Sodium oxybate (which is the sodium salt of gamma-hydroxybutyric acid) is used as a last resort medicine for sleep problems - under expert guidance only.
I have just come across a personal report about the interaction between sodium oxybate and levothyroxine. If anyone is interested, I'll post more but thought I'd first ask whether anyone has been prescribed sodium oxybate and what effects it had on them?
Helvella , Thank you for this interesting post . I for one would be very interested to learn more about the connections .
I've never heard of it before. And coming from a lifelong insomniac that really is saying something!
So, yes, I'd be interested to know more.
The British National Formulary page is here:
bnf.nice.org.uk/drug/sodium...
The product documentation is here:
The text below was posted on a Usenet forum (that is almost dead with virtually no posts - alt.support.thyroid). There are several further responses in the thread, but this initial one is what caught my eye. Straight copy and paste with no editing at all.
Thyroid and Sleep
The field of Endocrinology firmly believes the TSH and Free-T4 tests are
indicative of overall thyroid condition. Yet despite this there are many
patients who report feeling better with excess Levothyroxine.
A close relative of mine is one of them and due to wanting to confirm or
dispute the claim I ended up having an interesting experience.
I'm dealing with a debilitating sleep issue, the sort where sleep
medicine gets serious. A while back I simply asked a doctor with skill
in sleep medicine to throw everything at me and we'll see what sticks.
After many things had shown no benefit Levothyroxine finally hit the top
of the queue. What I was looking for was to simply try a classic
titration as was used up to the late 1970s.
Levothyroxine ended up having only a miniscule effect on my sleep issue.
It did have a /miniscule/ effect though, and I got to 75mcg before my
Endocrinologist of the time terminated the experiment. By pure accident
this experiment was terminated /after/ my sleep medicine doctor had moved
onto the last resort.
The last resort was sodium oxybate (sodium salt of gamma-hydroxybutyric
acid). Suddenly I felt *wonderful*. For what is apparently the first
time in my life I was *truly* awake. Soon after starting this, the
Endocrinologist terminated the experiment with Levothyroxine.
Insert your favorite metaphor or simile here for what happened three days
after the Endocrinologist terminated the Levothyroxine experiment. Being
hit by a bus, run over by a train, airplane crash, or choose your
favorite alternative. Let us say I felt rather worse on sodium oxybate
by itself.
What we have here is an extremely boring, yet extremely interesting drug
interaction. Ask a doctor of Sleep Medicine about the two drugs. In
particular ask about their effects and origins.
Levothyroxine is a stereo-isomer of T4 (a human, and other mammal
hormone), it treats variants of hypothyroidism and *nothing* else. There
are a few case where induced hyperthyroidism is beneficial (thyroid
cancer), but those are almost certainly exceedingly unpleasant. As such,
ask about the sleep effects of hypothyroidism.
Hypothyroidism is documented to suppress N3 sleep and cause central
apneas. Both of these sleep effects are Bad(tm). As a result of this,
Levothyroxine would be expected to increase N3 sleep and reduce frequency
of central apneas.
Gamma-hydroxybutyric acid was originally synthesized in the 1870s. It
wasn't until the 1970s that it was discovered to be a human (and other
mammal) nervous system chemical. Gamma-hydroxybutyric acid is documented
to have two sleep effects, it is *the* most potent promoter of N3 sleep
ever found, but has the adverse effect of causing central apneas.
This is an *extremely* boring interaction, because my medical record
suggests they did what they're documented to do. Yet despite that, this
*does* qualify as a drug interaction since they did influence each other.
The difference between no treatment and Levothyroxine was miniscule. The
difference between sodium oxybate; versus sodium oxybate with
Levothyroxine was gigantic (small improvement, versus complete
treatment).
This is an *extremely* interesting interaction, because we've got
chemicals normally found in the human body interacting. This might then
lead to topics for several papers:
Sleep and Hypothyroidism: Hypothyroidism has its documented sleep
effects by interfering with gamma-hydroxybutyric acid.
New Symptom-centered Test for Hypothyroid-type Conditions: Give the
patient sodium oxybate, and run a sleep test. Anything below 15% N3
sleep would be worrisome, below 10% N3 sleep would mean an urgent need
for some amount of Levothyroxine.
My medical record and observations point to a few other points which may
be worthy of study. Taken without Levothyroxine, sodium oxybate takes a
long time to take effect (>1 hour), once Levothyroxine is present a
sleep test showed a sleep latency of 20 minutes. Perhaps patients who
experience rapid onset (<15 minutes, there are reports of taking effect
in less than one minute) should be checked for Hyperthyroidism?
While hypothyroidism is /documented/ to suppress N3 sleep and cause
central apneas, my medical record suggests it might also cause hypopneas
and RERAs.
If you wish to criticize my report for "why hasn't anyone else noticed
this?" my response is easy. This is a /boring/ interaction. In order to
get an inkling of what is happening you need to have four experiences
relatively close together: no treatment, Levothyroxine alone, sodium
oxybate alone, and Levothyroxine with sodium oxybate.
Miss even a single one of those four and a patient won't have a clue
something interesting is happening, since everything will behave *as*
*expected*. Spread these experiences out over more than 5 years and it
becomes difficult to remember all of them and compare them.
Endocrinology also tries to prevent patients getting all four of these
experiences. Once you're on Levothyroxine, you rarely get off it so two
of the four experiences are semi-mutually exclusive.
Furthermore, sodium oxybate is not widely deployed. It does have a
number of highly valuable effects, but its criminal use stands in the way
of wide deployment.
My greatest fear is this test is squarely centered on the sleep effects
of hypothyroidism. I would strongly recommend to researchers to find out
how hypothyroidism causes osteoporosis. Such knowledge could be turned
into a different symptom-centered test for hypothyroidism. I'm very
worried such a test may give differing results from this sleep-centered
one. I suspect though such a test would correlate better with this sleep
test, than with the Free-T4 and TSH. Other trick is deploying this
sleep test (or a test derived from it) widely might cause the results of
osteoporosis candidate tests to stabilize since thyroid's actual effects
would stabilize.
If you're interested in starting World War III of Endocrinology, this
seems a good starting point.
One major issue, in order to actually recreate my experiences you need to
do a full titration of Levothyroxine. Absolutely no limit based on TSH
or Free-T4. If either of those is used as a limiter it could be the
combination saw no improvement due to actual thyroid hormone level being
too low.
A potential lesser test might be to form two groups of patients. Compare
how how much more N3 sleep 25mcg of Levothyroxine gives them. The
control group would be patients not on sodium oxybate. The study group
would be patients who get 7-12% N3 sleep on sodium oxybate. Weight would
need to be controlled for since greater body mass means less effect from
Levothyroxine. Ideally you would try greater amounts on patients who
weigh more.
The study group should see much greater gains of N3 sleep. The reasoning
for specifying 7-12% N3 sleep beforehand is to get patients more likely
to respond. Less than 7% N3 sleep and I would worry they might have a
severe thyroid problem which 25mcg wouldn't make enough of a difference
to be detected. More than 12% N3 sleep and I would be worried about pushing
patients into induced hyperthyroidism.
If you need medical records, contact me. If you're looking to recreate
this, you may be interested in just how far my Free-T4 has to be pushed
for me to feel good. I can also provide access to my family member who
has had access to what is too much Levothyroxine by the test results for
a decade, yet isn't in the slightest danger of osteoporosis.
--
butterflyattackgland AT a Ginormous MAILserver
(I had to come up with *something* nobody else had asked for)
jgelliss humanbean
That was very interesting! Then I imagined myself trying to discuss this with my doctor, and wanted to laugh but didn't quite manage it.
I would never get permission to try experiments with prescribed drugs. It took me nearly 25 years to get a prescription for 25mcg Levothyroxine after I was first told my thyroid was "borderline underactive".
I don't know why I thought so, but I would guess from the writing style that the author was male. Men are trusted by the medical profession far more than women are.
I also wonder where these experiments took place?
The thread degenerates rather, I'm sad to say. See if this link gets you to it:
groups.google.com/forum/#!t...
(You shouldn't have to sign in just to view.)
A quick scan does not identify where the poster is - maybe if I read it all carefully?
I suspect, but can't be sure, that they live in the US - I spotted this paragraph (which isn't really proof of anything) :
I've run into many Endocrinologists who go strictly by the tests, and the
few who are okay with TSH of 0.5 seem uncommon. At a very large, highly
respected medical institution (Massachusetts General Hospital) they have
turned thyroid into a sub-department of Endocrinology. "Thyroid
Associates" WILL NOT talk to you PERIOD without TSH or fT4 which are out
of range.
I would almost accuse you of living on another planet or at least outside
the US, despite your University of Michigan e-mail address. I've never
met an Endocrinologist who was okay with a TSH of 0.1.
Thyroid stimulating hormone
Buying natural thyroid hormone 
Sodium? In Levothyroxine?
Hallucinations with Levothyroxin Sodium 
