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If you have a thyroid issue, like an underactive thyroid (hypothyroidism), in addition to feeling tired, you might also feel like your skin is really dry and you’re constipated a lot, along with the lack of energy, says Dr. Shah. Hypothyroidism is a condition that occurs when your thyroid gland doesn’t produce enough of certain important hormones. While women are more likely to have hypothyroidism, thyroid function tests can diagnose hypothyroidism easily and if you have an issue, your doctor may prescribe a synthetic thyroid hormone. Here are other surprising signs of a thyroid problem.

When you have high blood glucose, your blood circulation may be impaired so cells can’t get the oxygen and nutrients they need and you feel tired, according to registered nurse blogger David Spero on Diabetes Self-Management.com. Low blood sugars levels also result in feeling fatigued, because there is not enough fuel for the cells to work well, he says on the blog. If your high glucose is causing blood vessels to get inflamed by sugar, that chronic inflammation can also make you feel fatigued, according to research. Here are other silent symptoms of diabetes you might be missing.

If you feel like you’re tired all the time, don’t want to get out of bed in the morning, and/or have trouble sleeping, you could be suffering from depression. Here are other hidden signs of depression. You primary care physician should do a depression screening during a regular visit, says Dr. Shah. Your doctor can use a screening tool to determine if you’re experiencing an ongoing depressive disorder, or whether a life stressor or alcohol affects your emotional state. “Depression, alcohol abuse, and fatigue are very tightly knit,” says Dr. Shah. Sometimes people will treat depression with alcohol and then be tired, she says.

Your gut is supposed to be a very tight tube of cells where nothing from inside of the gut gets into the outside—like a pathway where the body absorbs what it needs without having things enter the rest of the body, says Dr. Shah. “If you’re eating poorly, especially a lot of processed foods, the gut cells can become a looser, net-like structure instead of a tight structure, and proteins that aren’t supposed to be in our bloodstream leak into our bloodstream, which creates an inflammatory response,” says Dr. Shah. The inflammatory response can manifest as bloating, fatigue, moodiness, headaches, or weight gain. If you have food sensitivities (to foods like wheat and dairy) you can feel fatigued, get rashes, and experience bloating or brain fog. “There’s no real good test for food sensitivities,” says Dr. Shah. Following an elimination diet of possible food culprits and then slowly introducing them back in may help you identify what you’re sensitive to. If you remove all wheat from your diet and feel great, and then add it back and feel lethargic, that could be a telltale sign of a food sensitivity to wheat, Dr. Shah says.