Thyroid Dysfunction and Sleep Disorders

Probably not a substantial claim: may not pass S3 (load-bearing).

Sridhar et al. suggested that elevated levels of thyroid hormone were associated with several components of sleep dysfunction, including prolonged sleep latency, difficulty maintaining sleep, and excessive daytime sleepiness.

“Sridhar et al. (4) suggested that elevated levels of thyroid hormone were associated with several components of sleep dysfunction, including prolonged sleep latency, difficulty maintaining sleep, and excessive daytime sleepiness.”

• cites [4] Sridhar, 2011, Sleep in Thyrotoxicosis, Indian J Endocrinol Metab sourcePartly supported

  The Discussion reports associations between hyperkinetic features in patients with thyrotoxicosis and difficulty falling or staying asleep. The Results say patients with hand tremors were less likely to have excessive daytime sleepiness, rather than establishing the claimed association with that symptom. The cited passages concern diagnosed thyrotoxicosis and its features, not an association measured against thyroid hormone levels. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Chattopadhyay et al. assessed 36 patients with newly diagnosed Graves disease and comorbid psychiatric concerns, including 41% with generalized anxiety disorder, 16% with obsessive-compulsive disorder, and 16% with undifferentiated mood disorders.

“Chattopadhyay et al. (7) assessed a group of 36 patients in India with newly diagnosed Graves disease and comorbid psychiatric concerns, including 41% with generalized anxiety disorder, 16% with obsessive-compulsive disorder, and 16% with undifferentiated mood disorders.”

• cites [7] Chattopadhyay, 2012, An Assessment of Psychiatric Disturbances in Graves Disease in a Medical College in Eastern India, Niger J Clin Pract sourcePartly supported

  The Materials and Methods passage reports 36 newly diagnosed Graves disease patients, of whom 31 had psychiatric manifestations. It gives 41.67% with generalized anxiety disorder and 16.67% each with obsessive-compulsive disorder and mood disorder, consistent with the cited approximate percentages. It does not describe the mood disorders as “undifferentiated.” No page number is available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Bahammam et al. evaluated 271 patients referred for sleep studies and found that among patients with confirmed OSA, the prevalence of newly diagnosed clinical hypothyroidism was 0.4%, whereas it was 1.4% in patients without OSA.

“A study by Bahammam et al. (20) evaluated 271 patients referred for sleep studies and measured the patients’ TSH and T4 levels to determine the prevalence of thyroid disease. Among the patients with confirmed OSA, the prevalence of newly diagnosed clinical hypothyroidism was 0.4%, whereas it was 1.4% in patients without OSA.”

• cites [20] Bahammam, 2011, Prevalence of Thyroid Disease in Patients With Obstructive Sleep Apnea, Respir Med sourcePartly supported

  The Results report the claimed 0.4% and 1.4% prevalences of newly diagnosed clinical hypothyroidism. However, 271 was the number of patients with OSA, not the total referred group: the study also tested 76 patients without OSA. (LLM, conf=0.93)

  Experimental — accuracy not yet measured

May combine two claims.

In Chattopadhyay et al.'s study, both treatment groups showed significant improvement in symptoms of insomnia, irritability, and anxiety.

“The study showed significant improvement in symptoms of insomnia, irritability, and anxiety for both groups.”

• cites [7] Chattopadhyay, 2012, An Assessment of Psychiatric Disturbances in Graves Disease in a Medical College in Eastern India, Niger J Clin Pract sourcePartly supported

  The Results report significant improvement in both treatment groups, and the Materials and Methods passage reports significant improvement in psychiatric rating scores at one year. The paper identifies insomnia, irritability, and anxiety as common symptoms, but does not report significant improvement for each of those symptoms separately in both groups. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Song et al. showed that people with lower thyroid hormone levels or even subclinical hypothyroidism generally have longer sleep latency, shorter sleep duration, and lower satisfaction with their sleep quality compared with euthyroid individuals.

“Song et al. (8) showed that people with lower thyroid hormone levels or even subclinical hypothyroidism generally have longer sleep latency, shorter sleep duration, and lower satisfaction with their sleep quality compared with euthyroid individuals.”

• cites [8] Song, 2019, The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study, Risk Manag Healthc Policy sourcePartly supported

  The Results report that the subclinical hypothyroidism group had lower subjective sleep quality and longer sleep latency than the euthyroid group; adjusted analyses also found a greater likelihood of sleeping less than five hours. The Methods define subclinical hypothyroidism by elevated TSH with normal fT3 and fT4, so the study does not establish the same sleep pattern for people with lower thyroid hormone levels generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Both Song et al. and Akatsu et al. had relatively small sample sizes, and neither study effectively investigated or identified the actual mechanisms by which lower thyroid hormone levels might affect sleep quality.

“Both studies had relatively small sample sizes, and neither study effectively investigated or identified the actual mechanisms by which lower thyroid hormone levels might affect sleep quality.”

• cites [8] Song, 2019, The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study, Risk Manag Healthc Policy sourcePartly supported

  Song et al.’s Discussion says their cross-sectional study could not establish causality and offers hypotheses rather than identifying a mechanism, supporting that part of the claim. But the Methods report 14,846 participants, and the Discussion calls this a large population—not a relatively small sample. This verdict addresses Song et al.; their paper does not establish whether Akatsu et al. investigated mechanisms. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [9] Akatsu, 2014, Association Between Thyroid Function and Objective and Subjective Sleep Quality in Older Men: The Osteoporotic Fractures in Men (MrOS) Study, Endocr Pract sourcePartly supported

  The Discussion (page unavailable) explicitly identifies a small number of subjects, especially in the subclinical hyperthyroid group. The Methods describe analyses of associations between thyroid function and sleep outcomes, not tests of a biological mechanism. This paper does not establish the parallel claims about Song et al.; it also does not establish a mechanism by which lower thyroid hormone levels affect sleep quality. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

In Bahammam et al.'s study, the prevalence of newly diagnosed subclinical hypothyroidism was 11.1% for patients with OSA and 4% for patients without OSA.

“However, the prevalence of newly diagnosed subclinical hypothyroidism was 11.1% for patients with OSA and 4% of patients without OSA.”

• cites [20] Bahammam, 2011, Prevalence of Thyroid Disease in Patients With Obstructive Sleep Apnea, Respir Med sourceSupported

May combine two claims.

Hyperthyroidism and thyrotoxicosis are common and well-known causes of sleep dysfunction.

“Hyperthyroidism, defined as the presence of increased thyroid activity, and thyrotoxicosis, defined as the presence of too much thyroid hormone, are common and well-known causes of sleep dysfunction.”

May combine two claims.

Stern et al. assessed 137 patients with Graves disease and reported that 66.4% had difficulty falling asleep.

“Stern et al. (3) assessed 137 patients with Graves disease, the most common cause of hyperthyroidism, and reported that 66.4% of study participants had difficulty falling asleep.”

• cites [3] Stern, 1996, A Survey Study of Neuropsychiatric Complaints in Patients With Graves' Disease, J Neuropsychiatry Clin Neurosci Spring sourceNot checked — no full text of the source

May combine two claims.

Kittle and Chaudhary showed that thyroid hormone therapy could diminish (or in some cases, completely eliminate) apneic episodes and arterial oxygen desaturations, thus improving sleep satisfaction and sleep efficiency.

“This finding was corroborated by Kittle and Chaudhary (16), who showed that thyroid hormone therapy could diminish (or in some cases, completely eliminate) apneic episodes and arterial oxygen desaturations, thus improving sleep satisfaction and sleep efficiency.”

• cites [16] Kittle, 1988, Sleep Apnea and Hypothyroidism, South Med J sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Mete et al. described that hypothyroidism could alter ventilatory drive and respiratory muscle function.

“Hypothyroidism also could alter ventilatory drive and respiratory muscle function.”

• cites [14] Mete, 2013, Relationship Between Obstructive Sleep Apnea Syndrome and Thyroid Diseases, Endocrine sourceNot checked — no full text of the source

May combine two claims.

Both Lin et al. and Kittle and Chaudhary reported that some patients did not have improvements in their sleep experience with thyroid hormone replacement therapy.

“However, both studies reported that some patients did not have improvements in their sleep experience with thyroid hormone replacement therapy.”

• cites [15] Lin, 1992, The Relationship Between Sleep Apnea Syndrome and Hypothyroidism, Chest sourceNot checked — no full text of the source
• cites [16] Kittle, 1988, Sleep Apnea and Hypothyroidism, South Med J sourceNot checked — no full text of the source

May combine two claims.

Disordered sleep and psychiatric problems are closely tied to excessive thyroid activity, and treatment of thyroid dysfunction can improve or resolve the associated psychiatric symptoms.

“These findings support the idea that disordered sleep and psychiatric problems are closely tied to excessive thyroid activity, and treatment of the thyroid dysfunction can improve or resolve the associated psychiatric symptoms.”

Probably not a substantial claim: may not pass S4 (based).

Thyroid dysfunction can contribute to a myriad of symptoms that involve nearly every system in the body, including sleep function.

“Thyroid dysfunction can contribute to a myriad of symptoms that involve nearly every system in the body, including sleep function.”

May combine two claims.

Even if thyroid hormone deficiency is not directly causing insomnia, the wide range of symptoms associated with thyroid dysfunction can easily exacerbate sleeping difficulties and reduce a person's ability to achieve quality, restful sleep.

“Even if thyroid hormone deficiency is not directly causing insomnia, the wide range of symptoms associated with thyroid dysfunction can easily exacerbate sleeping difficulties and reduce a person’s ability to achieve quality, restful sleep.”

May combine two claims.

Even though current evidence suggests that thyroid hormone levels are not markers of sleep dysfunction, untreated thyroid dysfunction clearly can affect a person's ability to achieve healthy, restful sleep.

“Even though current evidence suggests that thyroid hormone levels are not markers of sleep dysfunction, untreated thyroid dysfunction clearly can affect a person’s ability to achieve healthy, restful sleep.”

May combine two claims.

In Petrone et al.'s study, after treatment with continuous positive airway pressure, 100% of patients with NTIS had T3 levels increase to the normal range, and 75% of patients with subclinical hypothyroidism had a decrease in TSH levels.

“After treatment with continuous positive airway pressure, 100% of patients with NTIS had T3 levels increase to the normal range, and 75% of patients with subclinical hypothyroidism had a decrease in TSH levels.”

• cites [19] Petrone, 2016, Abnormal Thyroid Hormones and non-Thyroidal Illness Syndrome in Obstructive Sleep Apnea, and Effects of CPAP Treatment, Sleep Med sourceNot checked — no full text of the source

May combine two claims.

Although thyroid dysfunction does not appear to directly cause RLS, it does affect RLS symptoms.

“Although thyroid dysfunction does not appear to directly cause RLS, it does affect RLS symptoms.”

May combine two claims.

In Tan et al.'s study, 12 patients (8.2%) with confirmed thyroid disorders had RLS-like symptoms, whereas only 4 control patients (0.9%) were similarly affected.

“Their study evaluated 146 patients with biochemically confirmed thyroid disorders and 434 control patients without thyroid disorders. Twelve patients (8.2%) with confirmed thyroid disorders had RLS-like symptoms, whereas only 4 control patients (0.9%) were similarly affected.”

• cites [21] Tan, 2004, Restless Legs Symptoms in Thyroid Disorders, Parkinsonism Relat Disord sourceNot checked — no full text of the source

May combine two claims.

Although thyroid dysfunction is generally not thought to be among the primary causes of OSA, studies have shown that they appear to be related.

“Although thyroid dysfunction is generally not thought to be among the primary causes of OSA, studies have shown that they appear to be related.”

May combine two claims.

Hyperthyroidism can cause or worsen other conditions such as anxiety or depression, which in turn can further impair sleep and insomnia.

“Additionally, hyperthyroidism can cause or worsen other conditions such as anxiety or depression, which in turn can further impair sleep and insomnia (6).”

• cites [6] Trzepacz, 1988, A Psychiatric and Neuropsychological Study of Patients With Untreated Graves' Disease, Gen Hosp Psychiatry sourceNot checked — no full text of the source

May combine two claims.

Although many studies support the hypothesis that OSA is associated with thyroid dysfunction, the level of thyroid dysfunction does not appear to predict OSA severity and the severity of OSA may have subtle effects on thyroid hormone levels.

“Although many studies support the hypothesis that OSA is associated with thyroid dysfunction, the level of thyroid dysfunction does not appear to predict OSA severity and the severity of OSA may have subtle effects on thyroid hormone levels.”

May combine two claims.

Bielicki et al. indicated that although hypothyroidism may be a contributing, if not causal, component of OSA for some patients, most patients with OSA have normal thyroid function or do not have improvement in sleep symptoms with thyroid treatment.

“Bielicki et al. (17) indicated that although hypothyroidism may be a contributing, if not causal, component of OSA for some patients, most patients with OSA have normal thyroid function or do not have improvement in sleep symptoms with thyroid treatment.”

• cites [17] Bielicki, 2016, Thyroid Hormone Levels and TSH Activity in Patients With Obstructive Sleep Apnea Syndrome, Adv Exp Med Biol sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The specific pathophysiologic mechanism by which hypothyroidism may contribute to OSA remains relatively elusive.

“However, the specific pathophysiologic mechanism remains relatively elusive.”

Classified as probably not a substantial claim.

Tan et al. suggested that elevated levels of thyroid hormone can be an inciting stimulus for RLS-like symptoms, such as tremors, hyperkinetic states, and insomnia.

“Tan et al. (21) suggested that elevated levels of thyroid hormone can be an inciting stimulus for RLS-like symptoms, such as tremors, hyperkinetic states, and insomnia.”

• cites [21] Tan, 2004, Restless Legs Symptoms in Thyroid Disorders, Parkinsonism Relat Disord sourceNot checked — no full text of the source

May combine two claims.

Although sleep dysfunction is not among the most common symptoms that clinicians associate with thyroid disorders, thyroid and sleep dysfunction commonly co-occur.

“Although sleep dysfunction is not among the most common symptoms that clinicians associate with thyroid disorders, thyroid and sleep dysfunction commonly co-occur.”

May combine two claims.

Petrone et al. evaluated 125 patients with moderate to severe OSA plus 60 control patients and showed that 10.4% of patients with OSA had nonthyroidal illness syndrome (NTIS), defined as normal TSH and low T3 levels.

“Interestingly, Petrone et al. (19) evaluated 125 patients with moderate to severe OSA plus 60 control patients with normal nocturnal respirations and showed that 10.4% of patients with OSA had nonthyroidal illness syndrome (NTIS), defined as normal TSH and low T3 levels.”

• cites [19] Petrone, 2016, Abnormal Thyroid Hormones and non-Thyroidal Illness Syndrome in Obstructive Sleep Apnea, and Effects of CPAP Treatment, Sleep Med sourceNot checked — no full text of the source

May combine two claims.

Many studies, including Bruyneel et al., showed that TSH and T4 levels were not significantly different among patients with moderate or severe OSA, suggesting that thyroid hormone levels are not necessarily a marker of OSA severity.

“In fact, many studies, including one by Bruyneel et al. (18), showed that TSH and T4 levels were not significantly different among patients with moderate or severe OSA, suggesting that thyroid hormone levels are not necessarily a marker of OSA severity.”

• cites [18] Bruyneel, 2019, Prevalence of Newly Established Thyroid Disorders in Patients With Moderate-to-Severe Obstructive Sleep Apnea Syndrome, Sleep Breath sourceNot checked — no full text of the source