depressants, anti-psychotics, and anti-inflammatory drugs (15). With regards to thyroid health, thyroid hormone medication (i.e. levothyroxine, Armour, Nature-Throid) usually won’t cause dizziness. However, with regards to hyperthyroidism, sometimes antithyroid medication such as Methimazole will cause side effects such as dizziness or lightheadness. Beta blockers such as Propranolol can also cause dizziness in some people. When dizziness happens while taking beta blockers it usually is because the blood pressure is becoming too low.
Treatment options: If you suspect that any medication you’re taking is causing the dizziness and/or lightheadedness then I would run this by your medical doctor.
Cause #9: Vestibular Migraine. Vestibular migraines are characterized by attacks of spontaneous or positional vertigo lasting anywhere from a few seconds to a few days (16). Headaches are often absent during acute attacks, but other migrainous features such as photophobia or auras, may be present (17). Some of the triggers of vestibular migraines include stress, sleep deprivation, and hormonal changes (17). Vestibular migraines are more common in women, and the highest prevalence is in young adults and between the ages of 60 and 70 (17).
Treatment options: Conventional medical treatment usually involves giving antivertiginous and antiemetic drugs. Natural treatment methods can be effective at times, and following an elimination diet is probably a good place to start, as food sensitivities can be the culprit. Hormone imbalances are also something to look into. There is evidence that mitochondrial dysfunction can play a role in migraines (18) (19), and so this is also something to look into. Vestibular rehabilitation can also be beneficial in some people (20).
Cause #10: Ménière’s disease. This is a condition of the inner ear that results in severe dizziness, along with tinnitus (ringing in the ears). It can also result in hearing loss. Some people with Ménière’s disease will experience dizziness every now and then, while with others the dizziness will be more frequent.
Treatment options: Pharmacologic treatments include diuretics, migraine prophylactic medications, histamine analogs, and oral steroids (21). With regards to alternative treatments, sometimes dietary changes alone can help greatly. A few studies show that acupuncture can be an effective treatment option in some people with Ménière’s disease (22) (23). I came across one study which showed that ginkgo can also be beneficial in some individuals (24). Using ginkgo is interesting, as some treat Ménière’s disease as a cerebrovascular condition, which explains why ginkgo might be effective, as ginkgo can increase the cerebral blood flow. Other herbs and nutrients which might be beneficial include hawthorn, magnesium, and even garlic.
In summary, many people with thyroid and autoimmune thyroid conditions experience dizziness and lightheadedness. Some of the potential causes of dizziness and/or lightheadedness include food allergies, benign paroxysmal positional vertigo, dehydration, hypoglycemia, orthostatic hypotension, inner ear problems, infections, certain medications, vestibular migraines, and Meniere’s disease. In most of these cases there are natural treatment options that can be effective, although some cases of dizziness and lightheadedness can be very challenging to treat.