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To understand how hypoglycemia and hypothyroidism can be related, it helps to first look at each condition on its own. Both involve hormones and metabolism, and both affect how the body produces and uses energy. When either system is out of balance, symptoms can overlap and reinforce one another.

What Is Hypothyroidism?

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones to meet the body’s needs. These hormones play a key role in regulating metabolism, heart rate, body temperature, digestion, and energy production. When thyroid hormone levels are low, many of the body’s processes begin to slow down.

Common signs of hypothyroidism include fatigue, weight gain, cold intolerance, constipation, dry skin, hair thinning, depression, and brain fog. Some people may also experience menstrual irregularities, fertility challenges, or elevated cholesterol levels.

At a baseline level, hypothyroidism is caused by anything that interferes with the thyroid’s ability to produce hormones or the body’s ability to use them effectively. Common causes include:

• Autoimmune conditions, such as Hashimoto’s thyroiditis
• Nutrient deficiencies, including iodine, selenium, and zinc
• Chronic stress, which can disrupt hormone signaling
• Thyroid surgery or radiation
• Certain medications that affect thyroid hormone production or conversion



Because thyroid hormones regulate the release and utilization of glucose in the body, reduced thyroid function may predispose individuals to blood sugar instability.

What Is Hypoglycemia?

Hypoglycemia refers to a state in which blood sugar levels drop below what the body needs for steady energy, particularly for the brain. Glucose is the body’s primary fuel source, and when levels fall too low, symptoms can appear quickly.

Common symptoms of hypoglycemia include shakiness, sweating, dizziness, irritability, anxiety, hunger, headaches, and difficulty concentrating. In more severe cases, it can cause confusion, weakness, or fainting.

Hypoglycemia can develop for several reasons, including:

• Skipping meals or eating too little, especially carbohydrates
• Blood sugar imbalances, such as insulin resistance, followed by sharp drops
• Diabetes medications or insulin use
• Chronic stress, which affects cortisol and glucose regulation
• Impaired liver function, reducing glucose release between meals

When the body struggles to maintain stable blood sugar, it often signals a deeper imbalance in hormonal regulation, one that can overlap with thyroid dysfunction.

Together, these foundations make it easier to see how hypoglycemia and hypothyroidism may intersect, especially when hormonal signaling and metabolic processes are not working in harmony.

Hypothyroidism and hypoglycemia are related, but not in a direct cause-and-effect way. Hypothyroidism does not usually cause severe hypoglycemia on its own. However, low thyroid hormone levels can predispose the body to lower-than-normal blood sugar by slowing key metabolic processes. 

When thyroid function is reduced, the liver produces and releases glucose more slowly, insulin stays active in the bloodstream longer, and overall energy demand decreases. Together, these changes can make blood sugar less stable and increase the likelihood of hypoglycemic episodes, especially in people who already have blood sugar regulation challenges.

At the same time, it’s important to understand that hypoglycemia does not directly cause hypothyroidism. Low blood sugar episodes may trigger stress hormone release and temporary metabolic shifts, but they do not impair the thyroid gland’s ability to produce hormones or cause thyroid disease. Hypothyroidism is most often driven by autoimmune activity, nutrient deficiencies, medical treatments, or structural issues affecting the thyroid itself.



In short, hypothyroidism can indirectly contribute to hypoglycemia through its effects on metabolism and glucose regulation, while hypoglycemia is typically a symptom of blood sugar imbalance rather than a cause of thyroid dysfunction.

How Hypothyroidism Can Lead to Hypoglycemia

While most people associate hypoglycemia with diabetes or high insulin states, it’s important to recognize that thyroid function also plays a key role in blood sugar regulation. Interestingly, just as there is a recognized phenomenon of hypoglycemia in hyperthyroidism, thyroid hormone imbalances in the opposite direction  (hypothyroidism) can also subtly influence glucose levels.

When thyroid hormone levels are low, several metabolic processes slow down, including glucose production and insulin clearance. These changes don’t usually cause severe hypoglycemia, but they can make the body more prone to mild dips in blood sugar, particularly during fasting, prolonged physical activity, or other periods of metabolic stress.



The combination of slower liver glucose output, reduced insulin breakdown, and decreased cellular energy demand creates a perfect environment for blood sugar to fall more easily than usual. The following sections break down these mechanisms in more detail, showing exactly how hypothyroidism can contribute to hypoglycemia risk.

Slower Gluconeogenesis

One key way hypothyroidism can contribute to hypoglycemia is through slower gluconeogenesis. Gluconeogenesis is the process by which the liver produces glucose from non-carbohydrate sources, such as amino acids, lactate, and glycerol. This mechanism is especially important during fasting or between meals, when the body relies on internally generated glucose to maintain steady blood sugar levels.

When thyroid hormone levels are low, the liver’s metabolic activity slows down. This means it produces less glucose from these non-carbohydrate sources, reducing the body’s ability to maintain normal blood sugar during periods without food. Over time, this slower glucose production can make someone more prone to mild hypoglycemia, particularly if combined with other factors like long fasting, stress, or additional metabolic challenges.

Reduced Glycogenolysis

Another way hypothyroidism can contribute to hypoglycemia is by reducing glycogenolysis, the process by which the liver breaks down stored glycogen into glucose. Thyroid hormones help regulate enzymes that control glycogen breakdown, so when hormone levels are low, the liver becomes less efficient at releasing glucose from its glycogen stores.



This means that during fasting, exercise, or other periods of increased energy demand, the body has a smaller glucose “reserve” to draw from, making blood sugar more likely to drop and increasing the risk of mild hypoglycemia.

Slower Insulin Clearance

Hypothyroidism can also contribute to hypoglycemia through slower insulin clearance. The liver normally helps break down insulin after it has done its job regulating blood sugar. When thyroid hormone levels are low, liver metabolism slows, and insulin remains in the bloodstream longer than usual.

This prolonged presence of insulin can slightly lower blood sugar by continuing to promote glucose uptake into cells, even when it’s not needed. Over time, this mechanism makes the body more prone to mild hypoglycemia, particularly during fasting or periods of metabolic stress.

Impact on Cortisol and Epinephrine

Thyroid hormones help regulate the body’s stress response, including the production and effectiveness of cortisol and epinephrine, two hormones that normally raise blood sugar during fasting or stress. In severe hypothyroidism, this hormonal response can be blunted, meaning the body doesn’t release or respond to these stress hormones as efficiently.

As a result, when glucose levels begin to drop, the usual “emergency” signals that prompt the liver to release more glucose or the body to mobilize energy are weaker. This impaired response can make individuals with hypothyroidism more susceptible to hypoglycemia during prolonged fasting, illness, or other metabolic stressors.

Hypoglycemia in people without diabetes is possible but rare because the body has strong counter‑regulatory systems to keep blood sugar stable. Hormonal defenses like glucagon, cortisol, and catecholamines usually prevent blood glucose from falling too low in non‑diabetic individuals.

However, when other health conditions are present, these safeguards can be weakened. Endocrine disorders, such as adrenal insufficiency, can blunt the body’s stress hormone responses that normally raise blood sugar during fasting or stress, increasing the risk of hypoglycemia. In adrenal insufficiency, cortisol deficiency interferes with glucose regulation, making low blood sugar more likely during illness or stress.

Hypothyroidism itself most often causes mild hypoglycemia rather than the severe episodes seen in diabetes. It becomes more likely when hypothyroidism is severe or untreated and is compounded by other hormone deficiencies or metabolic stress.

As a result, people who are on diabetes medications (especially insulin and insulin‑secretagogues) and also have hypothyroidism may be more prone to hypoglycemia, because slower metabolism can prolong the action of glucose‑lowering drugs and reduce the body’s ability to correct falling blood sugar levels on its own.

In these overlapping scenarios, a thorough evaluation of all contributing conditions helps ensure accurate diagnosis and effective management.

Hypoglycemia and hypothyroidism can share several symptoms, which sometimes makes it difficult to determine the underlying cause. Because both conditions affect energy production, metabolism, and the nervous system, their effects on the body can feel very similar. This overlap may lead to misdiagnosis or delayed recognition of one or both conditions.

Common overlapping symptoms include:

• Fatigue and weakness
• Brain fog or difficulty concentrating
• Dizziness or lightheadedness
• Cold intolerance
• Irritability or mood changes
• Slow reflexes or reaction times



Recognizing the shared signs of these conditions is important for accurate evaluation and treatment, especially for individuals experiencing persistent or unexplained symptoms.

Levothyroxine, the most commonly prescribed medication for hypothyroidism, replaces the missing thyroid hormone (T4) to help restore normal metabolism. In most people, levothyroxine actually supports healthier blood sugar regulation by normalizing metabolic processes. That said, some research suggests that in specific situations — especially when the liver is already compromised — levothyroxine may be associated with an increased risk of hypoglycemia.

A hospital‑based case‑control study found that levothyroxine use was linked to a higher risk of hypoglycemia in patients with liver impairment, compared with those not taking the drug or those with normal liver function. The risk was especially pronounced in individuals with reduced liver reserve, suggesting the interaction between thyroid hormone therapy and hepatic glucose regulation may be altered when the liver is not functioning optimally.

The liver plays a central role in glucose production and hormone metabolism, so when it’s impaired, both glucose homeostasis and hormone clearance can be disrupted. In such cases, levothyroxine might unmask or contribute to low blood sugar episodes because the liver’s ability to generate and release glucose is already weakened.

It’s important to note that this observation doesn’t mean levothyroxine directly causes hypoglycemia in most people; it’s a potential effect seen in the context of existing liver issues and is not a common reaction for people with normal hepatic function. Regular monitoring and communication with a clinician can help ensure that thyroid medication dosing supports overall metabolic balance.



Separately, many diabetes medications, especially insulin and certain insulin‑secretagogues (like sulfonylureas), can directly cause hypoglycemia if doses are too high relative to food intake, activity level, or changes in glucose utilization. These drugs lower blood sugar by increasing insulin levels or insulin action, so without careful balance with meals and metabolism, blood glucose can drop too low. 

Hypoglycemia treatment focuses on raising blood sugar quickly and preventing future episodes. The approach depends on severity:

1.Immediate treatment (for mild to moderate hypoglycemia):

• Consuming fast-acting carbohydrates such as fruit juice, glucose tablets, or regular soda
• Following the “15-15 rule”: 15 grams of carbs, wait 15 minutes, then recheck blood sugar

2. Medical intervention (for severe hypoglycemia):

• Injectable glucagon for people unable to consume oral carbs
• Emergency care if unconscious or experiencing seizures

3. Long-term management:

• Adjusting medications, such as insulin or oral diabetes drugs, under medical supervision
• Regular monitoring of blood sugar levels
• Addressing underlying conditions, including thyroid dysfunction

4. Nutrition-based treatment (holistic approach):

• Eating balanced meals with complex carbohydrates, protein, and healthy fats to stabilize blood sugar
• Avoiding long gaps between meals and incorporating snacks if needed
• Supporting liver and thyroid health with nutrient-rich foods (e.g., lean proteins, whole grains, vegetables, iodine- and selenium-rich foods)

By combining immediate interventions with long-term nutritional strategies, hypoglycemia can be managed effectively while supporting overall metabolic health.

Managing hypoglycemia alongside hypothyroidism doesn’t have to feel complicated. At HealthierU, we focus on practical, nutrition-based strategies that stabilize blood sugar, support thyroid function, and keep your energy consistent throughout the day.

By incorporating balanced meals, nutrient-dense foods, and thoughtful meal timing, you can help prevent dips in blood sugar while supporting your body’s natural hormonal balance. Our approach combines science-backed guidance with a holistic, personalized touch, making it easier to feel energized, focused, and in control of your health.



Whether you’re navigating fatigue, brain fog, or fluctuating energy levels, HealthierU is here to simplify nutritional support for both your thyroid and blood sugar so you can thrive, not just survive.