Elevated thyroid-stimulating hormone levels are associated with poor sleep: a cross-sectional and longitudinal study

[helvella]

Where to start?

Measuring TSH-only.

Selection of subjects.

Failure to demonstrate causality.

As far as I am concerned, I am 100% convinced that adequate thyroid hormone improved my sleep very considerably. If someone had checked my TSH every day, they would very likely have seen quality of sleep going up and TSH going down. But both (in my view) are due to levothyroxine.

If a temporary issue had caused thyroid hormone levels to drop, TSH to rise and sleep to deteriorate, then as that issue resolves you'd expect thyroid hormone levels to rise, TSH to fall and sleep to improve - without invoking TSH as the mediator.

Perhaps I am getting the wrong end of the stick.

Endocrine. 2021 Aug 25.

doi: 10.1007/s12020-021-02849-0. Online ahead of print.

Elevated thyroid-stimulating hormone levels are associated with poor sleep: a cross-sectional and longitudinal study

Yuerong Yan # 1 2 , Jiaqi Li # 1 , Huairong Tang 3 , Youjuan Wang 3 , Weiwei Zhang 1 , Hui Liu 1 , Leilei Zhu 1 , Zhen Xiao 1 , Hailing Yang 4 , Yerong Yu 5

Affiliations

• PMID: 34432233

• DOI: 10.1007/s12020-021-02849-0

Abstract

Purpose: Poor sleep accompanied by elevated TSH (thyroid stimulating hormone) levels is not uncommon since TSH secretion is controlled by the circadian rhythm. However, the relationship between poor sleep and TSH elevation is unclear; hence, we aimed to elucidate this relationship by conducting a cross-sectional and longitudinal study.

Methods: Participants with isolated elevated (N = 168) and normal (N = 119) TSH concentrations were recruited, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep status. Subjects with an isolated TSH elevation were followed up longitudinally. The serum TSH concentration was remeasured after sleep status improved.

Results: The proportions of poor sleep and occasional poor sleep in subjects with isolated TSH elevation were significantly higher than those with normal TSH levels (70.24% vs. 49.58%, p = 0.001; 9.52% vs. 1.68%, p = 0.006). Subjects with isolated TSH elevation had significantly higher PSQI scores in the subjective sleep quality, sleep latency, sleep duration, and habitual sleep efficiency dimensions than those with normal TSH levels (all p < 0.05). Poor sleep was significantly associated with isolated TSH elevation in the multiple logistic regression analysis [odds ratio (OR) = 2.396, p = 0.001]. Among subjects with an isolated TSH elevation at baseline, the percentage of TSH normalization was significantly higher in those who slept better than in those who still slept poorly (85.42% vs. 6.45%, p < 0.001).

Conclusions: This study revealed that isolated elevated TSH concentrations normalize when the sleep status is improved; hence, we recommend that clinicians thoroughly assess the sleep status of patients and remeasure TSH concentrations after sleep status improves.

Keywords: Poor sleep; Sleep improvement; Subclinical hypothyroidism; TSH elevation.

Rest of article inaccessible behind paywall:

pubmed.ncbi.nlm.nih.gov/344...

[jimh111]

This is useful, I will try and get the full copy from the British Library sometime. I feel sleep monitoring can be used to monitor thyroid status, especially in patients with impaired deidinase due to low TSH secretion (secreting too little TSH for their low normal fT3, fT4). See ibshypo.com/index.php/subno... .

Will need to read the full study but it looks like these patients have mild thyroid failure. Another possibility is that good sleep lowers TSH by prehaps producing more bioactive TSH (the correspondinig fT3, fT4 figures would confirm this). I think it is poor sleep due to hypothyroidism rather than good sleep altering TSH isoforms.

[jgelliss]

Great post as usuall helvella. Thank you so much sharing this valuable information . What I also found very helpful with being Optimally dosed with thyroid meds was the right Iron levels vitamin "D" B-12 too. It's a whole concerted effort.

[Doris11]

That will never happen 🤦‍♀️🤦‍♀️🤦‍♀️

[tattybogle]

wait for it ... " New research based Advice for GP's ~ before diagnosing or treating any patient for subclinical hypothyroidism , first ask if they have poor sleep . if they say 'yes' send them off with patient advice leaflet on 'sleep hygiene' , as once sleep pattern is improved their impending thyroid problem will have magically been cured , and even if it isn't they'll have buggered off out of you waiting room for now "

How are they going to work out what is/isn't an 'isolated ' elevated TSH , when they still haven't noticed there's a diurnal rhythm involved ?

[TSH110 in reply to tattybogle]

Damn you beat me to it!! Great minds think alike 😉 Odd how my sleep suddenly miraculously improved (even) on Levothyroxine and sleep hygiene came back naturally to me. I can’t seriously believe poor sleep hygiene causes thyroid disorder. I thought it was agreed that a failing thyroid gland causes symptoms of sleep disturbance no matter what sleep hygiene measures you try and force upon yourself! I had to stay awake for a full 48 hours to try and keep a job down whilst struggling with a serious undiagnosed thyroid disorder my sleep was so terribly disordered, but once I started on T4 matters improved and perfect sleep hygiene came to me on NDT, these researchers are plain daft.

[TSH110]

I can see the next development: it’s not a thyroid disorder it’s just poor sleep hygiene.

[jimh111]

T3 is essential for good quality sleep. We usually get it by converting T4 in the brain but when this fails there is poor sleep leading to fatigue and muscular aches and pains (80% of growth hormone is produced in deep sleep).

We can't measure brain T3 levels but we can go one better by indirectly measuring brain T3 activity by monitoring sleep using EEG. An ideal study would take people with signs and symptoms of hypothyroidism and normal TFTs and compare their sleep EEG with controls. For those with impaired sleep EEG an incremental trial of L-T3 couold be used to determine what dose is required to normalise sleep EEG (within safety limits). This is the sort of science based research which is not done in endocrinology.

[nightingale-56]

After having not been on any Thyroid treatment for 19 years after a sub-total thyroidectomy in 1978, my sleep very quickly improved once started on Levothyroxine (Cox). My sleep got bad again in 2010 when Goldshield Eltroxin was changed for Mercury Pharma Levothyroxine and has improved once again on NDT. Each time it has improved my TSH was under 1 and my FT3 was 5.6-5.7 (3.1 - 6.8).