Thyroid Health and Sleep

 

One of my passions is treating thyroid disease.

Optimizing thyroid function, especially if you have Hashimoto’s or other autoimmune thyroid disease, requires some good detective work including testing for all the important markers of thyroid health. If you haven’t read my blog on thyroid tests, you can find it here.

Next month, I will be giving a talk to other doctors and dentists on “The Clinical Management of Weight Reduction in Oral Sleep Apnea”. While reviewing my notes and creating my presentation I came across some interesting research regarding the thyroid and sleep apnea. Before I tell you about this research, it is important to note that many of my patients with thyroid troubles have disordered sleep patterns but this does not necessarily mean that have sleep apnea. One of the key signs that the thyroid has began to under function is feeling tired. In fact, many of my patients report wanting to sleep 9, 10, 11, or even 12 hours at a time- and still feeling fatigued!. On the other end of the spectrum, sometimes sleep can be disturbed when thyroid hormones are out of balance. These patients may feel tired because they have been up many times during the night, which could be a result of hormone imbalance.

Sleep Apnea, is a chronic health condition that is characterized by pauses in breathing while sleeping.  These pauses in breathing and lack of oxygen wake people up during the night and the result is un-refreshing, fragmented sleep. The symptoms of sleep apnea include: snoring, restless sleep, gasping for air while sleeping, fatigue, daytime sleepiness,  and nasal congestion. Sleep apnea has also been correlated to weight gain, high blood sugar levels and high blood pressure. So how does sleep apnea relate to thyroid disease? Interestingly enough, studies have found that 25-35% of people with hypothyroidism also have sleep apnea AND sleep apnea may be a disk factor for the development of autoimmune thyroid disease! Research that was reported in a 2012 study published in Endocrine journal revealed that over 50% of people with Obstructive Sleep Apnea (otherwise known as OSA) tested positive for thyroid antibodies (TPO or TG antibodies). These people still had normal levels of TSH, the “gold standard” marker for determining thyroid disease. However, thyroid antibodies can be positive long before TSH changes, and can be an early marker of thyroid dysfunction- especially if the patient has symptoms of thyroid disease!

Testing for sleep apnea requires having your breathing monitored overnight in a sleep lab. As unpleasant as this may sound early detection and early treatment significantly improves health outcomes. Remember, sleep apnea can cause weight gain, high blood pressure and high blood sugar. If you are diagnosed with sleep apnea, using CPAP or Oral Dental Appliance can improve fatigue and increase energy. If you are overweight, working to reduce weight can also be key in reducing symptoms.

If you have symptoms of hypothyroid such as:

  • Easy weight gain
  • Puffy face
  • Fatigue
  • Intolerance to cold
  • Heavy periods
  • Dry skin
  • Brittle nails

I would encourage you to ask your doctor, or work with another healthcare practitioner to have multiple thyroid tests run including TSH, T4, T3 and TPO.

I believe wellness requires working with a physician (medical or naturopathic) that is willing to get to the root cause of your symptoms. Don’t be shy to ask questions about your health- taking charge of your health is empowering!

Dr. Emily

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Thyroid Health: Keed to know info! and the 6 thyroid tests you need to ask for from your Doctor

thyroid-gland (tuberose.com)

 

 

 

 

 

(adapted from Dr.Aviva Romm, MD, 2014)

I see a lot of patients that complain of weight gain, fatigue, constipation, dry skin, PMS, and complaining of always being cold. All these symptoms point to the possibility of hypothyroidism, or under active thyroid function. Sometimes, their TSH (thyroid stimulating hormone), the most common test for thyroid function, has been tested and may still fall into the “normal range”. However, TSH is only one of the markers for abnormal thyroid function, and many patients are unaware that there are other tests that can give a much better picture of thyroid health and function.

Statistically, hypothyroid is an under diagnosed condition. In fact, in the US only ½ of Americans that have hypothyroidism know it.

What is the Thyroid?

The thyroid is a butterfly-shaped gland that sits at front of your neck and controls your metabolism. It therefore controls your weight, energy levels and also plays a role in cholesterol and hormone production.

When the thyroid is out of balance and not functioning optimally you can gain weight, have sluggish bowels, experience dry skin, have fertility problems, brain fog and feel tired…even if you have a great diet and activity level!

The Key Thyroid Tests

Thyroid tests should be easy to obtain from your primary doctor, naturopathic doctor or functional medicine doc. However thyroid tests do take some skill to interpret and some docs may be reluctant to order more than a TSH test. If this is the case, consider getting a second option by a doctor that is familiar with thyroid health and testing.

Thyroid Test #1: TSH (Thyroid Stimulating Hormone)

TSH is the commonly order thyroid test. This hormone is produced by the pituitary gland (a small gland in your brain). TSH communicates with the thyroid to tell it to produce more thyroid hormones T3 and T4. When all is going well in the body, TSH is in a normal healthy range and so is T3 and T4. When T3 and T4 (those important thyroid hormones produced by the thyroid gland) are LOW, TSH starts to INCREASE, telling the thyroid gland to produce more T4 and T4.

The “healthy TSH range” has become a somewhat controversial topic in medicine. Most Canadian labs consider the upper range of TSH to be 4-5mU/L. However, many experts, including many conventional endocrinologists, consider the upper limit of TSH should be no higher than 2.5-3mU/L. This is based on the data collected on Americans without any hypothyroid symptoms. When they have a TSH test done, this is the common upper range.

Thyroid Tests #2 and #3: T3 (Triiodothyronine) and T4 (thyroxine)

As mentioned above, T3 and T3 are hormones produced by your thyroid gland. T4 is produced in much higher amounts by your thyroid gland, and then is converted into T3 in the periphery. This is important because T3 is the more active form of thyroid hormones and is necessary for proper metabolic function.

Thyroid Tests #4 and #5: TPO and TGAb (Thyroid Antibodies)

As mentioned previously, autoimmune hypothyroidism is the most common cause of hypothyroid. As with any other health condidition, to achieve optimal health we must look at the underlying cause of the problem. If a patient has hypothyroidism, but does not address the autoimmunity (if present), the problem will not be addressed at the root cause. Thyroid antibodies can also be measured every 6-12 months to gauge how thyroid treatment is progressing.

Thyroid Test #6: Reverse T3 (RT3)

Although there is some controversy over the usefulness of this test, I have personally found it of benefit in my practice, especially if hypothyroid symptoms are persisting despite treatment. Sometimes, when the T4 is being converted to T3, it can be converted into RT3, a less active form of T3 that the body cannot use as well as T3. This can happen is one is under a large amount of stress or is sick. If the patient it producing a large amount of RT3, certain medication or supplements can help replenish the body with T3 and encourage the body to produce T3 over RT3.

If you have an inkling that your thyroid health is sub-optimal and your doc is not open or familiar with thyroid testing, consider switching docs or having a second opinion.

Yours in Health,

Dr. Emily