Aha! I was right about Hypothyroid and Sleep Apnea

Both sleep apnea-hypopnea syndrome (obstructive sleep apnea [OSA]) and hypothyroidism are common problems in internal medicine. Each disorder probably occurs in at least 2% (1) of the North American population. Unfortunately, OSA and hypothyroidism can easily be confused. Obesity, fatigue, decreased libido, depressed mood, and impaired concentration are symptoms common to both disorders. Even snoring, which is a prominent presenting complaint with OSA, has been observed universally within at least one group of hypothyroid patients(4). Periorbital and peripheral edema are usually associated with hypothyroidism, but are also frequently seen in OSA (5). Because the two disorders have been estimated to occur together in 1.6 to 11% of sleep clinic patients (6, 7), the sleep-respiratory clinic environment can be an opportunity for misdiagnosis.

This differentiation is not moot. Although an unlikely event in a sleep clinic, misdiagnosing OSA as hypothyroidism could result in inappropriate thyroxine therapy, which has not been shown to be effective treatment for primary OSA. However, the probability of mistakenly declaring OSA when the correct diagnosis is hypothyroidism, is much greater in the sleep clinic, and the consequences could be serious. Inappropriate treatment for OSA, including prescription of continuous positive airway pressure (CPAP), could relieve snoring and might normalize the polysomnogram, as a short-term "success." Meanwhile, the patient's presenting symptoms would persist, while a false diagnosis of OSA would delay or impede proper diagnosis and treatment of hypothyroidism. Supersensitive serum thyroid stimulating hormone (TSH) testing could be used to diagnose hypothyroidism among sleep clinic patients. However, the feasibility and economic justification of this biochemical screening has not been established (7).

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The relationship between sleep apnea syndrome and hypothyroidism.

1. C C Lin,
2. K W Tsan, and
3. P J Chen

- Author Affiliations

1.
Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.

Abstract

To evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with hypothyroidism, the prevalence of hypothyroidism in patients with OSAS, the possible factors predisposing to sleep-related breathing disorder in hypothyroid patients, and the effect of thyroid hormone in treating hypothyroidism associated with OSAS, we studied 65 patients with proven OSAS (apnea index [AI] > 5) and 20 hypothyroid patients. All patients were monitored for one overnight sleep study using polysomnography (Grass 78). We found only two (3.1 percent) of 65 OSAS patients had thyroid hypofunction. Of 20 patients with hypothyroidism, two showed moderate to severe OSAS and three had mild OSAS. Patients with both hypothyroidism and OSAS had impaired respiratory drive, but this was corrected by thyroid hormone therapy. Patients with hypothyroidism without OSAS were younger and had a lower percentage of ideal body weight than those with both hypothyroidism and OSAS. All hypothyroid patients were snorers. Thyroid hormone replacement was effective in correcting snoring only after one year of therapy. We conclude the following: (1) an overnight sleep study is not necessary in every case of hypothyroidism; (2) thyroid function studies need not be done routinely for every OSAS patient; (3) thyroid hormone therapy is effective for OSAS but it takes longer to correct the snore than respiratory drive; and (4) age and body weight are related to the development of OSAS.

So…when you visit your doctor, you have to be outspoken about your symptoms. Symptoms should be the conductor of the orchestra, and labs are simply adjuncts for more knowledge. Then, when labs are mentioned, below are those we recommend you insist to your doctor that you want. Farther down, you can see explanations of all labs.

* TSH But this lab is only for diagnosis of hypopituitary, NOT to diagnose or dose your hypo by.
* Free T4 and Free T3 (note the word “free”–important.)
* Thyroid Antibodies (anti-TPO and TgAb. YOU NEED BOTH.)
* Ferritin (and do stress FERRITIN, not just RBC)
* Adrenal Cortisol levels (but we strongly recommend saliva tests, not the one time blood test your doctor will do. See below, because you don’t need a prescription)
* B-12 and Folate, estrogen, progesterone, testosterone, DHEA, Vitamin D (25-hydroxyvitamin D lab test)…plus others your doctor may recommend.
* Reverse T3 (to be tested when your Free T4 is in the upper part of the range with continuing symptoms. You need to do it at the same time you do free T3 to measure the ratio)

So…when you visit your doctor, you have to be outspoken about your symptoms. Symptoms should be the conductor of the orchestra, and labs are simply adjuncts for more knowledge. Then, when labs are mentioned, below are those we recommend you insist to your doctor that you want. Farther down, you can see explanations of all labs.

* TSH But this lab is only for diagnosis of hypopituitary, NOT to diagnose or dose your hypo by.
* Free T4 and Free T3 (note the word “free”–important.)
* Thyroid Antibodies (anti-TPO and TgAb. YOU NEED BOTH.)
* Ferritin (and do stress FERRITIN, not just RBC)
* Adrenal Cortisol levels (but we strongly recommend saliva tests, not the one time blood test your doctor will do. See below, because you don’t need a prescription)
* B-12 and Folate, estrogen, progesterone, testosterone, DHEA, Vitamin D (25-hydroxyvitamin D lab test)…plus others your doctor may recommend.
* Reverse T3 (to be tested when your Free T4 is in the upper part of the range with continuing symptoms. You need to do it at the same time you do free T3 to measure the ratio)

tattooyu wrote:
I knew there were more tests than just TSH, but I didn't know about Ferritin and the others. You said above to "see below" about the adrenal/cortisol saliva tests, but I didn't see any more mention of it. Is there an online lab test you can order or something?

Are the B-12 and Folate, estrogen, progesterone, testosterone, DHEA, Vitamin D (25-hydroxyvitamin D lab test) tests absolutely necessary?

Of all those test you had, which ones led you to the diagnosis of your thyroid disease?

Below are lab facilities you can use without a prescription. Most are saliva testing, some are blood testing, and another is both saliva and blood–the STTM lab packages! (Saliva is highly recommended to test cortisol. Salivary glands have a high blood flow, and the “free” hormones from your blood (red blood cells and plasma) easily filter through your saliva glands into saliva where they can be measured accurately. So saliva tests better reflect your free and useable “bioavailable” hormones in your blood, thus making them more relevant.) We do not recommend saliva for sex hormones.

NOTE: by law, these facilities are now required to get a prescription for a Reverse T3 test. Sad.

1. Healthchecklogo LAB WORK packages designed specifically for readers of Stop the Thyroid Madness. Use the discount code STTM10 which will give you 10% off the already low prices! STTM Thyroid and Adrenal Lab Packages You can choose just saliva for cortisol, or use LabCorp facilities around the US for blood draws.
2. LAB WORK packages designed specifically for readers of Stop the Thyroid Madness -STTM Thyroid and Adrenal Lab Packages You can choose just saliva for cortisol (which is six times in a 24 hour period), or use LabCorp facilities around the US for blood draws.
3. LAB WORK from ZRT LABORATORIES Saliva and a blood prick test…or one or the other. Adrenal Function Test for cortisol. The blood spot test kit uses a finger prick and several tests can be done from a single sample. They state it’s on par with serum needle blood draw tests, though you can do this right in your own home. THIS IS ALSO A PLUS SINCE SALIVA CAN FAIL TO DETECT THYROID ANTIBODIES. One downfall: it’s at least $100 more expensive than saliva. http://www.salivatest.com/
4. LAB WORK from Direct Labs/Sabre Sciences. Use the Hormone Panel-Female, which will do 7 samples for estradiol and progesterone, 1 sample for testosterone, 6 samples for cortisol, and 3 samples for DHEA, collected at designated days and times. Also included is the Electrolyte panel of sodium, potassium and chloride. $307 http://www.directlabs.com/ Or you can just do the Special Thyroid Panel (forget their Complete Thyroid Panel–it also adds the useless T3 uptake, T7 and total T4).
5. LAB WORK from Vitamin Research Products Saliva Test kits including iodine, adrenals. They can do New York residents.
6. LAB WORK from Canary Club. This website is not a lab, but offers saliva for cortisol, plus more. Saliva for antibodies or female hormones not recommended by many patients. Shows screwy results. (Canary Club used to offer Diagnos, Tech, but as of late March 2009, they are removed. Probably a good thing, since some patients were finding results through Diagnos Tech which did NOT match their symptoms or other saliva results.)
7. United Kingdom Labwork from NP Tech, where they will send out the kit for an ASI (adrenal stress test), plus sex hormones and a full thyroid panel etc. (thanks to “Mo” for this info) http://www.nptech.co.uk
8. United Kingdom Labwork from Red Apple Clinic. Thyroid, Adrenals, and others. (thanks to Crunchie for this info). http://www.redappleclinic.co.uk
9. Australian Labwork from Analytical Reference Laboratories (ARL) or PathLab You can’t order the kits yourself, unfortunately, but can convince your doctor. Just ring either of these labs and ask what doctor in your area uses their kits. ARL: 568 St Kilda Road Melbourne,Victoria, Australia, 3004; (61-3) 9529-2922; fax (61-3) 9529-7277 info@arlaus.com.au. or PathLab: 68 Burwood Highway, Burwood, Victoria 3125, (61-3) 8831-3000; Fax (61-3) 9808 2247; (Nutritional Laboratory Services), Ed Sorich Integrative Medicine Dept; http://www.pathlab.com.au
10. Curious about your D levels? Go here: http://www.virginiahopkinstestkits.com/ ... dtest.html or you can use the STTM labs in #1 and #2 above for Vit. D and B-12.

NOTE: several labs above provide you with the term “Cortisol Burden” and a number. Cortisol Burden is the combined value of all 4 saliva cortisol readings for the awake period of that particular day. It can tell you if you are making more or less than the average.

BlackSpinner wrote:My daughter is hypothyroid but test "normal" most of the time. But now she on the correct dosage she is wide awake and intelligent. They must go by more then just the standard tests they need to go by the symptoms also. Luckily our doctor is also hypothyroid and keeps up with it.

newhosehead wrote: at me and said "you must be hypothyroid." Never showed on labs, though.

neverbetter wrote:You may have both.
Just get tested again when your TSH is above 2.

fidelfs wrote:

neverbetter wrote:I have both of course, but I think the hypothyroid is causing the OSA

dtsm wrote:

fidelfs wrote:

neverbetter wrote:I have both of course, but I think the hypothyroid is causing the OSA

Is that your premise or is there actual science behind hypothyroidism being a cause and/or major factor behind OSA? Wouldn't your sleep doctor, or endocrinologist be the one(s) to consult, and as soon as possible....I recall discussing my other medical issues and there was never a linkage btw the two?

Good luck!