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Thyroid UK
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The morning fatigue

We I'm always fatigued in the morning? IS it normal that Hypothyroid patients to be more fatigued in the morning? My cortisol is always normal and also thyroid, no matter where is my T4/T3 level (I tried increasing it; so that is not the answer). Could it be something related to T4 conversion?

I have central hypothyroid where my pituitary cannot makes TSH ( always around 0.1)

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We would have to see the numbers to be able to answer any of your questions : results and ranges, doses and dates. No point in just trying to guess.


My TSH is always low last result is 0.017 (.46-4.68)

My T4 is 18.7 (10-28). (I did before attempted to increase it to 25 but no improvements in symptoms)

My T3 is not tested anymore but from history it is always positively correlated to T4.

These were done two months ago.


In other words, you're saying you don't have a conversion problem?

But, you don't say what you're taking. There is room for an increase in dose, there. Your FT4 isn't even mid-range.

What about your cortisol results? How many hours do you sleep?


Yes. Sorry I take 100 mcg of levothyroxine. As I mentioned, I attempted to increase T4 up to 25 and without any benefits.

Regarding sleep. My sleep is interrupted every night by adrenaline surge that wakes me up after 5hrs of sleep. I cannot go back to sleep and feel fatigued all morning until noon when I can relax or nap.


Just because you don't get any benefit from increasing your levo, doesn't mean that you should reduce it again. It just means you take the extra for six weeks, retest and probably increase again. It's a long slow process to build up to the right dose.

Adrenaline is not cortisol. We were talking about cortisol - you said your cortisol is normal, so I presumed you'd had it tested. If so, what are your results?

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I agree adrenaline that wakes me up in the early morning and makes my heart pound and prevent me from going back to sleep is not cortisol (:

I took the extra dose 150 mcg in several weeks to rise my T4 level to 25. My doctor asked me to reduce back to 100 mcg and keep my T4 where it is. I will consider your advice for 6 weeks on higher T4 ..

Cortisol tests:

Cortisol free urine: 165+ ug/24h (normal 36-137).

The below tests done in one day different than the above:

Cortisol AM (serum): 358 nmol/l (normal 123-626)

Cortisol PM (serum): 40.3 nmol/l (normal 46-389)


I'm not familiar with urine tests, but yours is way over-range. I don't call that normal.

Your am serum cortisol is rather low, but your pm serum cortisol is very low! I don't call any of that 'normal'. And it could therefore very well be your cortisol levels that are making you tired in the morning.

But, what you really want is a 24 hours saliva cortisol test, to really know what's going on.

Even so, none of that detracts from the fact that you do need an increase in levo, and I can't understand why your doctor decreased it.


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