Subclinical hypothyroidism and patient response

[diogenes]

This paper shows that SCH can be accompanied by sleep problems amogst other things.

Wu et al. BMC Endocrine Disorders (2021) 21:112 doi.org/10.1186/s12902-021-...

Lifestyle is associated with thyroid function in subclinical hypothyroidism: a cross-sectional study

Kejun Wu1† , Yu Zhou1,2† , Sujie Ke1 , Jingze Huang1 , Xuelin Gao1 , Beibei Li1 , Xiaoying Lin1 , Xiaohong Liu1 , Xiaoying Liu1 , Li Ma1 , Linxi Wang1 , Li Wu1 , Lijuan Wu1 , Chengwen Xie1 , Junjun Xu1 , Yanping Wang 1* and Libin Liu1*

Abstract

Background: Few studies have focused on the association between lifestyle and subclinical hypothyroidism (SCH). The purpose of this study was to investigate the association between lifestyle and thyroid function in SCH.

Methods: This study was a part of a community-based and cross-sectional study, the Epidemiological Survey of Thyroid Diseases in Fujian Province, China. A total of 159 participants with SCH (81 males and 78 females) and 159 euthyroid (87 males and 72 females) participants without any missing data were included in the analysis. General information and lifestyle information including sleep, exercise, diet and smoking habits of the participants was collected by questionnaire and Pittsburgh sleep quality index scale (PSQI) was collected. Thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TgAb) and urine iodine concentration (UIC) were tested. Thyroid homeostasis parameter thyroid’ s secretory capacity (SPINAGT), Jostel’s TSH index (TSHI), thyrotroph T4 sensitivity index (TTSI) were calculated. Logistic regression and multiple linear regression were performed to assess associations.

Results: Compared with euthyroid subjects, patients with SCH were more likely to have poor overall sleep quality (15.1 vs.25.8 %, P = 0.018) and l less likely to stay up late on weekdays (54.7 vs. 23.9 % P < 0.001). In SCH group, exercise was the influencing factor of TSH ( β = -0.224, P = 0.004), thyroid secretory capacity ( β = 0.244, P = 0.006) and thyrotropin resistance ( β = 0.206, P = 0.009). Iodine excess was the influencing factor of thyroid secretory capacity ( β = 0.209, P = 0.001) and pituitary thyroid stimulating function ( β = 0.167, P = 0.034). Smoking was the influencing factor of pituitary thyroid stimulating function ( β = 0.161, P = 0.040). Staying up late on weekends was the influencing factor of thyroid secretory capacity ( β = 0.151, P = 0.047). After adjusting for possible confounders, logistic regression showed that those with poor overall sleep quality assessed by PSQI and iodine excess had an increased risk of SCH (OR 2.159, 95 %CI 1.186–3.928, P = 0.012 and OR 2.119, 95 %CI 1.008–4.456, P = 0.048, respectively).

[helvella]

Completely agree. Poor sleep started when my TSH was no higher than about 2.

I'll repeat what I have said many times in replies:

Before diagnosis, my sleep was badly disturbed. Typically, I would fall asleep fairly easily. Then wake up after something like half an hour to two hours. Once woken, I'd be unable to get back to sleep - often till dawn, or at all.

Once I started on levothyroxine, my sleep slowly improved. By the time I was taking an adequate dose, bad nights were unusual - just an occasional night where I might wake up for a while. Now, after years, I sleep very easily and deeply and rarely wake at all. If I do, I get back to sleep quickly.

The effect of poor sleep on day-time functioning is, of course, significant.

[TSH110 in reply to helvella]

Very significant. I suffered hideous sleep problems for decades. As soon as I started Levothyroxine I had immediate improvements. I rarely have any problems sleeping these days in fact I like falling asleep too much & can drop off in a nanosecond! Not when fully awake it anything scary like that - just at winding down times

[humanbean in reply to TSH110]

I suffered hideous sleep problems for decades.

Ditto. And I still do have huge sleeping problems.

In my late teens and my 20s I could, if I had the chance, actually sleep for 18 hours on the trot without ever waking up. In my 30s I could sleep for 15 hours without waking. My maximum sleeping time reduced by about three hours per decade. While I was working these long sleeps would usually only happen at weekends. During the week, if I was lucky, I would have to use alarm clocks that had a very good snooze function and I would be able to get up. Unfortunately I would often switch the alarm clock off (I would have no memory of doing so), and would go back to sleep.

If I was woken up before my body was ready to wake up I could actually be violent, and would lash out at my husband, for example. He learned to avoid me very easily, because a person who is 98% asleep can't aim very well. I never remembered any of this.

I also had misophonia :

en.wikipedia.org/wiki/Misop...

and would get almost homicidally angry when I was woken up by speech or music. My idea of hell would be to have a clock radio. Luckily, the homicidal anger is no longer an issue, but I still couldn't cope well with waking up to a clock radio or a TV even now.

Of course, the diagnosis I got from parents, siblings, friends, colleagues, doctors was that I must be the laziest person who ever existed. My parents dished out punishments galore. Society thinks that people like me are lazy scum. Nobody actually thought I might have some health problems, but as it turned out I had loads of them.

[TSH110 in reply to humanbean]

The converse of me - forever on the go, busy busy busy, trying to dissipate the excess energy. Yes I was admired for my energetic ways but it was a sign I was ill! Sorry you have been got at because your metabolism was on go slow it’s really not fair. I suspect no one is ínnately lazy it’s probably a sign that something is up. Same as people going through life at a million miles an hour - it’s abnormal.

[jgelliss in reply to helvella]

Same story by me too. Thank you helvella for describing the way it was for me too. I'm sure many others can relate to it too.

[humanbean]

After adjusting for possible confounders, logistic regression showed that those with poor overall sleep quality assessed by PSQI and iodine excess had an increased risk of SCH

Perhaps those with SCH had poor overall sleep quality. I certainly did.

The way they have written it the authors of this paper are suggesting cause and effect is the other way round, but how do they know that?

[helvella in reply to humanbean]

Yes - the way they discuss it is bizarre - my agreement was really that hypothyroidism can severely impact sleep - and it can be a very early symptom.

[jgelliss in reply to helvella]

Your right helvells. On the flipp side too when I'm hyper I go through the same problem. Hard to fall asleep wake up can't get back to sleep. It's like a vicious cycle. I know when I'm not on the right dose my body let's me know these little signs.

[TSH110 in reply to humanbean]

Chicken or egg? My moneys on SCH >sleep problems not the other way round because thyroid hormones are key in body clock function so lack or excess of them starts mucking up all those finely tuned clocks as I can attest to after resorting to staying awake for two days at a time to try and force myself to sleep a little in the night. The desired to nod off at 6 am and midday were very strong my body clocks were in utter chaos plus all the itching at 7pm on the dot. It was a tad more than SCH by then but I rarely slept for more than 4 hours a night since I was in my 20’s. It could have been over activity of thyroid tho.

How could it work the other way round? It’s making a symptom the cause.

[humanbean in reply to TSH110]

I can attest to after resorting to staying awake for two days at a time to try and force myself to sleep a little in the night.

I used to do that quite regularly. But I'm getting on a bit now and I can't do it any longer. I have to do things the other way i.e. go to bed later and later until eventually I'm sleeping at night and awake during the day. Unfortunately I revert to being nocturnal really easily and usually very quickly.

[TSH110 in reply to humanbean]

Yes left to my own devices I go to sleep later and later each day until I’m awake half the night or more. I must work on a 26 hour day!

[bookish in reply to TSH110]

Not sure but this, drgominak.com/sleep/, seems to imply that we make thyroid hormones during sleep. Interesting article, even if that isn't the case. Cheers

[TSH110 in reply to bookish]

That’s interesting it would explain why it’s low on waking and builds up in the day. Thanks for the link, it’s a most interesting read.

[jimh111]

Thanks. Full paper here Lifestyle is associated with thyroid function in subclinical hypothyroidism: a cross-sectional study .

[helvella in reply to jimh111]

Did you mean to post a link?

[jimh111 in reply to helvella]

Who nicked my link? Can't leave anything lying around here. Until we track down the thief here is another link bmcendocrdisord.biomedcentr... .

[Gcart]

My sleep pattern went from ‘normal’ to only 3/4 broken hours a night . Overhead fan on full blast . One winter it was often minus 5.

It was about 10 years to get a diagnosis of thyroid cancer ! .

I take combo T4/T3 now do rather better but rarely do I go more that 5 hours straight . That’s a blessing though, snd I am grateful for that .

This said no symptoms with thyroid cancer but that wasn’t my experience and the sleep problem was only 1 of them !