I feel severe fatigue and exhaustion even after a good sleep. Why?

Question

Hello doctor,

I am a 19-year-old female. For many years, I have had extreme fatigue. I can sleep for 10 hours at night, wake up exhausted, and sleep all day. I never feel refreshed and no energy. I have a generalized anxiety disorder and have been taking 20 mg of Prozac daily for five months. I have tried Zoloft and Paxil in the past with negative results. I was diagnosed with ADHD a few months ago and had been taking 15 mg Adderall for four to five months. I have lost 23 pounds from this medication. Even with Adderall and Prozac in my body (both stimulants), I have constant fatigue. Even coffee makes me tired.

I have a bad immune system, and I am always sick. My doctor calls me as her 1 % patient because it is very rare. I have had mononucleosis, flu type B, bronchitis, esophagitis, COVID-19, strep throat, and many sinus infections in the past year. With all of these illnesses, I never had a fever. Not a single, even slightly elevated temperature. For years, my body has not generated a fever, despite feeling as if I have one (burning up, flushed face, chills) but never run one. My typical body temperature is 97.4 and never gets higher than 98-99 even if I am very sick.

I have the MTHFR gene variant, and I am not consistent with getting my vitamin B shot, so my levels are extremely low. I have very bad menstrual cycles, so my doctors started me on hormonal birth control five years ago. Before birth control, my periods were two weeks long each month and extremely heavy (bleeding through a super plus tampon every hour).

I got some blood tests done last week.

Vitamin D: 25.5 ng/mL (normal, but on the lower end apparently. My levels were always on, the lower end of normal).

My thyroid panel is all normal.

TSH: 1.961 uIU/mL.

Thyroxine (T4): 8.6 mcg/dL.

T3 : 24.0 %.

Free thyroxine index (FTI): 2.1.

CBC and differential all seem normal. The only red flags were low neutrophil (43 %) and high lymphocyte (48 %).

I have TMJ on the left side. This started a bit randomly over a year ago. I am nearly 5’9 (just over 5’8 and three quarters) and 124 pounds. I have a speedy metabolism (small bowel movements many times per day), and I get angular cheilitis on the corners of the mouth very often. I do not know what is wrong. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and the reports (attachment removed to protect patient identity).

I suggest that you might benefit from cognitive behavior therapy for your symptoms, and also consulting a psychotherapist might help you with your symptoms. I would suggest screening for celiac disease by checking with your gastroenterologist. Eliminating gluten from the diet can help in reducing many autoimmune conditions. You can do a peripheral blood smear to detect any hematological disorder that you might be having since your lymphocytes were high, but they could also be a result of any previous infection.

Answer 2

Hello,

Welcome back to icliniq.com.

Well, there is a possibility of you having adrenal fatigue syndrome, but it is very difficult to detect it. But even if you do not have a gluten intolerance, it usually helps with decreasing some amount of inflammation in our body and thereby decreasing fatigue and the rest of the symptoms. Sometimes even having a low-carb and gluten-free diet helps in reversing the symptoms and improving general well-being. Try it for six months and see how much you might benefit from that.

I feel severe fatigue and exhaustion even after a good sleep. Why?

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