# Why are the mornings the roughest time?



## Mike (Mar 23, 2013)

I was diagnosed as hypo by my GP over a month ago and went on meds. I have an appointment in three weeks with an endo. 
I'm not sleeping well and when I get up its the worst part of the day. I'm extremly anxious , in a fog and nervous. The feeling tends to fade around noon. 
Is this normal?

TSH 3.29 (.46 to 4.68)
T3 3.7 (2.8 to 5.3)
T4 .9 (.8 to 2.2)

He put me on 50MCG and 5MCG Clytomel

Thanks in advance


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## Andros (Aug 26, 2009)

Mike said:


> I was diagnosed as hypo by my GP over a month ago and went on meds. I have an appointment in three weeks with an endo.
> I'm not sleeping well and when I get up its the worst part of the day. I'm extremly anxious , in a fog and nervous. The feeling tends to fade around noon.
> Is this normal?
> 
> ...


What time do you get up and what time do you take your thyroxine replacement?

Has your doctor ever run your FREE T3 and FREE T4? Have you had your cortisol checked?

Have you been checked for diabetes?


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## Mike (Mar 23, 2013)

Andros said:


> What time do you get up and what time do you take your thyroxine replacement?
> 
> Has your doctor ever run your FREE T3 and FREE T4? Have you had your cortisol checked?
> 
> Have you been checked for diabetes?


No, I haven't had any other test. I don't think it's my doctors specialty so I'm going to see an endo. Are you saying it could be cortisol? I take my meds at about 6AM as soon as I get up.


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## midgetmaid (Jul 22, 2010)

My husband is hypo and also has low testosterone. The two conditions sometimes occur together. Ask the endo to check your testosterone.

You may not need the Cytomel. It can cause the nervous, anxious feeling. I'm a big fan of trying Synthroid alone first and getting the TSH to a good place for you and then deciding if you need anything else.

Mornings are still the worst time of day for me and hubby both.

Renee


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## Andros (Aug 26, 2009)

Mike said:


> No, I haven't had any other test. I don't think it's my doctors specialty so I'm going to see an endo. Are you saying it could be cortisol? I take my meds at about 6AM as soon as I get up.


Could be as the adrenals kick in during the early morning slot. Usually; for most folks anyway.


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## Mike (Mar 23, 2013)

midgetmaid said:


> My husband is hypo and also has low testosterone. The two conditions sometimes occur together. Ask the endo to check your testosterone.
> 
> You may not need the Cytomel. It can cause the nervous, anxious feeling. I'm a big fan of trying Synthroid alone first and getting the TSH to a good place for you and then deciding if you need anything else.
> 
> ...


I do have low testosterone and have been on replacement therapy for six years.
I started the cytomel three weeks into treatment and had worse sleep problems for about a week.


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## Keba (Aug 11, 2012)

Talk to your Doctor about Melatonin use.
For me sleepness nights, and anxiety go hand in hand and for the first time in 10 years I tried Melatonin and slept like a baby and was still able to get up at 4:45am.


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## midgetmaid (Jul 22, 2010)

Do you get copies of labs? My hubby was feeling worse so I looked back at his labs and he'd forgotten to get the last couple of copies. He called urologist and got results over the phone. His testosterone level was way below range in spite of a monthly shot! Apparently they just slid that report right into his folder without looking at it!

Get copies of everything-they might prove useful.


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## Mike (Mar 23, 2013)

midgetmaid said:


> Do you get copies of labs? My hubby was feeling worse so I looked back at his labs and he'd forgotten to get the last couple of copies. He called urologist and got results over the phone. His testosterone level was way below range in spite of a monthly shot! Apparently they just slid that report right into his folder without looking at it!
> 
> Get copies of everything-they might prove useful.


I do. I always ask for copies and keep a file.

When I had my thyroid tested, the nurse called and said my thyroid was fine. I had to push back and ask the doctor to look it over. He even said I was fine, but just a little low and willing to try some meds. I still don't feel right so I asked for a referral. You really have to look out for yourself. This is a great forum too. It's nice to be able to speak with people that have expierence and want to help.


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## HotGrandma (Sep 21, 2012)

Mike said:


> I do have low testosterone and have been on replacement therapy for six years.
> I started the cytomel three weeks into treatment and had worse sleep problems for about a week.


Zinc deficiencies are a cause of low testosterone. Zinc deficiencies also go hand and hand with vitamin B deficiencies. A usual tell tale sign is if mosquitoes like you.


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## midgetmaid (Jul 22, 2010)

One of my husband's previous docs was an Armour fan and believed all thyroid patients should be on it. It made him a nervous, anxious wreck! Armour and Cytomel contain T3 and is great for those of us who need it but not everyone does.

The usual course is to start on a low dose of Synthroid and check labs in 8 weeks. Titrate if necessary 'til the TSH is optimal then add Cytomel if symptoms persist and T3 is low.

When do you see the endo? Hopefully he/she will help and you'll feel better eventually.

Renee


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## Mike (Mar 23, 2013)

midgetmaid said:


> One of my husband's previous docs was an Armour fan and believed all thyroid patients should be on it. It made him a nervous, anxious wreck! Armour and Cytomel contain T3 and is great for those of us who need it but not everyone does.
> 
> The usual course is to start on a low dose of Synthroid and check labs in 8 weeks. Titrate if necessary 'til the TSH is optimal then add Cytomel if symptoms persist and T3 is low.
> 
> ...


I don't see him until the 29th. I tried several and they are all busy. At least I will have been on the meds long enough. I can't wait. It's really getting old feeling like this. 
Thanks


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## bigfoot (May 13, 2011)

Working on Hashi's and Low Testosterone here, too. Have been taking some type of thyroid medication (T4, T4 + T3 combo, or compounded sustained-release T3) and also using Androgel for three years now. I have also noticed that mornings are really, really rough. I don't have any concrete answers for _why_, but the tests below might lead you and your docs in the right direction. I don't know how much of this stuff you already know, but I'll throw it out there just in case. Much of it has been learned over the course of 5 years the hard way...

Definitely get the Free T3 and Free T4 tested. Ask for TPO Antibodies and Thyroglobulin Antibodies, too. And if your doc hasn't kicked you out of the office at that point and is still open-minded, ask for TSI (Thyroid *Stimulating* Immunoglobulin) as well. Many docs think you mean TSH, they are not the same test. TSI can be present for Hashi's, but also can suggest Graves' disease or Thyrotoxicosis. A thyroid ultrasound is a good idea to get a baseline at this point, too.

I don't know what the status of your other hormones are, but getting Estradiol tested is a great idea if you have Low T. You could be converting much of your Testosterone over to Estrogen, leaving you still symptomatic. Also, if they haven't run these yet, make sure they are checking the entire Testosterone picture, not just "Total T" (so that means Free T, % Free T, SHBG, DHT, etc.).

If you are using a topical testosterone gel like Androgel or Testim, it's best to apply it to the lean parts of the body, so shoulders and upper arms. The info packets tell you to smear it on your stomach, but that's where most of your fat is, and your body will quickly aromatise the testosterone into estrogen, which is _no bueno_. The excellent tips I read on another site, is to follow this procedure: Immediately after taking a hot shower and your pores are open, dry off, cup your hands with your fingers together, put all of the gel into one palm, lightly press your palms together to get an equal amount on each, then apply one palm to a shoulder/upper arm, and the other palm to the other side, trying not to get it between your fingers. Any excess can be wiped on your flanks. Don't try to "rub" the gel in, as it is absorbed over the surface area, and doesn't soak in like lotion or anything. Try to be consistent with when you apply the gel, ideally before 9:00 am. Put on a T-shirt after it dries so that your wife, kids, dog, etc. don't start growing things they shouldn't have.

Folks are right, your Cortisol levels peak in the early AM, then diminish over the rest of the day. A one-time blood test first thing in the morning may or may not reveal issues. Especially if you don't like needles; a quick trip to the lab can spike Cortisol levels itself. A far better check is done using a 24-hour urine collection broken into different collection periods, or else a 24-hour saliva test kit in the quietness of your own home. This way you know how your adrenal glands are doing in the early AM, noontime, late-afternoon, and early-evening. While they are at it, have them check your DHEA level, and Prolactin level (looking for pituitary disfunction), too.

When they check your ongoing testosterone levels during treatment, be sure this is also first thing in the morning, and *before* applying or taking your testosterone. This will give you an idea of how things look at the absolute worst part of the day in regards to testosterone, since your body isn't making any due to adding an external T. source. FWIW, my Total T. AM levels were around the 200 mark. Now on 5g of Androgel they are hovering around 500+-, but have been a little wonky lately. Dr. Shippen has a great book (a little older, so the treatments are not up to date) called "The Testosterone Syndrome". Cheap on places like Amazon and easy to browse & read.

I know I have read on other sites that folks should really get the thyroid and adrenal issues in good order before pursuing testosterone therapy. Wish I had known that before starting out on this journey. It's also important they check as to "why" you aren't making sufficient testosterone before starting treatment; something else nobody told me.

Your cholesterol, especially Triglycerides, are probably sky-high. Likely even your blood pressure, too. And your glucose/A1C as well. This can be due to thyroid, testosterone, and adrenal issues. IMHO, I'd avoid starting all sorts of other meds for these sorts of things until further investigation is done. Liver levels should also be checked, as you convert a TON of thyroid hormones in your liver. Celiac disease and gluten sensitivity can be a problem area; you can have a gluten issue even without Celiac. Going GF is an excellent idea for thyroid, inflammation, overall health, and so forth.

If your doc isn't willing to investigate these things or discuss them, they have no business treating your thyroid and male hormone issues, IMHO.

Phew... okay... hope this helps, I'm sure I duplicated a lot of what you know, any questions please fire away.

hugs6


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## bigfoot (May 13, 2011)

Forgot to also add... I've read that after applying things like T. gel, it can cause your blood glucose to nose-dive. I don't know if there's any hard and fast research on this, but I certainly seem to notice it myself. So definitely eat some breakfast around the time you apply Androgel, Testim, etc. That could be causing some of the crappy morning feeling.


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## Andros (Aug 26, 2009)

bigfoot said:


> Forgot to also add... I've read that after applying things like T. gel, it can cause your blood glucose to nose-dive. I don't know if there's any hard and fast research on this, but I certainly seem to notice it myself. So definitely eat some breakfast around the time you apply Androgel, Testim, etc. That could be causing some of the crappy morning feeling.


All of this is very interesting and to think you came here for info. You are a wealth of it now; that is for sure! You go, bigfoot!!!


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## Mike (Mar 23, 2013)

bigfoot said:


> Forgot to also add... I've read that after applying things like T. gel, it can cause your blood glucose to nose-dive. I don't know if there's any hard and fast research on this, but I certainly seem to notice it myself. So definitely eat some breakfast around the time you apply Androgel, Testim, etc. That could be causing some of the crappy morning feeling.


That's great information. Ill have a lot to talk to the endo about. 
I was fighting some fatigue for a long time. Not as bad as I am now. About six years ago I asked to have my thyroid and testosterone checked. I had previously asked doctors to check my testosterone and they refused. Anyway, I got it tested and it came back 190! She said my thyroid was fine, but gave me a script for gel. I wanted injections, but she refused. I kept pushing and she finally said they didn't do T injections there. So I did the gel and it actually lowered my levels more. For what ever reason it just doesn't work with everyone. I then went back to a doctor that I used in the past before I moved and he put me on injections and within a week it was like magic. I have learned a lot since then and watch my levels close and keep myself in the top 1/3 range. My body is good at not converting test to estrogen so I'm good there. I recently had my liver tested and everything checks out there. Like you, I never found out why I was low. I was just happy to get it. I can honestly say it has worked great for me. 
Thanks for all the information. Ill take notes and talk to the endo.


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## Mike (Mar 23, 2013)

Andros said:


> What time do you get up and what time do you take your thyroxine replacement?
> 
> Has your doctor ever run your FREE T3 and FREE T4? Have you had your cortisol checked?
> 
> Have you been checked for diabetes?


I got my results back from a blood test taken about two weeks ago. It was after being on synthriod for about five weeks and before I started cytomel. I'm still waiting to see an endo.

Tsh. 2.73
T3. 3.6
T4. 1.0

Please let me know what you think.


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## midgetmaid (Jul 22, 2010)

The ranges on the T3 and T4 would be helpful.


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## Andros (Aug 26, 2009)

Mike said:


> I got my results back from a blood test taken about two weeks ago. It was after being on synthriod for about five weeks and before I started cytomel. I'm still waiting to see an endo.
> 
> Tsh. 2.73
> T3. 3.6
> ...


Even w/o the ranges you sure look hypo to me. Most of us like the TSH @ 1.0 or less and the FREE T3 at about 75% of the range supplied by your lab.


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## Mike (Mar 23, 2013)

Andros said:


> Even w/o the ranges you sure look hypo to me. Most of us like the TSH @ 1.0 or less and the FREE T3 at about 75% of the range supplied by your lab.


Here are the ranges:

TSH (.46 to 4.68)
T3 (2.8 to 5.3)
T4 (.8 to 2.2)

on 50MCG and 5MCG Clytomel


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## bigfoot (May 13, 2011)

Your numbers look very similar to mine. Like Andros mentioned, the TSH could probably use some improvement, and your Free T3 and Free T4, too. Hopefully that Cytomel helps to bring the FT3 up a little bit.

Glad to hear you were able to convince the docs to finally test for this stuff! I've read about other folks starting testosterone therapy and also seeing the Total T. take a nose-dive. I think it has something to do with the external T. shutting down your own production or pathways. That is awesome you were able to switch to injections! That's on my short list here. I'm curious -- what kind (probably test. cyp.), dosage, and how frequently are you doing the injections? At home, or in the doc's office? Do you notice a "slump" or feel crappy towards the end of the cycle before the next injection?


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## Mike (Mar 23, 2013)

I take 100mg test cyp and inject weekly at home. I have also gone as high as 200mg at times. As long as I inject weekly I never go into a slump. My doc originally had me injecting every two weeks, but I'd crash at about ten days.


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## joplin1975 (Jul 21, 2011)

Butting my nose in to say that, yes, when you start T supplementation, your body will stop making it naturally. My husband had a hard, hard time with the idea of testicular shrinkage when injections were introduced into the conversation, but he got over it. 

He, too, did bi-weekly shots and crashed the second week. He's trying out pellets now which seem to be helping tremendously.


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## Mike (Mar 23, 2013)

joplin1975 said:


> Butting my nose in to say that, yes, when you start T supplementation, your body will stop making it naturally. My husband had a hard, hard time with the idea of testicular shrinkage when injections were introduced into the conversation, but he got over it.
> 
> He, too, did bi-weekly shots and crashed the second week. He's trying out pellets now which seem to be helping tremendously.


Your body does shut down natural production when you supplement testosterone and the testicals can shrink. He can take HCG if it is an issue. Many people make it part of their HRT protocol. 
I've heard of people using pellets, but its not very common. I like injections and it only takes a couple minutes once a week. Plus I can adjust the dosage as needed if my bw shows that I am low.


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