Highly symptomatic, but normal test results

[agb621]

I was recently diagnosed with Hashimoto's thyroiditis.  My test results showed normal thyroid hormone levels (I'm not sure if they did an antibody test as well).  I've been experiencing overwhelming fatigue, trouble concentrating, forgetfulness, muscle weakness, joint and muscle pain (sometimes severe), sensitivity to hot and cold temperatures, sleepiness (I never wake up feeling rested), and sensitivity to medications.  I have experienced fatigue since the age of 11, but it has worsened in the past few years. I am a 22 year old female.  I have so many of the symptoms of hypothyroidism, could my thyroid still not be functioning very well despite normal test results?

I am a senior in college and I have every intention of attending graduate school programs but I simply will not be able to effectively do what I want to do with this level of fatigue.  Even if I felt only 20% better it would be like being reborn.  I'd be a thousand times more confident about continuing my education.  Any advice would be great.

[agb621]

Jules - My endo says the cortisol test I had was definitely normal.  I asked about the Hashimoto's diagnosis and the nurse I spoke to (since so few doctors actually speak to you directly) said that my endo still thinks I have it.  I asked about the normal tests, including the normal antibodies and she seemed very insistent that my doctor, who is apparently a thyroid specialist, believes that I have Hashimoto's based on just the look of the gland.  I'm getting a second opinion though, from a thyroid specialist at Johns Hopkins.  We'll see what he has to say.

The anxiety is a little better, but I think I might have what seems to be a classic hypothyroid symptom.  I'm not positive, but it looks to me like I might be losing the hair on the outer portion of my eyebrows.  I'd noticed that some of them were sticking out in a way they never have before, and it really feels to me that the outer third of the length of my left eyebrow in particular is becoming more sparse.  It's one of those things that's too subtle to be really certain of though, I keep looking at them closely but if you don't spend a lot of time staring at your eyebrows it's hard to notice if they're changing.

My psychiatrist believes a substantial portion of the fatigue is caused by my anxiety issues.  He is not suggesting I stop looking for a physical cause, just that we tackle the anxiety a bit more head on.  I'm fine with that, I hate having such a severe anxiety problem.  But I know from experience that it isn't such a good idea to chock up physical symptoms to something psychological and leave it at that.  Last year, I remember saying several times that I was concerned that my stomach pain and loss of libido could be indicative of a problem in my relationship with my boyfriend but I wasn't sure how much was physical and how much was psychological. It turned out to be 100% physical, that was the beginning of the infection which put me in the hospital last spring.  At least exploring the causes of my anxiety and learning how to cope better isn't going to be wasted, whether it's contributing to my fatigue or not.  It's not like I'll be working on a problem that isn't there.

I don't think I should start any thyroid treatment before I see this specialist, I don't want to cloud any symptoms he'd be able to pick up on.  Hopkins is an excellent hospital though, my hope is whoever I see there has something more to offer.

It always amazes me how little doctors look at the patient and how caught up they are in just the labs.  If the numbers look okay, you must be crazy if you still have symptoms.  It's really depressing, I want to believe that most doctors know how to think outside the box.  But even the ones who say they can't help me almost never have any advice about what I should be pursuing next.

[Jules77733]

Some good websites explaining the cortisol stimulation test and what the results mean:

http://labtestsonline.org/understanding/analytes/cortisol/test.html

http://www.drugs.com/enc/acth-cortrosyn-stimulation-test.html

http://www.wardelab.com/Appendix09_ACTHa.pdf

http://organizedwisdom.com/ACTH_Stimulation_Test

http://www.ucsfhealth.org/adult/adam/data/003696.html

Sorry it took me awhile to get back to you; the past two weeks I've had midterms, so I've been swamped with work. I hope you're doing better by now, but I'm sorry to hear you felt really sick. It could be thyroiditis (likely not thyroid storm) caused by whatever underlying illness it is that you have. Any new symptoms, or are you still feeling pretty much the same?

[agb621]

Ugh, I've been doing absolutely horrible.  There's some tension with me and my boyfriend right now, and a few other things that are making me feel incredibly stressed out, and as a result I've been feeling depressed, anxious, and overwhelmed.  The night before last I woke up every half hour with my heart pounding most of the night, and last night I woke up with a full-blown panic attack after only two hours of sleep, which kept me up for close to 3 hours.  I feel like I'm in a state of crisis and something has to be done quickly or else I'm worried about my ability to continue school right now. Hell, I'm worried about my ability to function at all.  I can barely eat, I've been losing weight, I'm nauseous all the time, the pain in my lower back, hips, thighs, and knees is overwhelming, I can't concentrate or study, I always feel out of breath from anxiety, and the depression just further exacerbates the fatigue.  I feel like I'm in a downward spiral but no matter what I do, it keeps getting worse.  I feel completely lost, I don't know what to do next.  And I don't think my symptoms are strictly anxiety/depression-related.  The fatigue still overwhelms me even when I feel quite stable psychologically, and it's unusual for me to experience this level of mood instability without a clear meds-related cause.  Maybe it is just anxiety and depression, but they probably exacerbate whatever is causing the fatigue, I don't think they alone are the culprit.

I found this online: "during a thyroiditis attack, common symptoms are anxiety, panic attacks, heart palpitations, swelling in the thyroid area, problems swallowing, and frequently, problems sleeping."  I've had terrible anxiety and panic attacks for a long time, but it wasn't until within the past year that I've actually woken up in the middle of the night with a full-blown panic attack.  I'd occasionally wake up anxious if I was particularly stressed, but that's different than waking up with your heart about to pound its way out of your chest, your stomach clenched up and needing a trip or two (or several) to the bathroom, intense overwhelming nausea, shortness of breath...to have it happen so out of nowhere like that feels like more than just my psyche telling me there's stuff I need to think about (though I know that's part of it).  I didn't have problems swallowing, but the nausea was "located" it felt right around my sternal notch (that small indentation above your ribcage), which is around the area of the thyroid.  And this type of nausea, feeling so localized in this area, started within the past year as well, right around the time I was coming down with the bacterial infection that put me in the hospital last spring.  Maybe it's just coincidence, but if something seems even remotely significant, I figure it's worth mentioning.  You never know what seemingly benign or irrelevant symptom will cause the "a ha!" moment for someone else.

And yes, links to other sites that describe the cortisol test would be great, wiki is the only site I've found which gives me any details whatsoever.

[Jules77733]

I'm not usually one to quote Wikipedia as a good source, but they do a good job of summarizing the cortisol stimulation test, as well as what the results should be:

http://en.wikipedia.org/wiki/ACTH_stimulation_test

Let me know if you need another website, because I found a few others. Wikipedia just does a great job describing it concisely.

How've you been doing lately? Any new symptoms or clinical breakthroughs?

[Mandapanda291]

I also have "normal" TSH levels of 3.8.  But have every single symptom of Hypo.  I also had RAI for a nodule/hyperthyroidism 16 years ago.  My paternal grandmother was hypo as well.  Yet it literally took years for my doctor to even TRY synthroid-which I just started today.  

Read "The Thyroid Solution".  Every page was a "lightbulb moment" for me.

Take care and best wishes.

[agb621]

I did get free T3 and T4, they looked very middle of the range normal, but I really don't remember what the numbers were.  I want to say that the TSH was lower, actually more around 1.5, so again very middle of the range.  I should hear from my endo about the ACTH stim test tomorrow, maybe she will have something to offer.  My GP is willing to put me on a small dose of thyroid medication, but I think I'd like a better idea of whether this is really due to my thyroid or something else.  I'm also going to get a tilt table (eventually, gotta actually remember to call the cardiologist) as well as some allergy testing.  I will also call my GP tomorrow and ask if I could get a copy of my blood work so I can show it to other doctors (and give people on here more details, but I won't tell him that because he seems to believe every bit of information on the internet is bogus).

[gimel]

That result of 3.2 sounds like TSH, rather than T4, since you gave a range of .5-5.0.  By the way, that is the old range for TSH.  About 7 years ago, the Amer. Assn. of Clinical Endocrinologists decided that based on actual data, that a more correct range would be .3-3.0, which would place your result in the hypo area.  Unfortunately it seems that very few labs and doctors have even adopted the new range.  In addition, with your other symptoms and your temperature, I would confidently make a bet that you are hypo, and the sooner you find a doctor that recognizes that and prescribes meds. that you need, the faster you will get better.  Since you are in the process of finding another doctor, I suggest that you try to find one that does not determine dosage by testing TSH level only.  In my opinion you also need free T4 and free T3, along with your symptoms and body temperature, in order to make good decisions.

[agb621]

I first had an ultrasound.  The doctor saw what she claimed was "classic Hashimoto's", though I am questioning that diagnosis based on the blood work.  I don't have the exact numbers, but my thyroid levels were basically all mid-range normal.  Like, I think the T4 was something like 3.2, when normal is .5 - 5.  I'll ask my doctor to give me the test results so I can bring them to new doctors.

I haven't started any thyroid meds. I had one thyroid level that was closer to hyper- rather than hypothyroidism, but still well within the range of normal.  If my thyroid is fluctuating a lot (which is possible) it seems a bit risky to give me more of a hormone I potentially have too much of.  I mean, how do you treat a fluctuating thyroid without taking it out or otherwise disabling it?  I think I'd like more information about what exactly is going on with my thyroid before I start treatment.

I wasn't aware of the relationship between thyroid and bipolar, I'll check out the link, thank you.

[gimel]

I'm getting lost in all these posts.  What thyroid test was run?  What was the actual result?  Don't ever accept from a doctor that it was "normal". Always get a copy of the results.  By the way, are you aware of the relationship between thyroid problems and bipolar disorder?  If interested, check this link.
http://www.psycheducation.org/thyroid/introduction.htm

Have you started on any thyroid med. yet?  If not, why not?

[agb621]

Thank you both for the advice.  Jules, the 97 value was of some antibody, but I didn't recognize which one.  I thought it was maybe the one associated with Hashimoto's.  The bladder inflammation was looked at briefly with an ultrasound by a urologist that I really didn't gibe with. He recommended a weird over the counter medication I'd never heard of and the way he told me to try it, it felt like he had to be getting kickbacks from the company.  I did try it, but soon after I started to have a flare-up of whatever my GI problem is.  I don't think they were related, but I don't want to risk it.  I'd like to see another doctor about it.  My GP suggested an interstitial cystitis but didn't offer any suggestions to either confirm the diagnosis or treat it. My GP also thinks I have something called neurally mediated hypotension, I'm gonna try andget into see a cardiologist and get a tilt table to confirm that because it could explain my symptoms as well, it's just really tricky to treat.

I'm not sure if my sed rates have been tested, but they probably were and looked normal, I think I remember seeing them.  As for the elevated white count, what do you do if I don't have any distinct symptoms but my white count is high?  Doctors noted it but it was never high enough for them to be particularly concerned.  They usually just asked if I'd been sick lately and even if I said no they just shrugged it off.  I began to just assume my white count was naturally high (which maybe it is).  I did have mono a couple of years ago (long after the high white count started, by about 6 years), but I didn't notice an increase in fatigue after, like the infection never cleared or something.  It's a route I'm also just really afraid to go down because there is very little you can do for a virus that won't clear your system.  I do probably carry it, my boyfriend came down with it about six weeks to the day after we started dating.  But things were going really downhill even before I got it, the fatigue that accompanied it was hardly the worst I'd ever had.

The fatigue did actually get worse back in high school when I took up gymnastics again and landed on my head trying to do a back flip.  (The spotter thought I had it.) It was a subtle change, more weakness than anything, but I did notice it.  I put it together later when I had a brain-scan done and they said it looked like I'd had an injury.  I tried some treatments called neurofeedback, which were utterly ineffective.  Though the brain scans did show what I've been feeling: a lot more slow waves that are associated with sleep, a lot more fast waves associated with anxiety, and a lot less middle waves associated with concentration and focus.

As for the bipolar, it's under good control.  I don't think I'm crazy.  I accept that I have it and even see it as an advantage in some ways.  I experience life more intensely than most people, it helps me be creative.  I appreciate the suggestion for joining a support group for it, but the few I've looked at just depress me.  I have plenty of support.  My brother is also bipolar, and my mother has been with me through the treatment so closely that there isn't the usual divide between those who are bipolar and those who are not.  My boyfriend is learning.  (Actually, if there's anyone who needs the support group, it's probably him.  He needs to see how good he has it that he has a girlfriend who takes care of her meds, never stops them carelessly, doesn't get psychotic, takes care of her mental and emotional needs, and recognizes when she's suffering from irrationality associated with instability! I started therapy at the age of 9 and I wasn't diagnosed until I was 17.  The therapy was at times extremely intense, and given the improper medication I was being spoon-fed, it was the only thing that let me regain any functionality.  I am extremely self-aware.  Not much in my psyche slips by unnoticed.)

[2mara]

I just found this site again and read your posts. My old computer crashed and I lost everything.   I just have to comment, of course.  I was finally diagnosed in 1963 with Hashimotos.  I was diagnosed by biopsy in Chicago by a Dr. that flew in.  I was young then and remember most but not all.  I had radiation treatment, I believe also after but not sure.  I was mostly stable until I hit 40, now I guess hormones kicked in and I can not get stable in my tests.  I am now on Synthyroid 300mcg, up from 275mcg.  Their site offers great info and coupons. I have symptoms still as you though and can not seem to get "normal" lately.  Unfortuneately, I have gained 50 lbs since going on the Effexor XR and am not happy about it.
It's great you are eating well and on gluten-free. Celiac disease runs in my family and Gluten-free is what you have to be to be without the digestive trouble.   http://digestive.niddk.nih.gov/
I too am bipolar, have colitis, nerve damage,and am highly hyper most of the time, or completely drained to the point I can not get up for days.   I take meds for ADHD but not sure if they work well.  The amphtamine type worked better but made me feel too drugged.  I have a few other things but I am not writing to talk about myself now.  Don't know if you know that you have an autoimmune disease or not.  I am a member of that society and have found out the thyroid goes hand in hand with the others many times.  I've done extensive research on the thyroid disease and think it is the root of my other problems.  Check out the Mayo Clinic site, it has alot of great info. and up to date testing suggestions.  I also would try to find a good Endocrinologist that specializes in your diagnoses.  I think Synthyroid is the best, the generics are just not the same and made from different things.  One is from Sheep hormone, one is man made, and one other is from something else. I wouldn't mess with high levels of B-12.  It could be toxic to you, I believe.  Some is good, too much I'd be leary.
One thing I do know from experience is don't EVER stop taking the meds.  I did 30 years ago when I was pregnant due to some quack saying I didn't need them, and I was barely coherent and on the verge of coma by the time I was treated by a specialist.  I've never met anyone with the disease who's had it longer than I, so, I guess I was one of the first ones.  I was about 6 or 7 only.  But now I go every 3 months for blood work and have completely changed my diet. 1200 mg of salt sodium a day was the hardest, I think but now am used to herbs and spices instead.  
Good luck to you with your battle.  I hope you are feeling better soon.  Also, try to find a DMDA group( I think they changed the name) for the bipolar.  It helped me alot knowing I was not crazy, and not alone.

[Jules77733]

Blue nailbeds suggests a cardiac issue...the CO2 levels being abnormal is definitely important...and the urge the urinate (especially if it is independent of any actual bladder inflammation--was this measured or noted on a CT scan or something?) would indicate a neurological problem. If your bladder really does swell more often than it should, that could be musculoskeletal in nature, or potentially even some type of vasculitis. Have you ever had your Erythrocyte Sedimentation Rate (ESR) measured? This is good for measuring, in general, whether or not there is significant or systemic inflammation occurring in your body--just another generally useful number.

I'll get you a website or two regarding your cortisol results, because I've definitely found some in the past...but if your level started out at 36 and didn't increase much within the hour, I would definitely say that's an issue. It looks like primary adrenal insufficiency, but if you have TSH values that are out of whack, it's likely to be your pituitary.

Elevated white blood cell count would suggest infection...over several years though...did your doctors ever think this was strange, and order further tests?

I'll think about all your symptoms/test results and get back to you with any ideas. The information is very helpful! The value of 97 that you speak of is probably not signifcant. I'm trying to think what it could be...maybe one of the cholesterol levels? Or one of the ions (like potassium).

[agb621]

Why can't you edit posts!!!!  Apparently there's a problem with coding.  I will not use greater or less than signs in this one then...I was blaming my cat who loves to walk on my keyboard for erasing that line, but it was probably just some screwy html thing.

It SHOULD read "normal was LESS THAN 99, borderline was between 100 and 120, and positive was GREATER THAN 120.  Mine was 97."

There we go.

[agb621]

Ok a whole line got erased in my post, that's what I get for not proofreading...In the part that says "normal was 120", it should read "normal was 120.  Mine was 97."

[agb621]

Oh yeah I forgot to address that. I did look through my test results, there were a couple of things of questionable significance.  The first is that my carbon dioxide was one point below normal.  My doctor didn't think anything of it but I feel like I've seen things about it in reference to the adrenal insufficiency. Secondly, there was a test in which my thyroid levels were very slightly elevated (by maybe a point) but I was told that wasn't at all significant because it wasn't the "right kind" of thyroid test to be significant (so why do they do it?!).  There was a certain antibody whose name I did not recognize at all which was within normal range but seemed to be "borderline borderline".  In other words, normal was 120.  Mine was 97. Maybe it means nothing, but I don't know.

The only other thing that I thought was significant was that my white cell count was actually normal in my last round of blood work.  My white cell count has been consistently elevated for at least 8 years or so.  It's typically 12-13, this time it was 9.6.  Strange that this normal test should seem odd to me, but when something is consistently abnormal it makes you wonder what it means when it's suddenly normal.

I've not mentioned this before, but I do have one other symptom which may or may not be relevant to everything else.  I have a consistently inflamed bladder/urethra.  I feel like I have to pee constantly, I get up 3-6 times a night, I pee about 15 or more times a day, I've had more times that I've felt dangerously close to an accident than any adult should.  There was a time recently when I was stuck in traffic, it hadn't even been an hour since we'd left (and I had peed immediately before leaving, as I always do), but I had to go so bad it was actually making me nauseous.  This has happened more times than I care to admit.  It feels utterly unrelated to everything else, but I figure it's worth mentioning just in case a light bulb suddenly went off in someone's head and they said, "Ah, now it all makes sense! I know exactly what's wrong with you!"  I doubt that will happen, but better safe than sorry.

My fingernails are blue right now. It's not even that cold, I know that objectively, but I'm freezing.

[gimel]

Low body temperature is definitely significant.  Also, how about following through on my other suggestions regarding finding out the actual test results and supplementing with other tests, as required.   Also, here is another site that might be of interest.   Keep giving us info and we'll probably give you more info/suggestions than you even want.  LOL   But there is no way you should have to be going through all that.  

http://www.altsupportthyroid.org/tsh/tshmedrefs1.php

[agb621]

The cortisol test was supposed to start at 8 am but we didn't actually start it until 8:45. I'm not sure if that's really all that significant (I'm not a morning person anyway, why do people think that everyone's pituitary gland should be tested at the same time?  Isn't it at all significant that I have a delayed circadian rhythm, which was diagnosed by a sleep specialist?)  Anyway, it was done through a blood test.  I also thought the increase seemed unusually low, but these tests I understand typically are used to diagnose the extremes (Addison's and Cushing's) and it can be complicated to diagnose any subtle issues in the middle.

I had an MRI done a few years ago that was normal, but I suppose things may have changed or become more pronounced since then.  But if everyone thinks things are normal, they're not going to let me get the MRI. I would like a second opinion though, I just hate having to wait 3 months to get into see a doctor. I am having trouble finding anything besides Wikipedia that gives me any information on what the "normal" results would entail.  Jules, have you come across any worthwhile information in that regard?

My stomach issues have worsened lately too.  I've been eating about two small meals a day, but almost never actually feel hungry. I've been dropping weight, I'm at the lowest weight I've been at since middle school (10 years ago). I'm nauseous and my stomach hurts all the time.  I have an appointment in about 4 weeks with my gastroenterologist, I might try to get in sooner if things don't start to feel better, but I doubt there's much he can do.

Gimel: Thank you for the link, it was very interesting.  According to the "scorecard" I'm leaning towards adrenal fatigue or mixed.  I don't know that I'll really be able to do the temperature tracking since my schedule is highly variable, but I do typically have a very low body temperature.  It's typically about 97.5 but it can get as low as the low 96s.  My hands and feet are always cold, my nailbeds often turn blue.  I also occasionally feel hypoglycemic, sometimes to the point where I'm so shaky I can hardly walk (though this is rare).  I was surprised that one of the symptoms of adrenal fatigue is to startle easily.  Strangely enough, I've noticed an increase in that recently as well.  Also, every time I go to my doctor he remarks on the bags under my eyes, another symptom they listed.  My old doctor used to remark on my pallid complexion, another symptom on there.  I also bruise easily, at the moment I look like I've been beaten up from the last two times I got blood work done.  I have two huge disgusting bruises.  One has been there for nearly two weeks.  I don't know if by "slow healing" it also implies cuts or scrapes, but even a small scratch might take weeks or even months to heal, and I scar easily.

It can be tricky to define the difference between a symptom and an idiosyncrasy.  My body temperature might run low, it might not be anything significant at all.

And I probably should start a new link, but all the important info is on this one already.  I probably will pretty soon though, maybe once I have a little more information from my doctors.

[gimel]

Sorry to get in on the end of this thread, but I couldn't refrain from putting in my two cents.  I always get concerned when I read that someone who has a possible thyroid problem is told by doctor that their test results were normal.  In the medical community normal covers an enormous area, subject to the particular lab that ran the tests and the doctor's knowledge and acceptance of the new range  for the primary test used for  diagnosis - TSH.   Did you see the actual test results?  If not, I would request a copy of the data and find out what tests were run that resulted in the decision of "normal".  Then considering the symptoms that you mentioned, I would also  do my own testing of body temperature.  If that interests an academic like yourself, then here is a good link.

http://www.drrind.com/scorecard.asp

Bring this info back to the forum and I'm sure you will get some very useful opinions and experiences that might relate.
P.S. Please start a new link as I am now totally fatigued myself, just reading through this one.   LOL

[Jules77733]

One last thing, I promise--was this a urine or blood test? This would definitely affect how the results are interpreted.

[Jules77733]

Sorry, the second-to-last sentence in the first paragraph of my last post should read: "Your initial cortisol level was high....." I had one too many "cortisol"s in there!

By the way, if your doctors weren't surprised or worried by the results, then they might know something I don't know--like how the medications (vitamins, too) you're currently taking might affect the test. I didn't take that into account, so it's quite possible your results are normal for you, if even they don't seem normal, in general.

[Jules77733]

In a normal test, your levels should double over the course of approximately one hour. Since you began with a level of 36, your level after the injection of ACTH should've been around 72. The fact that yours only rose 7 points in an hour (I'm assuming it was an hour) suggests that you have primary adrenal insufficiency (your base value of 36 less than doubled over the course of the 60 minutes), likely a result of your cortisol production having all-but-ceased over time. What is confusing about your results is that typically people with primary adrenal insufficiency begin with a cortisol level that is in the low-to-mid teens, like 10 or 15. You began with a 36. Was your test done early in the morning, or in the afternoon? Either way, I strongly recommend that you get an MRI of your pituitary gland done promptly, if you can. Your cortisol initial cortisol level was high and this might mean an ACTH-secreting pituitary tumor or another neoplasm in that region of your head. This would explain your thyroid going haywire, too.

I guess the bottom line is that from what I read, your ACTH stimulation test results aren't normal...and that means a problem with your adrenals or a problem with your pituitary. I'm inclined to think it's the pituitary since you're having thyroid/hormonal issues. Hope this helps...

[agb621]

I haven't heard from my endocrinologist what her opinion is regarding the ACTH stimulation test but my primary care physician seemed to think the results were not significant.  My levels were initially 36 and they rose to 43.  I don't know what constitutes a normal test, so if anyone has any input that would be great.

[agb621]

Ok it does seem necessary to get a few facts straight. They might be scattered about in other posts but let's get them all in one.

The bipolar disorder may not be helped by whatever is causing the fatigue, but trust me when I say that it is a diagnosis in and of itself.

I am under the care of an excellent psychiatrist, one of the top in his field, who I go to for just about everything, whether it's related to the bipolar disorder or not.  He's been working with these vitamin treatments for 15 years, he knows his stuff, I get yearly blood work specifically to monitor things that could be influenced by these medications.  I understand the dangers of over-vitamining (it's a new word!) but I trust this doctor implicitly.  If you're interested, I can tell you the story of how he came to use these nutrients, it's actually a pretty interesting story.  He was very incredulous at first, now he's the foremost specialist on their utilization (though how much that really says is unclear as so few doctors use such an intimidating alternative treatment.)

A lot of doctors like to pin the problems on the meds I take for the bipolar disorder.  My meds are NOT the problem, I am 100% certain of that.  The fatigue has preceded every one of my current medications by at least 7 years.

I maintain a far better diet and sleep schedule than the average person.  If diet is to blame, it would not be due to irresponsibility, it would be due to a subtle problem as yet undiscovered.  I also think it is highly unlikely that my sleep is to blame.  I know what good sleep feels like, even though I don't feel refreshed when I wake up.  Still, I find it unlikely that sleep alone is the problem.  

I'm still in the dark about what all my blood work showed, and a bit confused as to whether the diagnosis of Hashimoto's was premature, but if there is anything significant I will certainly mention it.

In short, the following things have been ruled out or nearly ruled out as causes for the fatigue:
Depression related to the bipolar disorder
The medications related to the bipolar disorder
Poor diet or sleep habits

My symptoms include:
Fatigue
Drowsiness
Waking up without feeling refreshed
Needing lots of sleep (typically 9-10 hours, but I've been known to sleep 13-14 hours for weeks in a row and not feel any more refreshed)
Pain in my lower back,  hips, thighs, and knees
Fogginess and a sense of slowness in my brain
Poor concentration
Difficulty with learning (a newer development, post-high school)

The brain symptoms are the most frustrating.  Whenever I sit down to do homework, I literally feel like I want to run an electric current through my brain to give it a jump start.  I've been known to hit myself on the forehead with my fist in the vain hope that jostling things around in there could get things moving again.  It doesn't work.  It's a fatigue I can literally feel, it's like my head is full of cotton.  If I try to focus for more than 20 or 30 minutes, my brain feels like it's expended every bit of energy it has and I just want to curl up and sleep for awhile.  I used to love reading, it was my favorite pastime.  Now I can't pick up a book and feel like I can make the mental commitment to reading it, even if it's by an author I love or a topic I'm really interested in.  I used to devour a new book every couple of days, this is a hugely drastic change for me.

Possibly related symptoms:
Sensitivity to cold, fluctuations in comfortable temperatures (my fingers and toes turn blue frequently, other times I feel overheated)
Sensitivity to many medications (my meds for the bipolar increase this, but I am very sensitive regardless)
Gastrointestinal symptoms, including nausea, pain, general stomach unrest, and some other unpleasant things
Anxiety
Depression

Depression is a weird one...I'm very sensitive to different kinds of depression: circumstantial, stress-related, chemical due to a problem with my medications, chemical due to interactions with other medications, and what I am experiencing right now which feels like a combination of stress and something else I can't quite pinpoint, it feels chemical but not bipolar-chemical, if that makes any sense.

Ok this is really rambling but I hope it clears up some questions.

[Jules77733]

You take large amounts of B complex vitamins? This could really be a problem, although it might not seem like one at first. If you take too much of a particular vitamin, it can cause an insufficiency with another one (analogous to competing species). Was your medication/vitamin regime designed and/or approved by a doctor? I'm guessing it was, but I'm checking, just in case, to be helpful since I know treating bipolar disorder with vitamins isn't standard procedure. Insufficiency of certain vitamins or too much of particular vitamins (especially if they're fat soluble, they hang around in your body until they're needed and you'll get a build-up) can wreak havoc on your system. Are your levels consistently monitored? I'd hope so, because believe it or not, overdosing on vitamins can be pretty dangerous for your system.

Your cortisol level being elevated is actually very useful. This strongly suggests an adrenal issue, likely a result of your body's response to stress, which can cause excessive weight loss in individuals, as well as mood changes or mood swings--like developing depression and then suddenly becoming irritable. Decreased motivation, loss of appetite, and loss of muscle are additional symptoms of elevated cortisol levels.

May I ask how your bipolar disorder was diagnosed? I wonder if maybe your cortisol levels are really to blame for your mood swings. If you think I sound crazy or something, just let me know and I'll stop with the interrogation and suggestions lol.....

I hope your cortisol test goes well tomorrow (assuming you're able to get it)!