Sleep: Underactive & Overactive Thyroid

There is part of the brain called the Suprachiasmatic Nucleus (Just call it the SCN) and it is located in the Hypothalamus. It's in charge of the master circadian clock which regulates our bodies 24 hour cycle called the circadian rhythm.

The SCN releases different hormones that control different functions. One of these hormones, the thyrotropin, stimulates the thyroid to release thyroid hormones. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body, even the way your heart beats. Without enough thyroid hormones, many of your body’s functions slow down.

If the thyroid is overactive or underactive, this can disrupt the production of thyrotropin and your overall circadian rhythm. This is why thyroid imbalances are linked to sleep problems.

A study found that people who sleep seven hours or less per day are at greater risk of developing hyperthyroidism, although sleeping more than nine hours per day might increase the risk of both overactive and underactive thyroid function. Therefore, the aim would be to improve the quality of sleep at a healthy eight hours per night.

Hypothyroidism (Underactive Thyroid)

Having an underactive thyroid is when the thyroid gland doesn’t produce the amount of thyroid hormones that your body needs. Studies have linked an underactive thyroid to poor quality sleep, increasing the time of how long it takes to fall asleep and having a shorter sleep duration overall. Also, it can increase the risk of sleep apnoea and obesity which can also play a role in insomnia.

Hashimoto Thyroiditis:

The most common cause for hypothyroidism is Hashimoto's disease which is an autoimmune disorder. The immune system attacks the thyroid making the number of hormones produced inadequate. Hashimoto Thyroiditis can be a cause or consequence of obstructive sleep apnoea (OSA). The risk of developing severe OSA increases with obesity or type 2 diabetes.

Sleep apnoea is when your breathing stops during sleep for 10 seconds or longer and may happen a few times a night. 4 in 10 people with an underactive thyroid have sleep apnoea.

Thyroiditis is another cause. It inflames the thyroid which then causes the hormones that are stored to then leak out of your thyroid gland. At first, the leakage increases hormone levels in the blood, leading to hyperthyroidism and may last for up to 3 months. The thyroid might then become underactive and usually lasts between 12 to 18 months, but is sometimes permanent.

Symptoms that affects Sleep:

• Weight gain

• Tiredness

• Muscle aches

• Weakness

• Sensitivity to cold

• Constipation

• Difficulty getting to sleep

Younger individuals and women are all considered at higher risk of developing sleep problems due to hypothyroidism.

You are more likely to develop hypothyroidism if:

• Previous thyroid issue, such as goitre

• Have health problems such as:

  • Type 1 Diabetes

  • Pernicious Anaemia (Vitamin B12 deficiency)

  • Lupus (Chronic inflammation condition)

• Consuming excessive amounts of iodine

• Previous surgery to treat a thyroid problem

• Pregnant in the last 6 months

Treatment for an Underactive Thyroid

It is relatively easy to diagnose and treat thyroid problems, but blood tests are the only way to reliably confirm a diagnosis of hypothyroidism.

Medication:

The medication for hypothyroidism is thyroid hormone itself. It's called Levothyroxine and can only be prescribed by the doctor. Make sure you take the medication consistently otherwise the results of the blood tests can be affected. It is also best absorbed on an empty stomach and is recommended to eat food about 30 minutes after.

Unfortunately, Levothyroxine will most likely make it difficult for you to sleep. If you are prescribed high doses, then it could escalate to insomnia.

Combination Therapy:

Combination therapy involves taking both Levothyroxine and Triiodothyronine (T3), and was the first treatment for hypothyroidism. Here in the UK, the NHS very rarely use combination therapy due to the lack of evidence to show that it is better than just taking Levothyroxine alone. They say it should be avoided because it carries a risk of causing side effects, such as atrial fibrillation (abnormally fast heart rate), strokes, osteoporosis and fracture.

There have also been 10-12 worldwide studies designed to look at combination therapy in a systematic manner using different ratios of Levothyroxine to T3 and also four meta-analyses. None of those studies showed any consistent effect of combination therapy.

This type of treatment may sometimes be recommended in cases where a person has a history of thyroid cancer and has a significant risk of it reoccurring.

Hyperthyroidism (Overactive Thyroid)

Graves' disease is an autoimmune disorder and is the most common cause for Hyperthyroidism. It is where the immune system attacks the thyroid, causing it to then produce too much thyroid hormone.

Another cause for hyperthyroidism are overactive thyroid nodules. This usually occurs in older adults 60+. Thyroid nodules are lumps in your throat that also produce higher amounts of thyroid hormone. Taking too much thyroid hormone medicine can also raise your thyroid hormone levels.

Symptoms that affects Sleep:

• Fast weight loss

• Tiredness

• Difficulty getting to sleep

• Weakness

• Increased sweating

• Sensitivity to heat

• Nervousness

• Fast heart rate

• Diarrhoea

• Excessive Hunger

These symptoms make it difficult to sleep and could also lead to sweating at night and frequent urges to urinate. Menopause is commonly associated with night sweats.

You are more likely to develop hyperthyroidism if:

• Have health problems such as:

  • Type 1 Diabetes

  • Pernicious Anaemia (Vitamin B12 deficiency)

  • Primary Adrenal Insufficiency (Hormone disorder)

• Consuming excessive amounts of iodine

• Certain heart medications

• Adults 60+, especially women

Treatment for an Overactive Thyroid

Radioactive Iodine Treatment:

It sounds very intense but it's nothing to worry about. People are given a drink or a tablet that contains iodine and a low dose of radiation, which is absorbed by the thyroid. Most people only need a single treatment. This is a very effective treatment and can cure an overactive thyroid. It may take a while for results to show and therefore medication will be prescribed.

Medication:

For hyperthyroidism, there are two medications that are commonly used in the UK: Carbimazole and Propylthiouracil. Both of these medications can cause tiredness. They work by reducing the amount of thyroid hormone released into the circulation. They are either used for short term to prepare for surgery or radioactive iodine treatment, or long term for patients with Graves’ disease. Carbimazole is the first choice drug, but if it's not tolerated in the system or the patient is pregnant then propylthiouracil is used.

Surgery:

It is sometimes recommended to have surgery if:

• Thyroid is severely swollen due to large goitre

• Your symptoms return after previous treatment

• You can't have other treatments

If the entire thyroid gland is removed then patients would have to take the medication for the rest of their life to make up for no longer having a thyroid gland. These are the same medications used to treat an underactive thyroid.

Tips for Better Sleep

1. Temperature The average recommendation for a bedroom temperature is around 18°c. But for those who have a thyroid disease are recommended to have between 15.5-19.3°c. This is because having an overactive thyroid can affect your tolerance to heat and having an underactive thyroid affects your tolerance to the cold.
   

2. Track Your Sleep Help your doctor help you by sharing any new or continuous physical symptoms by keeping a sleep journal.
   

3. Healthy Eating One of the crucial parts of good sleep hygiene is having a healthy diet. Heavy meals leading up to bedtime can be disruptive to sleep, so it’s better to go for lighter meals instead. People with thyroid issues should pay close attention to their iodine intake. I am very big on tracking iodine as it is an important mineral for everyone, but having too much or too little can affect thyroid activity. You will also want to avoid caffeine and alcohol before going to bed, as both can disrupt sleep.
   

Supplements

I have looked into the safety of these 3 following supplements being taken alongside thyroid medication. However, it is always recommended for you to talk to your doctor before you begin taking a supplement or make any changes to your existing medication.

1. Melatonin If you have circadian rhythm disturbances due to thyroid issues, then know that melatonin is a circadian rhythm regulator. Two separate benefits of melatonin are that It is a potent fighter against the growth and spread of cancer cells and prevents the formation of two proteins that are key biological markers of Alzheimer’s disease. But be aware that those with autoimmune issues or lymphatic cancers may find melatonin to cause depression. This isn’t a concern in those with just hypothyroidism, but those with Hashimoto’s should be aware.
   

2. Magnesium Magnesium deficiency is common for adults. It is an essential mineral that your body needs in high quantities. People with low magnesium often experience restless sleep and waking frequently throughout the night. Insomnia is a common symptom of magnesium deficiencies. Maintaining healthy magnesium levels often leads to deeper and better sleep. Because it is not produced in your system, you need to find it in foods and/or supplements. Magnesium rich foods Include; nuts, meat, dairy, broccoli and leafy greens. Supplemental magnesium is also quick and effective and I usually take it in the evening an hour or so before hopping into bed. It has been shown to have a stabilising effect on mood. It is effective in relieving symptoms of moderate anxiety and moderate depression. There are different types of magnesium and I recommend magnesium glycinate. Magnesium citrate is usually the cheapest, but that is due to the poor quality and can also cause diarrhoea.
   

3. Taurine Taurine is an amino acid, but unlike other amino acids, it doesn't build protein. However, it supports the body in other ways such as hydration, mineral regulation and supporting sleep. It plays a positive role in calming the nerves. Taurine decreases anxiety and has been used to help those with seizures. A good benefit about taurine is that it won’t make you sleepy if you take it during the day.

Stats and Facts

Here are the statistics and interesting facts from the UK and US.

UK:

• Estimations show that 1 in 20 people in the UK have a thyroid problem.

• NHS estimates that 1 in 50 women have an overactive thyroid.

• Women are 6 times more likely to have an overactive thyroid than men.

• Women are 10 times more likely to have an underactive thyroid than men.

• The number of thyroid prescriptions in the same 4 year period has risen by 5006.

• Levothyroxine is the third most prescribed drug in the UK.

• In March, April, May and June 2019 the term ‘overactive thyroid’ was searched on google at an average of 33,200 times.

• In March and May 2019, the term ‘underactive thyroid’ was searched an average of 74,000 times.

• In one month alone (April 2019), there were 32,185 prescriptions for levothyroxine at a cost of £4,942,451.

US:

• More than 12% of Americans develop a thyroid condition during their lifetime.

• An estimated 20 million Americans have some form of thyroid disease.

• Up to 60% of those with thyroid disease are unaware of their condition.

• Women are 5-8 times more likely than men to have thyroid problems.

• 1 out of 8 women will develop a thyroid disorder during her lifetime.
  

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Source & Reference

15-20 sleep studies come out each month. That's between 180-240 studies a year.

1. Dr Michael Breus (@thesleepdoctor) - Clinical Psychologist and Diplomat of the American Board of Sleep Medicine and also the Academy of Sleep Medicine. Specialises in Sleep Disorders with more than 15 years experience.
   

2. Dr Matthew Walker - PhD in Neurophysiology from the Medical Research Council in London. Professor of Psychiatry at Harvard Medical School. Director of the Centre for Human Sleep Science. Over 100 published scientific research studies.
   

3. Dr Jason Mckeown - CEO of Neurovalens Medical Devices. Associate of British Neurologists, currently a Visiting Scholar at the University of California's Center for Brain & Cognition.
   

4. Shelby Harris, PsyD, Director of the Behavioural Sleep Medicine Program at Montefiore Medical Center in New York.
   

5. Betul Hatipoglu, MD, an Endocrinologist of the Cleveland Clinic.
   

6. Terry Davies, MD, at the Mount Sinai Medical Center in New York.
   

7. UK National Health Service - Symptoms: Overactive Thyroid (Hyperthyroidism).
   

8. UK National Health Service - Statistics: Thyroid Prescription Data
   

9. American Thyroid Association - General Information/Press Room
   

10. Google Search Trends Data
    

11. National Institute of Diabetes and Digestive and Kidney Diseases - Hypothyroidism (Underactive Thyroid).
    

12. National Institute of Diabetes and Digestive and Kidney Diseases - Hyperthyroidism (Overactive Thyroid).
    

13. Hashimoto Thyroiditis - US National Library of Medicine - National Institutes of Health.

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Disclaimer

This blog is for informational purposes only and does not replace professional medical advice. Always consult your doctor before starting any new medication or weight loss program.