Inclusion criteria:
Age range of 18 to 65 years.
Diagnosis of primary hypothyroidism confirmed by medical history, patient records, or specialist assessment.
Receiving standard levothyroxine therapy for at least 3 months prior to study enrollment.
Stable dosage of levothyroxine for at least 6 to 8 weeks prior to enrollment.
Documented euthyroid status with TSH levels within the normal range (0.35–3.5 mIU/L) in the past 3 months.
Fatigue Severity Scale (FSS) score ≥ 4 (indicating significant clinical fatigue).
Willingness and ability to attend scheduled treatment sessions and follow-up assessments.
Agreement to refrain from initiating any new complementary or alternative therapies related to fatigue or thyroid condition during the study period.
Ability to read, understand, and complete the Persian-language study questionnaires.
Provision of written informed consent to participate in the research.
Exclusion criteria:
Secondary or central hypothyroidism (due to pituitary or hypothalamic disease).
History of thyroid surgery due to thyroid cancer.
Pregnancy or lactation.
Severe acute or chronic medical conditions that could significantly affect fatigue levels or inflammatory markers, including: - Active systemic inflammatory diseases - Acute clinical infections - Clinically significant anemia - Active autoimmune disorders - Active malignancies - Severe cardiac, hepatic, or renal insufficiency - Uncontrolled psychiatric disorders (e.g., severe major depressive disorder or severe anxiety disorders) capable of causing significant fatigue.
Concurrent use of medications that significantly influence fatigue, systemic inflammation, or metabolic rate, such as: - Systemic corticosteroids - Immunosuppressive agents - Central Nervous System (CNS) stimulants - New or recently initiated antidepressant medications.
Any dosage adjustment of levothyroxine within the past 6 to 8 weeks prior to study enrollment.
Pregnancy occurring during the study or planning to become pregnant during the follow-up period (for female participants of childbearing potential).
Initiation of new medications affecting fatigue, inflammation, metabolism, or thyroid function (e.g., systemic corticosteroids, immunosuppressants, new antidepressants, weight-loss drugs, lipid-lowering agents, or drugs interfering with levothyroxine absorption/metabolism).
Failure to complete the primary study questionnaires or scheduled laboratory evaluations at the designated time points.
Serious protocol violation or persistent non-cooperation by the patient, at the discretion of the principal investigator.