For years now I've been going to bed feeling reasonably content 90% of the time. However, almost every morning I feel dreadful. It can range from a heavy brain fog to extreme anxiety and suicidal thoughts.
I have asked psychiatrists (plural) and my endocrinologist for answers to this, but I've drawn a blank every time.
So I'm asking the people who may have experienced this phenomenum: you guys! Can anybody help me please?
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. I am hoping that at their present levels of 20mcg T3 and 200mcg Levo, we should hit optimum levels very soon.
This is quite a hefty dose....but we need what we need!!
(And that comes from someone who needs a supraphysiological dose of T3-only to function!)
When do you take your last thyroid hormone dose of the day?
Have you tested cortisol levels?
An example
medichecks.com/products/cor...
Symptoms of low levels of morning cortisol could include fatigue, muscle weakness, depression, loss of appetite, weight loss, low blood pressure, and abdominal pain. In severe cases, it may lead to low blood sugar (hypoglycemia), confusion, or even loss of consciousness.
Just a thought!
DD do you recall where you got this description of low cortisol? I ask because I have recently come to the conclusion that hypoglycaemia is a likely suspect for myself. I have not found this explanation anywhere.
Sorry! It was a paragraph that I c&p'd to notes ....stupidly forgetting to add the source. But, this might help
niddk.nih.gov/health-inform...
Thank you. My Cortisol results were: Blood 350. Saliva - see Screen Print. I have no saliva in the morning so the first two test were aided with by little water.
Is lack of morning saliva normal for you? Could be a red flag.
First 2 readings unreliable due to water taken.
Dehydration is a symptom of adrenal insufficiency ....worth investigating
nhsinform.scot/illnesses-an...
Yes, I can't talk clearly until I've drunk copious amounts of water. I'll speak to my endo. Thank you.
Thank you seems like I could be on the right track OR it’s just another wonder of hypothyroidism - nothing unusual really!
Thanks DD, I will dig out my two Cortisol test results and let you know.
My last T3 is taken early evening - 10mcg.
It might help to understand if you explained your dosing timetable.
Do you take it all at once first thing in the morning?
Or split into multiple doses?
Interesting thought, helvella, thanks. First thing in the morning I take 10 T3 and 100 Levo. I also take 1mg Lorazepam and 200mg Modafinil. About an hour later, to avoid a clash with T3, I take 200mg Sertraline. Early evening I take a further 10 T3 and 100 Levo. At bedtime I take 350mg Pregabalin and 500mg Quetiapine.
There are a few complicating factors there!
Have I got it right that you get up, take 10 T3 and 100 Levo, and - after a while - feel somewhat better, improve through the day, and are best a few hours after your early evening dose?
I'm trying to ignore everything else for now - but would it be viable to take your early evening dose a bit later and see if that somehow carries you through the night better - such that at least some is still available in the morning?
(When I have been under-dosed, I have tended to feel more tired and less well into the evening. As I take my levothyroxine at bed-time, that makes some sort of sense to me. I'm trying to focus on just one aspect of your situation. Others might look at everything else.)
I have only been on Thyroid meds for about ten months, but my morning issues go back several years. However, what you say makes sense and is certainly worth trying. Thank you.
Hi helvella. I took my evening dose of Levo at bedtime last night. I felt severly light headed and dizzy in the morning. Is that just a coincidence? If it isn't will those effects wear off shortly? Thank you.
I wish I knew!
Could be you need to go the other way and take it earlier. But the fact hat it did make a difference is another factor to try to incorporate into your (and their) understanding.
Sounds very much like an adrenal problem to me. Have you had any sort of cortisol testing? If not, ask your GP for an early morning serum cortisol test, see what that gives.
Yes, I've had two Cortisol tests over the past three months: one saliva-based over 7 periods of a day. This showed my Cortisol was high around midday, but normal at other times. A blood test produced a "normal" result.
What do you mean by 'normal'?
Within the parameters set by the testing company. The blood test read 350. I wasn't given any numbers by the saliva testing company, just a graph showing the normal range and the seven results plotted on it.
You might find this link useful :
rt3-adrenals.org/cortisol_t...
See Example 1 for optimal results of a saliva cortisol test.
Thank you, humanbean. I'll check it out.
Do not fall into the trap of believing that anything within the range has to be good. That is not how ranges work. This article might be of interest to you:
helvella.blogspot.com/p/the...
Pretty sure there must have been numbers on the graph - it would be rather strange if their weren't. But 350, going by most ranges, is on the low-side.
TRhat's really helpful, as usual, greygoose. Thank you.
You're welcome. 
Hi greygoose. I found the results of my saliva test for Cortisol. You were right, of course, there is numerical data and ranges. The first two readings were obtained by taking a small amount of water because my mouth is so dry in the mornings. I wonder if that distorted the results?
It could have distorted the first two readings, yes, but I really don't know. It would be best if you could contact the company and ask them.
In any case, that first reading may be in-range, but it's low in-range. Less than mid-range. First thing in the morning it should be up near the top of the range.
Then, it suddenly jumps up high on the third sample, which is suspicious, but I still don't know if it was due to the water.
And then your cortisol is high on the last reading, which must be affecting your sleep. Rather strange results but not unlike the early stages of adrenal fatigue. Did you get your DHEA tested at the same time?
No, I didn't get my DHEA tested - I'll look into it, thanks. What is the cure for adrenal fatigue?
I wouldn't exactly say there was a cure as such. If that's what it is, what your adrenals need is plenty of rest and TLC.
- avoid stress (I know, easier said than done)
- plenty of sleep - always go to bed and get up at the same time every day
- optimise your B vits and keep them topped up
- get plenty of salt, potassium and vit C - have you heard of the adrenal cocktail?
- have a protein-rich breakfast as soon as you get up in the morning - so best to take your thyroid hormone at other times in the day
- optimise you FT3
No, I haven't heard of the adrenal cocktail. my breakfast has been oats plus fruit for a long time now. Perhaps I'll add a protein shake?
Depends what's in the protein shake. I was thinking more of real food, like eggs, cheese, ham or something.
There are many versions of the adrenal cocktail, but basically it's a glass of orange juice (for the vit C) with 1/4 tsp salt and 1/4 tsp cream of tartar (for potassium). You can drink it any time of day, or just sip it slowly throughout the day.
Thank you, greygoose.😊
you're welcome.
Have you had a sleep study?
No, I haven't. I'll check it out.
You should, just to cross if off. Sleep apnea can cause all kind of symptoms. And many of them overlap with hypothyroidism.
All the best to you.
Scrolling through just to see if anyone had mentioned sleep apnoea, cos if they hadn’t, I would have done!
Lack of oxygen overnight definitely leaves you feeling awful in the morning.
Yes, it had been mentioned. I have a lot of useful suggestions to work through, but sleep apnoea certainly rings some bells for me. Thank you.
Maybe get a saliva cortisol profile with CAR (cortisol awakening response). Genova Diagnostics do one. Also, I think when we’re hypothyroid our bodies aren’t doing what they should be doing at night, which includes metabolising what we consumed in the day. It’s quite likely our livers aren’t performing adequately, we sometimes don’t produce enough digestive enzymes, hypothyroidism affects our kidney function to some extent, our migrating motor complex should be washing all the gunk through our intestines at night, and this is often less when hypo, our control of blood sugar is often affected, slow peristalsis gives us constipation, so we’re re-absorbing toxins, we easily get dehydrated and electrolytes out of kilter, our brains are meant to be cleansing themselves at night, and I wouldn’t be surprised if our brain wave patterns aren’t quite right either, plus the extra chemical processing from multi pharmaceuticals some of us have to take for the associated symptoms and all this must affect our microbiome, so I’m not surprised that I sometimes wake up feeling I’ve got an almighty hangover.
Things I’ve found helped a bit are trying to be more hydrated, not to eat too heavy a meal in the evening, take a good thyroid dose at night, cutting out sugar and refined carbs, and giving my microbiome a treat with Dr William Davis’s L-Reuteri yoghurt, which really works. It makes you feel amazing. Your microbiome has a big affect on your mood. I got the recipe from his book, “Super Gut”, though the effects don’t last if you stop taking it. Hope you find something that works for you.
Thank you, bluejourney. That's very thorough and thought provoking. Despite drinking lots of water throughout the day, I am as dry as a bone in the morning and it takes two pints of water before I generate any saliva. That may preclude me from taking a CAR?
When you say "a good thyroid dose at night, are you referring to T3, T4, or both?
I'll give the L-Reuteri yoghurt a try.
Maybe try an electrolyte drink sometimes. Lots of plain water doesn’t hydrate you much if for example you’re low in salt.
Thank you for the tip, bluejourney. I will do that.
One more question: when you say "take a good thyroid dose at night", are you referring to Levo, T3, or both? I've just started taking Levo at night and it's leaving me groggy and light headed in the morning. Presumably this will settle down?
Well, there’s a rise in FT3 in the night in people with normal thyroids, which must help with all the functions a body needs to do while we sleep, so what I mean is, take some of your dose, whatever it is, at night to help you get that rise.
That is my thinking too~ about the healthy thyroid system giving us higher T4/T3 levels during the night / very early morning. Makes sense to me to try and mirror this if possible , as presumably the body is set up to be doing something useful with it at that time . i've been splitting my levo into (roughly) half morning / half bedtime for several years for this reason.
It ties in with better cortisol levels which seems to be the key, I take my T3 & T4 between 4-6am (pee time) which I find works well at giving a better lasting effect than splitting 🤷♀️ this is when my cortisol levels are at their most 'normal'
I rarely have a pee time, so I'll be splitting my dose: 50% at bedtime and 50% on waking. I'll bear in mindyour suggestion if and when I need an early morning pee!
Thank you for interest.
Tes, that's what I'll be doing as well. Not just Levo, but the T3 as well.
Great! That makes sense. So I'll take the second half of my T3 (20mcg) and Levo (100mcg) when I go to bed. I've already been taking Levo for the last three nights; it has left me very light-headed in the morning, but I'm sure that will wear off.
Thank you.
Just picking up on your post again. I'm very dehydrated first thing in the morning. Would you recommend electrolyte at night and again in the morning? Thank you.
I’d experiment and see what works. If you’re not hypertensive, just a few grains of salt in your water may hydrate you more. I’ve been experimenting with a third of a packet of electrolyte with my breakfast to perk me up a bit. You could also try a snore app to see if you’re sleeping with your mouth open, which is very dehydrating. You can get aids to keep your mouth closed at night.
Thank you for your prompt reply, bluejourney. I've bought some electrolyte powder, so I'll experiment with that. I'll also try the snore app!
I didn't realise the yoghurt recipe was so complicated. Is it not possible to buy it?
No, you have to make it. I bought a Luvele yoghurt maker, which you can set to the right temperature for L-reuteri, and Luvele thermometer, bought the bacteria (BioGaia ) and inulin powder online, and got organic full cream milk. It’s time consuming but the results are very good. You seem to glow with health. People kept saying how healthy I was looking, even though they didn’t know I was on it. I was amazed actually. And my mood went up. I kept singing and dancing! I haven’t made any lately, as I did find the fermentation went haywire during hot weather, but I am going to have another go when the weather cools down a bit. L-reuteri is in human breast milk apparently. I think you can get supplements with it instead, but they probably wouldn’t be as effective, as the bacteria wouldn’t be in such high numbers as in the yoghurt.
OK, you've convinced me! 😀Thank you
I am a 74 year old male ,you have my sympathy because I have exactly the same symptoms,wake up feeling dreadful then gradually improve as the day goes on
I've had some useful replies in Depression and in Thyroid. Check them out and let me know what you think.
I have been on levo for about 30 years.I wasn’t too bad then about 10 years ago I started getting symptoms of low blood sugar even though tests proved negative for it then started getting the symptoms you have spoken about.just occasionally at first but now it’s every morning
Sorry to hear that. Are you on antidepressants as well as thyroid drugs?
Mirtazapine ,because I don’t get restful sleep
I am certain that everything is down to unresolved thyroid related problems .but doctors all seem a waste of time
My sister was on pregablin. She changed completely and had real bad depression. As soon as she came of it she was fine ... just a thought
Hmm, interesting. Thank you giggy63 👍
I felt the same at one point. The thing that made me feel better was healing my adrenals as well. Only then did I start feeling better. I started by taking 3000 mcg of vitamin c every day. That alone helped so much. No intense exercise. I’m now weaning off such a high dose and am feeling a 1000x better. Also low dose naltrexone has been incredible. I take .75 in the am 1 hour after my Synthroid and another .75 at 4 pm.
Thank you Hypoandaleep. I'm experimenting with a couple of things. If they don't work then I will pick up on your suggestions.
You have had quite a bit of advice which seems more relevant, but in case there's something to it, I'll add my personal experience too.
I've had similar experience of feeling worse and feeling gloom in the morning, which cleared up later on the day, although not as extremely as you seem to experience it. Taking vitamin D made a big difference in this for me.
Thank you, Dandelions. I take 8000ug of Vit D per day. Is that enough?
That sounds like a lot. But it could be right.
This helped me.
healthunlocked.com/thyroidu...
It has a link to a page that explains how to decide on dosage.
It's also advised to check twice a year what your current levels are. April and October are good times to possibly adjust for summer sun.
Thank you.
Need Advice Please 
Increased anxiety…
Menopaused. Would starting HRT mean reducing NDT? Has anyone experience of this please?
I’m fine. Really?
Thyroidectomy or not? Thyroidmegaly and multi modular goiter. 
