Hypothyroid and sleep Apnea

I have hypothyroidism and have not reached therapetic synthyroid dosing yet. There are some overlapping symptoms between HypoT and OSA........cognitive impact, fatigue, sleep disturbance. I'm curious if there are other HypoT/OSA members who have reached therapetic thyroid treatment. If so, how have you distinguished between OSA and HypoT symptoms with regards to fatigue, cogitive clarity and energy. I have a Sleep MD appt. in a couple of weeks and think medication for daytime fatigue may still be on the agenda. I don't want to make a mistake of treating OSA when it very well may be a hypoT issue. I'm awaiting results of a TSH taken last week. Thanks!!!!

I have Graves' Disease, which makes you HYPERthyroid. But after getting your thyroid zapped away, you go HYPOthyroid and have to take Synthroid, which is my story. I was diagnosed with this "little" problem six months before being diagnosed with OSA.

To your question of how to distinguish between the symptoms of OSA and hypothyroid? Good question, and if you find the answer, let me know. Then add in my phase of life (post-menopause) and there's a third player in the mix. I'm getting ready to start attacking this again, as I'm still tired and sleepy during the day (even though my AHI numbers are good, and the endo says my thyroid numbers are fine).

I know I'm not any help, other than to say I know how you feel. It's so frustrating to have several different health issues, and the problems you're having could be caused by any of them (or all of them).

Pam

My story is similar to Pam's with a bunch of years between. I was diagnosed with Graves about 22 years ago and had my thyroid nuked. OSA was diagnosed in 01. I've tried cpap, apap and bipap. I've tried--- lost count of masks and types. I've tried different types of thyroid. Today I feel pretty good. My AHI is usually between 1 to 2.75. With the thyroid problems, it's really hard to lose weight. But, I'll say it again I feel pretty good. The folks of this forum has helped me greatly and have been better than some of the doctors I've seen.

As for which one causes which, I wish I could tell you. I figure if I can improve one, it'll help the other one. For me, I think of daytime sleepyness as OSA. Everything else could be thyroid.

I suggest you make small steps and see what helps, don't try more than one change at a time. T4 Thyroid changes take 3 to 6 weeks to feel differences. Cpap pressure changes may take several days (weeks) to feel better.

It'll take time, but you will feel better!

Al

by elg5cats on Wed Mar 04, 2009 8:07 pm
I have hypothyroidism and have not reached therapetic synthyroid dosing yet. There are some overlapping symptoms between HypoT and OSA........cognitive impact, fatigue, sleep disturbance. I'm curious if there are other HypoT/OSA members who have reached therapetic thyroid treatment. If so, how have you distinguished between OSA and HypoT symptoms with regards to fatigue, cogitive clarity and energy. I have a Sleep MD appt. in a couple of weeks

Hi elg5cats,

I've been treated successfully with T4 (Synthroid) AND T3 (Cytomel). Your body is supposed to convert the inactive T4 (Synthroid) to T3, but when we get to be over 50 . . . sometimes this conversion doesn't take place. (Not many physicians are tuned into this, by the way.) You can send me personal messages and we can talk about this more if you wish. Once I got successful treatment (T3 added to my regimen) my whole life changed . . . but keep in mind that most people are able to convert to T3 on their own.

HOWEVER, even with my thyroid well normalized . . . I STILL remained tired all the time, my blood pressure required more meds to be controlled (four BP pills!)), and still some memory stuff remained. Once I got on CPAP - THE NEXT DAY, in fact, I woke up ALERT and didn't need to nap or sleep half the day! I finally found out how other people feel . . . alert, alive, energetic. My whole life is changing ONCE AGAIN . . . most dramatically the energy I felt from the beginning. My BP is beginning to drop after a couple weeks, and I don't have to get up to pee 3-4 times a night anymore (once now if at all). My Internal Medicine physician who is an anti-aging specialist anticipates more improvements the longer I am on CPAP . . . memory improvements, etc.

I'd advise you have your physician (primary care is fine) order a diagnostic test for you overnight in a "good" sleep lab, hopefully covered by medicare and/or your insurance. And have him prescribe a tablet of Ambien to take to the lab "in case" you need it (don't take it until they hook you up first). The Sleep lab where I didn't have a sleeping med . . . I couldn't sleep all night and it was a total waste. The second time, I woke up extra early that morning (to really tire myself out) and had the prescription in tow when I went to the sleep lab . . . and I was able to sleep and have a very productive diagnostic test!

Good luck,
Joy

I forgot to mention this is a really good forum for people with thyroid issues: http://thyroidhost.proboards30.com/. The wonderful folks over there helped me as much with my thyroid issues (and still do), and everyone here does with OSA!

And just a little side thing, if you plan to take anything before a sleep study, and you've never taken it before, it might be a good idea to try it out at home first. Some sleep medications like Ambien can have weird side effects, or the dosage prescribed might not be enough to help. I took Ativan (anti-anxiety) and that helped me a lot. (On a regular dose, Ambien does nothing for me or my son. On a higher dose doc suggested, my son had hallucinations and thought the bed was flying, not to mention it didn't help him sleep, either! I, obviously, never tried a higher dose due to his reaction. )

Pam

This is to Joy D.
After reading the posts, and having the same problems - yes, the CPAP therapy is making a world of difference - not so the Synthroid treatment - I have a question . . . . How do you know if your T3 isn't converting to T4? I've had a feeling all along that something like that might be happening. My doctor just bumped my T4 dose up even though it should be fine according to my numbers because I'm still fatigued even though I feel well rested now and alert, and my metabolism and heart rate are slow. I barely digest food. That was my first clue that my thyroid might be out of whack, and seems to be the way I'm able to tell if the Synthroid might not be the right level. When I say fatigued - I have no stamina to speak of. I can do only a certain amount of physical work and then I have to rest. But the CPAP therapy has almost totally relieved the mental fog. Still having memory issues, but I was told by the doctor with the sleep center that my problem was more that I wasn't getting enough oxygen at certain stages of sleep and that the apnea was only moderate. Oxygen deprivation is permanent loss according to her, so I won't regain what has already been lost. A good reason to go ahead with the therapy if indicated. I waited a year after being told I needed a CPAP - until I was falling asleep at the wheel. If I had followed through and knew about the oxygen problem, I wouldn't have waited and risked my life and my kids.

Joy K - and yes, the weight isn't coming off either - that's thyroid, for sure

Hello---I have HYPO Thyroidism too--had it for years before I was diagnosed with OSA. I do not take Synthroid--I take LEVOXYL instead, the generic SYNTHROID does not work on me. I have been on LEVOXYL for many years. Once I finally figured out that I was not sleeping ---all made sense why I was SO VERY Tired. I am losing weight now and still a bit tired in the afternoon. I am not taking any meds to keep me awake, I don't want to start all that. Good Luck in getting your Thyroid fixed. I get blood work done every 3 months --for my TSH and all that good stuff.

Carrie

by joylk1 on Wed Mar 04, 2009 10:38 pm
This is to Joy D. After reading the posts, and having the same problems - yes, the CPAP therapy is making a world of difference - not so the Synthroid treatment - I have a question . . . . How do you know if your T3 isn't converting to T4?

Actually it's T4 that converts to the "active" T3. Yes, your doctor must send out for a "FREE T3" blood test. That will tell you if you are able to convert the inactive T4 to the active T3. NOTE: When they order "T3", the lab is doing a "BOUND T3", not a "FREE T3", and the bound form won't tell you if you are able to convert from T4 to T3.

Mary Shomon has written several best-selling books about Hypothyroidism. I'd recommend her "Living Well With Hypothyroidism: What Your doctor Doesn't Tell you...That You Need to Know". She has also run a Thyroid Site for several years on about.com that was a "life-saver" for me as it gave me the information that I needed that finally opened my as well as my doctor's eyes. She is a life-long journalist researcher on the topic as well as a hypothyroid patient herself. Her website: http://thyroid.about.com/mbiopage.htm

Re. the post about Levoxyl. Synthroid and Levoxyl are both "brand names" of the synthetic form of the T4 hormone. They are manufactured by two different companies, and have different brand names, but are both "L-thyroxine" (the generic name). Lots of small companies manufacture generic L-thyroxine, without as much rigorous quality control, and I also would not use them.

Since this isn't a Thyroid Forum . . . I hesitate to get further into this, but if anyone wants to . . . you can send me a "Private Message" and I'll be happy to discuss my experiences with hypothyroidism privately. You can find the PM link just above the list of equipment when you click on JoyD.

Hope this helps . . . now back to Sleep Apnea . . .

Joy

I am with Joy D. on this. I have Hashimoto's Thyroiditis, which is an autoimmune disorder that damages the thyroid. I was started on T4 as levoxyl, but really didn't feel that much better, though the big lump in my throat did go down. My doctor tests for both free T4 and free T3, in addition to the TSH. But we barely look at the TSH, as it doesn't seem to correlate to health.

My T3 was staying in the bottom, so we added T3 in the form of Cytomel. Still didn't help. Finally my doctor added Armour thyroid, which is pig's thyroid. It has both T3 and T4 in it, but the T3 is more than some people need, so we also use some Levoxyl, to keep the right balance of T4 to T3. That finally brought T3 levels up to normal, and I stopped being cold, stopped losing hair, my skin wasn't so dry, and my blood pressure stopped being so terribly low. But it didn't stop me from being tired.

A month ago I started on APAP. Almost right away I stopped falling asleep in the daytime. I am better mentally, but still pretty tired physically. But then, I have been exhausted for 16 years, and I still have several other medical issues, so I don't know if XPAP will fix that, or if it does, how long it might take. I can tell a difference, though. I am sleeping straight through the night, for the first time in many years.

I think the truth is, that everyone will respond to thyroid treatment slightly differently. It helps to learn what thyroid meds might affect, so you can watch to see if the symptoms change, or not. But it is trial and error, much like XPAP, and the medications that do well for one person, may not work for you.

Mary Shomon's board, thyroid.about.com, was extremely helpful to me.

Good luck!

Thanks for the discussion, I think we all agree HypoT is a challenge in the face of OSA. Since starting APAP, I have noticed my morning fatigue has improved, dull headaches are gone in the morning. ( I didn't realize I had the headaches until they vanished). I also notice I no longer need the 2 hours to get ready and out the door for work...mornings are better. I continue to struggle with sluggishness and easily become fatigue which I suspect is related to HypoT as I'm not able to correlate the sluggishness with previous night or nights sleep data. Last night after posting I read about HypoT and OSA. It seems in the late 90's there may have been a surge in interest about HypoT and OSA. There were some small studies to evaluate if patients should be automatically tested for Thyroid disease before or as a part of a sleep workup. There were a few patients to be found to have resolution of OSA when hypoT was treated. However. they exclued the previously diagnosed HypoT patients in the study. Final conclusion appears to be it was not cost effective to test all potential OSA patients for HypoT. Perhaps some recognizion a small number of patients have OSA caused by hypoT that will not be treated affectively w/o HypoT treated.

I wish I could find the clear relationship between HypoT and OSA explained. My dilema is considering possibly adding a medication for daytime sleepiness used for OSA when it's unclear if my daytime fatigue is OSA or HypoT or a combo of both. I'm hoping my TSH results will help clarify this. I have a T3 ran when my TSH is outside of the range, last time T3 was slightly outside of the range on the low end. My synthyroid was increased. I tend to have short term partial benefit for about a month after synthyroid is increased. Urgh!!!!!

Chiming in here - three years on CPAP, recently diagnosed as mildly hypothyroid. No fatigue relief yet, sadly.

How long does it take for Armour thyroid to work?
I've been taking armour thyroid for 3 months. I started at 30mg, then 60, and now 90mg and have had no change. I have had severe, constant fatigue, joint pain, and heart palpitations for the past 10 months. None of the doctors I've been to know whats going on. All the test I've done have come back inconclusive. The only reason I'm take Armour is because my sister (and deceased grandmother) has hypothyroidism. Does anybody have a clue or a suggestion or something. I'm running out of hope.

Have you and they been able to rule out fibromyalgia and chronic fatigue syndrome?

For Armour Thyroid info, check out...

http://www.stopthethyroidmadness.com/

It advocates it use and some folks do very well on it (myself included). But the majority (and most doctors) recommend synthetic thyroid replacement. Remember, it takes 3 to 6 weeks to see any change in type/dosage of thyroid.

Have any of you read Mark Starr M.D.'s book--Type 2 Hypothyroidism? It is well worth the read. He says that you cannot always trust or go by the Thyroid blood tests. He said that there are millions of people who are Hypothyroid and yet their blood tests say otherwise. Just like Type 2 Diabetes, where the pancreas secretes insulin but is rejected at the cellular level, he says that Type 2 Hypothyroidism doesn't show up in the blood tests because it's not that the Thyroid is not creating hormones; it's that the hormones which ARE detectable in the blood are rejected at the cellular level--just like Type 2 Diabetes. He cites many case studies to prove his point and has treated thousands of people successfully using this hypothesis.

A year and a half ago I had many of the symptoms of Hypothyroidism: Constantly cold, unbelievable fatigue, lost all of the hair in my armpits (I'm already bald), outer third of my eyebrow hair gone, joint aches and pains, high cholesterol and triglycerides, Pre-Diabetic, etc. My internist said "Well I don't think you are Hypothyroid, but that would explain a lot". He did the blood test, and of course it was within the range of normal. Mark Starr says to ignore those test results if A)Your basil temperature is below normal and B)You are symptomatic of Hypothyroidism. Sure enough my Basil temp was in the low 96's (hence feeling cold all the time), and I was indeed symptomatic. He is also a big fan of Dessicated Thyroid and doesn't really like the synthetic products (although it does work for many). So I started Dessicated Thyroid at 1/2 Grain and went up from there. I am now at 3 and 1/2 grains. I am no longer cold, the joint pain is gone, my Triglycerides have gone down by 66%, my Cholesterol is in the normal range, my A1C is almost in the normal range and I think I am bald for life , but I can handle that.

Even better, I gave my internist a copy of the book. He read it and said that it made sense. He recently told me that he put a patient on it who was symptomatic just like me but whose blood tests were normal and just after a month she was a new woman. Dessicated Thyroid is a prescription medication as it should be. If you have the symptoms of Hypothyroidism, get the book and read it and find an open minded doctor who will look at this with you. Untreated Hypothyroidism can cause diabetes, heart disease and a host of other problems. I have to wonder if sleep Apnea causes Hypothyroidism. I know it can be vice versa.