Thyroid hormone replacement therapy has no effect on OSA

Discussion in 'Fibromyalgia Main Forum' started by gapsych, Jun 2, 2010.

  1. gapsych

    gapsych New Member

    There has been a discussion on this board about OSA (Obstructive Sleep Apnea) and whether hypothyroidism could cause OSA based on some anecdotal reports on the discussion forum.

    Both of these conditions can be misdiagnosed as CFS as they share common symptoms, so a distinction is important.

    While hypothyroidism can occur with OSA, it does not cause OSA. In fact the reverse is true, untreated OSA can cause hormone problems along with other conditions such as high blood pressure, cardiac problems, lung problems, etc.

    The only time hypo T might be causing OSA is if it causes a structural abnrmality such as a goiter which might be large enough to compress a patients air passage. This would be a secondary cause and not primary.

    As this study shows, treating hypothyroid patients with Thyroid Hormones did not make a difference in the number of apnea episodes both pre and post treatment with thyroid replacement therapy.


    Thyroid testing and thyroid hormone replacement in patients with sleep disordered breathing.
    Mickelson SA, Lian T, Rosenthal L.

    Atlanta Ear, Nose, and Throat Associates, Washington University School of Medicine, St. Louis, USA.

    The current literature recommends that patients who have symptoms of sleep disordered breathing should be evaluated for hypothyroidism. Thyroid hormone replacement therapy has been reported by some authors to be effective in treating obstructive sleep apnea in hypothyroid patients.

    The present study prospectively evaluated the prevalence of hypothyroidism in 1,000 consecutively presenting patients who came to the office for evaluation of snoring or obstructive sleep apnea syndrome. The authors also examined the efficacy of treatment for hypothyroidism on sleep apnea in patients with both disorders. Of the 1,000 patients, routine thyroid testing was performed on 834; only 10 of these patients (1.2%) were discovered to have previously undiagnosed clinical hypothyroidism. Four of the 10 patients with newly diagnosed clinical hypothyroidism had obstructive sleep apnea syndrome, and they received thyroid hormone replacement therapy. Once these four patients achieved a euthyroid state, repeat polysomnography showed that there was no significant difference between their pre- and posttreatment respiratory disturbance index.

    Based on the results of our study, we conclude the following:

    1) The prevalence of hypothyroidism in patients who are evaluated for sleep disordered breathing is no greater than that of the general population.

    2) Thyroid replacement therapy results in little or no improvement in sleep apnea in patients with clinical hypothyroidism.

    3) Routine thyroid function screening is not indicated for patients who are being evaluated for sleep disordered breathing.

    [This Message was Edited on 06/03/2010]
  2. SnooZQ

    SnooZQ New Member

    "Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 732-735
    Division of Critical Care, Dept. of Medicine, University of Calgary, Calgary, Alberta, Canada

    Screening for Hypothyroidism in Sleep Apnea

    Primary sleep apnea-hypopnea syndrome (obstructive sleep apnea [OSA]) and hypothyroidism have many signs and symptoms in common. The overlap in clinical presentation, and the sleep-disordered breathing that can accompany hypothyroidism, create a significant risk of misdiagnosis of sleep apnea among patients referred to sleep clinic who have undiagnosed hypothyroidism.

    We determined the point prevalence of hypothyroidism in our sleep clinic patients with newly diagnosed sleep-disordered breathing. Of 290 sequential patients referred to sleep clinic, 200 (69%) patients judged at high risk for OSA underwent polysomnography (PSG) and biochemical screening for hypothyroidism. Of these, 124 (62%) were judged to have sleep apnea. This included three patients (1.5% of patients undergoing PSG or 2.4% of those judged to have OSA) who were also discovered to have previously undiagnosed hypothyroidism.

    These three patients with "secondary" sleep apnea were treated with thyroxine therapy alone, and followed with sequential sleep studies and serum thyroid hormone assays; symptoms, sleep-disordered breathing, nocturnal hypoxia, and thyroid deficiency resolved simultaneously.

    We conclude that biochemical screening for hypothyroidism is required to prevent inadvertent misdiagnosis of hypothyroid sleep-disordered breathing as primary sleep apnea, and that it is a cost-effective component of the investigation of sleep apnea."


    I find it interesting that in this study, sleep-disordered breathing & nocturnal hypoxia resolved with thyroxine replacement.[This Message was Edited on 06/03/2010]
  3. SnooZQ

    SnooZQ New Member

    "International Journal of Endocrinology
    Volume 2010 (2010), Article ID 474518, 11 pages

    Fabio Lanfranco, et al. Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy

    Review Article: Neuroendocrine Alterations in Obese Patients with Sleep Apnea Syndrome

    Obstructive sleep apnea syndrome (OSAS) is a serious, prevalent condition that has significant morbidity and mortality when untreated.

    It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH) secretion coupled to reduced insulin-like growth factor-I (IGF-I) concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL) rhythm.

    A disrupted Hypothalamus-Pituitary-Adrenal (HPA) axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH) secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism.

    Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences.

    The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death."


    According to this review article, the jury is still out on TSH & OSA.

    I find it interesting that the author suggests that understanding of the complex interactions & multi-disciplinary approach may be helpful to people with OAS.

    In light of the evolving understanding of the inter-relationship between OSA & the neuroendocrine system, I find the title of this thread to be -- at best, premature.

    The title of this thread ("Thyroid hormone replacement therapy has no effect on OSA" ) may mislead some readers into thinking that the weight of scientific evidence lies with that statement. And that may lead some people to further ignore hypoT symptoms that should be tested & perhaps treated.

    The cost & inconvenience of thyroid testing & hormone replacement if warranted is a small thing compared to the cost of PSG & the cost & inconvenience of CPAP. In cases where thyroid hormone replacement resolves OSA, it is highly cost-effective, in terms of both personal & monetary costs.

    Best wishes.[This Message was Edited on 06/03/2010]
  4. TigerLilea

    TigerLilea Active Member

    Hi Jamin - Doctors are trained to check TSH only. If those come back normal, then they don't check T3 and T4.

    Oprah is a good example of why that doesn't always work. Three years ago she was seriously thinking of walking away from her show because she was so ill and after four years of going doctor to doctor they couldn't figure out what was wrong with her. It wasn't until she had a doctor put together a team of specialists to figure out once and for all what was wrong with her that they discovered it was a thyroid problem. Her original doctor had done a TSH test but because it came back in the "normal" reference range every other doctor concluded that it wasn't a thyroid problem and looked elsewhere. It wasn't until Oprah mentioned that she had received hundreds of emails from TV viewers over the past few months asking if she had a thyroid problem that they decided to recheck her TSH and at the same time check T3 and T4. That was when they discovered that even though her TSH was still "normal" either the T3 or T4 was way off.

  5. SnooZQ

    SnooZQ New Member

    "Eur J Med Res (2004) 9: 570-572


    S. Erden, T. Cagatay, S. Buyukozturk, E. K?yan, C. Cuhadaroglu

    Hashimoto’s Thyroiditis (HT), an autoimmune disease of the thyroid gland, has been declared to present concomitant with several systemic diseases.

    In this study, the coexistence of Hashimoto disease with sleep apnea syndrome has been examined. Seven female patients (33-66 year of age) with Hashimoto thyroiditis were evaluated for sleep apnea syndrome. The diagnosis of Hashimoto disease was based on the high titers of anti-thyroid antibodies and histological findings. None of the patients had any complaints of sleep disturbances. Seven healthy subjects with similar age and sex characteristics were taken as the control group. All the patients and the control subjects were undertaken a full polysomnography (PSG).

    Five patients with HT showed the characteristics of obstructive sleep apnea syndrome (one severe, one moderate and three mild OSAS), whereas no sleep breathing disturbance was found in the control group.

    These findings suggest that sleep related breathing problems may develop in the patients with autoimmune thyroiditis even if they are euthyroid."


    Hashimoto's Thyroiditis is a relatively common autoimmune disease, frequently presenting as hypothyroid.

    Many people with subclinical hypothyroid symptoms will be offered only a TSH test, which may totally miss the elevated thyroid antibodies of HT, if present.

    Note that none of the HT subjects had sleep complaints, yet 5/7 had confirmed sleep disordered breathing on their sleep studies. (!)

    Even though this study is slightly off the thread topic, I post it here to inform those with HypoT symptoms: get your thyroid tested, incl. thyroid antibodies. If warranted, get it treated. If you have Hashi's and have residual symptoms following thyroid hormone replacement therapy, consider having a sleep study done.

    IMO, the relationship between sleep-disordered breathing, neuroendocrine and immune function is highly complex. Med/sci understanding of that relationship is evolving.

    One is wise to cover ALL the bases. Get the appropriate tests & treatment.

    Best wishes.

    [This Message was Edited on 06/03/2010]
  6. bigmama2

    bigmama2 New Member

    regarding snoozg posted study (the first one)---

    thanks for posting this info. its always good to see actual scientific information such as this. I read it all and noticed that the thyroid medication resolved sleep apnea in only 3 out of 290 patients. that is a very very small amount of people, but for those 3 people- getting proper thyroid medication is crucial.

    my thoughts- all people (regardless of having sleep apnea or not) who have symptoms of hypothyroid (tired, unexplained gaining weight, feeling cold, and more) should be tested for hypothyroid- tsh, and free t3 and free t4. treat accordingly.


    and ps- to jam-- as far as sleep apnea being a "fad diagnosis" - huhhh???? they do a polysomnogram (sleep test) and determine if one does or does not have sleep apnea. it's not a fad diagnosis. that is absurd.

  7. gapsych

    gapsych New Member

    Speaking of fad diagnosis.............???? Okay I will not say anything at this time.

    I see the sleep neurologist tomorrow. At that time I will report back, LOL!!

  8. LdyM

    LdyM New Member

    I have been away from this wonderful board for an extended period. Coming back, I see all this hateful argueing! What's up with that I wonder? Miss the former board..

  9. gapsych

    gapsych New Member

    Welcome back. I see you used to frequent the Lyme boards.

    I can't speak for other threads but we are actually having a friendly exchange of opinions backed up by science based medicine.

    I was not the individual who started this debate, so look elsewhere for negativity. Unfortunately, I fell hook line and sinker for a post aimed at me. You live and learn. Next time I will know better.


    If you read the above studies carefully and with a critical eye, you will see that they are saying the structal effects of being hypothroid are associated OSA which is a bit different than causing it.
    [This Message was Edited on 06/03/2010]