How Thyroid Dysfunction Can Cause Sleep Disorders

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The thyroid influences numerous bodily functions, many of which can affect sleep quality and duration. Unfortunately, thyroid disease and its effect on sleep is frequently overlooked. Understanding the role of the thyroid, its common forms of malfunction, and how they can impede sleep quality may help you resolve persistent sleep problems.

What is the Thyroid?

The thyroid is a small gland located in the neck. This powerful system is also responsible for regulating and influencing a wide range of essential bodily functions including metabolism, neurological function, immune activity, and others. The thyroid accomplishes this through the production of several hormones.

Although there are many hormones produced by the thyroid, for the purposes of this discussion we will focus on just three: thyroxine (T4), triiodothyronine (T3), and reverse triiodothyronine (RT3). Each hormone is charged with specific tasks and must work together to maintain healthy bodily function.

  • T4, also known as the storage or inactive form of thyroid hormone, is produced by the thyroid and encourages specific metabolic processes in cells and tissues. T4 may also be converted into T3 or RT3.
  • T3, dubbed the active form of thyroid hormone, is responsible for accelerating metabolic activity thereby hastening bodily processes.
  • RT3, the mirrored form of T3, impedes T3 activity thereby acting as a regulator or fail-safe against excessive hastening of bodily function.

When working as intended, the thyroid maintains an appropriate balance of these and other thyroid hormones. However, thyroid dysfunction in the form of hypothyroidism and hyperthyroidism can disturb hormone balance and activity resulting in a wide range of symptoms some of which may contribute to a decline in sleep quality.

Types of Thyroid Disease

There are multiple types of thyroid disease. The two most common being hypothyroidism and hyperthyroidism.

Hypothyroidism leads to a slowing of thyroid activity and by extension overall bodily function. The condition is usually caused by decline in T4 and/or T3 or an excess of RT3.

In contrast, hyperthyroidism is described as accelerated thyroid activity resulting in an excessive hastening of bodily processes. Typically, hyperthyroidism involves increased production of T4 and/or T3.

These two forms of malfunction are attended by their own set of symptoms with some issues shared between them. A short list of possible hypothyroid and hyperthyroid symptoms is shown below:

Symptoms of hypothyroidism include:

  • Changes in mood
  • Constipation
  • Difficulty losing weight
  • Dry skin
  • Fatigue
  • Hair loss
  • High cholesterol
  • Increased PMS symptoms
  • Loss of libido
  • Sensitivity to cold
  • Slowed heart rate
  • Trouble thinking clearly
  • Weight gain
  • Yellowing and/or brittle nails

Symptoms of hyperthyroidism include:

  • Accelerated heartrate
  • Anxiety
  • Diarrhea
  • Difficulty focusing
  • Erratic fluctuations in energy level
  • Excessive sweat
  • Hot flashes
  • Increased appetite and hunger
  • Insomnia
  • Irregular heartbeat
  • Irritability
  • Jitteriness
  • Missing or short menstruation
  • Mood swings
  • Muscle weakness
  • Panic attacks
  • Protruding or puffy eyes
  • Rapid unexpected weight loss
  • Shakiness

In many cases, thyroid disease perpetuates itself by creating dysfunction elsewhere in the body. The relationship between thyroid disease and sleep is just one such example. Many of the symptoms induced by thyroid disease can reduce sleep quality thereby further impeding thyroid function and overall wellness.

How Thyroid Disease Promotes Sleep Issues

Thyroid issues may disrupt sleep in a variety of ways. Some of the most prominent thyroid-related sleep inhibitors are poor temperature regulation, insomnia, and sleep apnea.

Poor Temperature Regulation

Hypothyroidism is often accompanied by sensitivity or intolerance to cold. As such, patients may find it difficult to fall asleep and stay asleep because they are unable to reach an adequate level of warmth. Conversely, hyperthyroidism can lead to excessive warming of body temperature resulting in discomfort and night sweats that may interrupt sleep.


Insomnia often accompanies thyroid disorders. This is because thyroid symptoms such as intolerance to cold or heat, snoring, diarrhea, and general physical discomfort can make quality sleep difficult to attain. Thyroid patients commonly report problems characteristic of insomnia including disrupted sleep, unrefreshing sleep, or difficulty falling asleep.

Sleep apnea

Sleep apnea affects a relatively large portion of the population. The condition makes it difficult to breath, encourages snoring, and may cause physical discomfort. Poor thyroid function may encourage apnea by limiting the body’s responsiveness to chemical changes and damaging nerves or muscles used to facilitate breathing. Additionally, hypothyroidism specifically may cause extreme swelling of the tongue, known as macroglossia, which can impede airflow and cause apnea to worsen.

Properly Testing and Treating the Thyroid

Without resolving an underlying thyroid condition, certain sleep issues are likely to remain. Therefore, accurate thyroid testing and effective treatment are important parts of alleviating sleep problems.

Sadly, current standards for assessing thyroid function are insufficient and often result in misdiagnosis of patients. At present, most doctors only evaluate thyroid function based on the amount of thyroid stimulating hormone (TSH) in the system. Although this metric has its uses, it is not reliable as the sole indicator of thyroid function. This is because TSH only measures how well the needs of the thyroid are being communicated and not its actual functionality.

To get a truly accurate assessment of thyroid function a more thorough array of testing must be done. At minimum, a full thyroid panel should include TSH, T4, T3, RT3, thyroid antibodies, and sex hormone binding globulin (SHBG). Measuring these factors of thyroid function allows for a far more accurate picture of thyroid activity.

Get a FREE downloadable thyroid panel lab slip here.

Resolving thyroid issues, and any sleep problems associated with it, requires patient specific care. Thyroid disease is highly individualized meaning that there is no one-size-fits-all method. As such, when treating thyroid dysfunction there are several approaches to consider. Depending on the specific needs of the patient one or more of the following treatments may be more effective than others.

  • Thyroid hormone replacement therapy increases the value of specific thyroid hormones. This approach is most often used in cases of hypothyroidism. Depending on patient needs, treatment may include T4 only, T3 only, combination T4/T3, time released, or bioidentical formulations.
  • Nutritional supplementation and dietary improvements designed specifically to support thyroid function may be employed to restore thyroid function.
  • Thyroid hormone inhibitors that reduce the number or activity of thyroid hormones may be used in cases of hyperthyroidism.
  • A complete or partial thyroidectomy, wherein some or all of the thyroid gland is removed, may be done to combat hyperthyroidism or thyroid cancer.
  • Radioactive iodine treatments can be used to reduce the size and functionality of the thyroid gland in patients with hyperthyroidism.

Solving Sleep Issues by Supporting the Thyroid

Thyroid disease in the form of hypothyroidism and hyperthyroidism can contribute greatly to the occurrence of sleep issues while also being easy to overlook. In some cases, the best way to resolve your sleep problems is by thoroughly testing for and subsequently treating any existing thyroid dysfunction.

At Holtorf Medical Group, our physicians are trained to provide you with cutting-edge testing and innovative treatments to help you get the treatment you need. If you suffer from insomnia or poor sleep and believe your thyroid may be to blame, give us a call at 877-508-1177 to see how we can help you!


1. Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).”
2. Kent Holtorf, MD. “Thyroid Hormone Transport.”
3. Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?”
4. Kent Holtorf, MD. “Why Doesn’t My Endocrinologist Know All of This?”
5. Lencu C et al. “Respiratory manifestations in endocrine diseases.” Clujul Med. 2016;89(4):459-463.
6. Ong JC, Crawford MR. “Insomnia and Obstructive Sleep Apnea.” Sleep Med Clin. 2013;8(3):389-398.
7. Skatrud J et al. “Disordered breathing during sleep in hypothyroidism.” Am Rev Respir Dis 1981;124:325.

About Holtorf Medical Group

The Holtorf Medical Group specializes in optimizing quality of life and being medical detectives to uncover the underlying cause of symptoms, rather than just prescribing medications to cover-up the symptoms. We are experts in natural, prescription bioidentical hormone replacement and optimization, complex endocrine dysfunction, fibromyalgia, chronic fatigue syndrome and Lyme disease.

We’ve dedicated our practice to providing you the best in evidenced-based, integrative medicine that’s not only safe and effective, but provides measurable results.