Hello folks,
I read a couple of older threads in this group about people feeling better in the evening after having a lot of fatigue during the day - feeling normal or even energetic.
Is this a common theme for thyroid problems?
(Reason for asking: have been suffering unexplained daytime fatigue that resolves later on. Also have had slightly low thyroid blood test.)
More likely to be an adrenal problem than a thyroid problem. If your adrenals are struggling - due to long-term undiagnosed/under-medicated hypothyroidism - the cortisol will be low in the morning (when it needs to be high) and high in the evening (when it needs to be low). So, that would affect energy levels throughout the day, cause sleeping problems which makes energy problems worse.
Thank you for the suggestions. Have had cortisol testing and it all came back normal.
I had just noticed a few threads here in which people describe a pattern of feeling fatigue during the day that resolves in the evening, when they feel normal. (Not only on this board, but on dysautonomia and CFS forums too.)
Am trying to find out what the pattern could be. Of course there are so many things that cycle in the body and I am not a scientist ...
My doctor thinks the thyroid result could be from being run down, as it has always been normal in the past. I am very run down at the moment so we will see what happens at re-test in 8 weeks.
There's no such thing as 'normal' where blood test results are concerned. When a doctor says 'normal', he just means 'in-range'. But the ranges are so wide most of the time, that it's where the results fall within the range that counts. I would suggest you post your cortisol test results on here and let people have a look.
Was it a 24 hour saliva cortisol test you had?
Fair enough. I should have said "unremarkable".
Tested twice in a blood test (one fasting in the morning, one non-fasting later in day)
Once in a single saliva test (at midnight)
Over several hours in a synacthen/ACTH test
Each time I was told it was in range.
I only have one result handy:
Serum cortisol, fasting, 8.30 am: 545 nmol/L (ref. range 145–619)
The only symptom I have that corresponds to low cortisol is fatigue (and maybe irritability).
Serum cortisol testing is not reliable. Although that result doesn't look too bad, it could be higher. When did you have that done?
Yes, a doctor would just tell you it was in-range so it has to be good. They don't know any better.
A synacthen/ACTH test tells you nothing about andrenal fatigue. It's all about black and white. Adrenal Fatigue is about shades of grey. But doctors tend not to believe it exists.
Once in a single saliva test (at midnight)
So, you're in the US? I've heard about this single saliva test at midnight. And, I just can't see how that is relevant. It doesn't tell you what is happening in the rest of the 24 hours. In the UK, there is a 24 hour test, where you take samples of saliva four times throughout the day. Which gives you a much better idea of how the adrenals are performing.
Being tired in the morning and more active later in the day is not a hypothyroid symptom as far as I know - I've never seen it mentioned on any symptom list. It is, however, an adrenal fatigue symptom. Adrenal Fatigue and hypothyroidism go hand in hand, so not surprising that a lot of hypos mention it. 
POTS can be caused by hypothyroid especially Hashimoto’s
myheart.net/pots-syndrome/c...
Hypothyroidism/Hashimoto’s frequently upsets adrenals
Please add actual thyroid results and ranges
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Low vitamin levels common as we get older too
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Thank you for the comprehensive reply. I have only had a simple test at this stage:
Free T4: 12.7 pmol/L (ref. range (10–23)
TSH: 6.05 mIU/L (ref. range 0.5–4)
Test was done at 9am, fasting.
My doctor wants to retest in 8 weeks. I am very run down at the moment (due to the fatigue). Even though I feel better every night at about 9 or 10pm, feeling exhausted all day is taking its toll on me.
The only other finding was low vitamin D, which I am addressing with a supplement. I realise that could be a symptom of Hashimoto's, but it can be explained by the fact that it's winter here and I have barely left the house recently due to feeling so unwell during the day.
I don't have any other symptoms of Hashimoto's, only fatigue. I'm investigating dysautonomia (similar to POTS), so that was a good suggestion!
Thank you again.
Sarah (in Australia)
I would almost be relieved if the cause of my fatigue turns out to be thyroid in origin because I have an excellent endocrinologist who treats me for another endocrine disorder (mild and controlled with medication and probably unconnected).
I've been suffering with this fatigue for 17 years. At first, it was very minor, and I don't think I even mentioned it to anyone for the first five years because it only affected me for an hour or so in the morning. Then it started to extend further and further into the day. I started asking doctors about it and a decade went by with no help.
Finally it got to the point when the fatigue was lasting almost all day, from breakfast until 10 or 11pm. It's hard to fit your life into a couple of hours before bed.
So the last two years I have been pursuing this the best I can, with very little result. I have had to constantly ask for tests and suggest diagnoses, against my better judgement because I have no medical training.
I managed to get referred to a dysautonomia specialist, who is good, but I can only have phone consultations and he cannot order any testing. None of the many interventions and two drugs that usually help have done anything and I am starting to question the diagnosis (which was basically made by me putting together a convincing narrative).
Anyway, just needed to get that all off my chest!
Thank you to the people on this forum and the others I have visited for their kindness and sharing of info with those of us who are searching for a diagnosis or are diagnosed but not getting the best advice.
I think I am turning into a bat. I am a slug all day, but come around 5 o'clock in the afternoon, I suddenly have energy and can do "stuff" and flit about. I was laying tiles last night at 1 o'clock!
I only have one adrenal gland, and sometimes it fires off and I have to walk it off as the fight or flight is so strong. No one has ever tested my levels of that. Maybe I should wait until I get a surge and then see the GP - that would frighten them!
It is a strange feeling, isn't it? I sometimes call it Jekyll & Hyde Syndrome because I am two different people: one is exhausted and sits on the couch thinking "Oh god I feel tired". The other one is full of energy, cleaning the house and doing aerobics at midnight!
I dare say your doctor would be surprised if you turned up at 1am covered in grout and asking for a blood test
On a serious note ... it is really annoying that testing is only available 9 to 5. I feel sure there are cases like ours in which something useful could come from being tested at different times of the day because of symptoms coming and going.
I am just trying to get grout out of one eyebrow and the butter dish. Dont ask...
I hope the "batteries out" feeling shortens for you soon.
I had to post one more time ... I was up at 2am last night doing aerobics! I got up to go to the loo, then when I lay down to go back to sleep, I started to feel well again, and my batteries were back in!
It was a pleasant feeling, not like a panic attack or adrenaline rush. I exercised, sat for an hour afterwards knitting, then yawned and felt pleasantly tired, drifted off to sleep and slept really well for 7 hours.
Hi, here's a perspective: maybe you are simply a nightperson? There are a lot around the world and I'm one myself. I also know quite some "late starters". I don't think it's strange at all to feel fatigue or no energy during the morning/day and later on you "suddenly can do things". Society is based on a situation not per se applicable anymore. It's not a necessity to "hunt during the day" or "do things during daylight". Your biological rythm can differ from this. Forcing an early day rythm (as society mostly does with work and school) can be devastating for people with other biological rythms on the long run.
Regarding something which is "simply" different from the norm as a problem, can also feed this "problem". Which then becomes a bigger (real) problem and can even get out of hand.
I found out myself after chronic latecoming and tiredness in the morning which simply wouldn't change no matter what ("you just need to get used to things" really doesn't apply), that by rearanging my schoolhours which I luckily could at the university within boundaries and later on only applying for work which starts later, it would greatly effect my total energylevels. This was because I could sleep at the hours my body most desires and needs to. The great test came when I applied for an early morning job again.. it failed as quite expected. But I had at least clear proof for myself (and I guess others) I'm really NOT a 8/9 to 5 person, after trying really hard. Colleagues could also see it for example with just half an hour difference. At some point I managed to get exampted from starting the earliest shift as the only one. They really saw it didn't work for me and it would be better for all to let it be, because I would perform better.
Probably you have (had) more going on in your life influencing your sleepinghabits and tiredness and now got out of hand. But your story at least reads to me as you got stuck into a downward spiral. Maybe you find some recognition in my story?
Maybe an idea to firstly not see your high energylevels later the day as a problem, but as a pointer. You ARE capable, even now, of having high energy. Just at an other time. You know for example someone in bed stressing they can't fall asleep... makes that person not fall asleep even more. Relaxe and at least some of the stress evaporates. Maybe starting to be more accepting of your different rythms, may release some energy.. which can be used to stretch these few hours you now have.
Long reply, just sharing an other perspective.
Yes, I have seen people propose this. And I am an owl chronotype.
However, when it first showed itself, my fatigue problem started around 8am and resolved around 10am, so it doesn't seem to be connected to my chronotype. Also, at that time, I slept well and was completely healthy for the rest of the day.
On other forums, people who have the same daily fatigue pattern as me have commented that they are owl, lark, or mid-range chronotypes. There doesn't seem to be a link.
So it doesn't look like chronotype is the answer, unfortunately. I appreciate the suggestion though!
Because my symptoms nowadays run from about 9am to 9pm, I have thought of going on a self-imposed "night shift", and sleeping during the day. However, I am concerned that it would be too isolating.
The way I perceived it concerned more the earlier state of your being. So I thought (maybe didn't explain well enough), you could maybe resonate my story with a period in your life when you were still working etc. So in an earlier state. I could imagine how dragged out I would be now, if I for some reason had to continue this "early day life".
Maybe it's something else in your case but seeing you also admit being an night owl, I guess it might still be part of how it started to go bad. When you only had it early morning, were you working or going to school early? Did you experience before that (also) more effort in waking up and such, then the people of your age or you were surrounded with?
Well, the same kind of fatigue problems can come from different types in my opinion. At some point it just becomes tiredness. But if a lark gets this tired during the day like you and active at night, I would say there's an other problem or the person's biological rythm changed for some reason.
But you have it quite severe so it might be complex, but I just thought to still share my thoughts, because you explained tests comming out "normal". I also believe going against somebody's biological rythm too much, could (in some cases) really make it this bad in the end. Getting a person dysfunctional at some point.
An interesting thing to try out, to throw your rythm around and see what happens. This is far from medical advice: but if you have the space to do so (you don't work right?) and are in this for a long time already and feel your body wants this. Why not? It's kind of happening already right? Or do you still force yourself with for example pills to sleep at a bit "normal" times or force yourself to stay awake during the day?
It all depends, but it doesn't have to be a total change. You could also just try to let go for a bit and maybe it will turn around again by itself after a day or few. For example if you indeed force yourself to stay awake and fall asleep at night with pills. Just fall asleep when your body feels tired enough, stand up when you feel energetic enough, do your stuff, even if it's night and so on. At some point your body might catch up and you get into a more normalized rythm. It doesn't have to be a whole dailylife change for the next 3 months purely living at night and missing out on daily contact and activities.
I'm making this long because I'm trying to be carefull with what I say. I don't know you and your rythm well enough. For some people this might work against it.
Well to add a personal touch: I have periods of sleeptimes. Periods when I sleep a strict amount of hours, no matter if I go to bed early or late. An other period I sleep after 3 a.m., an other period I sleep for some weird reason around 11 or 12pm. (I say weird, because for me that is), and so on. For as far as I can, depending on if I have work and what the hours or days are, I let it be. I'm not the kind of person who does things or needs things the same way my whole life. But you have people who are like that.
Ramble... just some food for thought and seeing you are already thinking of changing your rythm, it's good to elaborate about it I guess? Sorry if it's too long or too much.
Here's a more scientific appraoch:
"Why we sleep" written by Matthew Walker. Copy paste: "The first sleep book by a leading scientific expert—Professor Matthew Walker, Director of UC Berkeleys Sleep and Neuroimaging Lab—reveals his groundbreaking exploration of sleep, explaining how we can harness its transformative power to change our lives for the better."
I have to point out the difference between:
a) having a certain chronotype, which means you feel more or less alert at certain times of the day, and that you would prefer to sleep and wake at certain times
b) crippling, medical-grade fatigue, which means you can barely move or do normal tasks.
Owl chronotypes feel less alert earlier in the day. They are not so ill that they can't work, have friends or pursue hobbies.
I was a happily functioning owl for 35 years. Now I am ill. There's a big difference between someone who feels a bit dull in the morning (old me) and someone who is too exhausted to grate cheese on their lunch (current me).
Hi yes, I understand what you are saying. I just meant that a happily functioning nightowl, in the continuous wrong environment, can change over time into a crippling person not able to lift a finger. This is one of the reasons I took this approach in replying to you, also because you or docters didn't find any cause right? If I read it right your blood samples weren't out of the ordinary. A lot of people underestimate how important sleep really is for good health. Some are more sensitive to it than others.
But I'm sorry if this rubs you the wrong way. I just want you to know that I understood in my replies that you have a severe condition right now. Sometimes these kind of things really can have "simple" causes. Doesn't have to be in your case, but who knows, just sharing perspectives.
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