8 Reasons You’re Waking Up Mid-Sleep, and How to Fix Them

Talk about a rude awakening.
woman laying in bed at night on her cell phone

One minute you’re snoozing peacefully, the next you’re wide awake in the dead of night. Sound familiar? Unless you’re blessed enough to conk out like the most determined of logs, you may have experienced this form of sleeplessness before. Waking up during the night isn’t uncommon—a study of 8,937 people in Sleep Medicine estimates that about a third of American adults wake up in the night at least three times a week, and over 40 percent of that group might have trouble falling asleep again (this is sometimes referred to as sleep maintenance insomnia).

So, what’s causing you to wake up in the middle of the night, and how can you stop it from happening? Here are eight common reasons, plus what you can do to get a good night’s rest.

1. Your room is too hot, cold, noisy, or bright.

Your arousal threshold—meaning how easy it is for something to wake you up—varies depending on what sleep stage you’re in, Rita Aouad, M.D., a sleep medicine physician at The Ohio State University Wexner Medical Center, tells SELF.

When you sleep, your body cycles through different sleep stages: 1, 2, 3, 4, and rapid-eye movement (REM). (Some schools of thought lump together stages 3 and 4.) The first stage of sleep is the lightest, Dr. Aouad explains. That’s when you’re most likely to startle awake because a door slams, a passing car’s headlights shine into your window, or because of some other environmental factor like your room being too hot or cold.

Ideally, your room should be dark, comfortably cool, and quiet when you sleep. This might not all be under your control, but do what you can, like using earplugs and an eye mask to block out errant noise and light, or buying a fan if your room is stifling.

2. You have anxiety.

Anxiety can absolutely wake you up at night,” Nesochi Okeke-Igbokwe, M.D., a physician in New York, tells SELF. In fact, trouble sleeping is one of the most common symptoms of an anxiety disorder, according to the Mayo Clinic. That’s because you can experience anxiety-induced issues that are severe enough to rouse you, like a galloping heartbeat or nightmares.

“Additionally, there are people who may experience what are called nocturnal panic attacks, meaning they may have transient episodes of intense panic that wake them up from their slumber,” Dr. Okeke-Igbokwe says.

If your anxiety regularly wakes you up, Dr. Okeke-Igbokwe recommends mentioning it to your doctor, who should be able to help you get a handle on any underlying anxiety or panic disorder at play. Doing so may involve cognitive behavioral therapy, anti-anxiety medication, or a combination of the two. “Meditation and deep-breathing exercises can also sometimes alleviate symptoms in some people,” Dr. Okeke-Igbokwe says.

3. Your full bladder can’t wait until the morning.

Nocturia—a condition that’s generally viewed as getting up to pee at least once during the night, though some experts say that’s not often enough to qualify—appears to be fairly common. A study in the International Neurourology Journal found that out of the 856 people surveyed, around 23 percent of women and 29 percent of men experienced nocturia.

Causes of nocturia include drinking too much fluid before bedtime, urinary tract infections, and an overactive bladder, per the Cleveland Clinic. Untreated type 1 or type 2 diabetes may also be a factor; having too much sugar in your bloodstream forces your body to extract fluid from your tissues, making you thirsty and possibly prompting you to drink and pee more, according to the Mayo Clinic.

If cutting back on your evening fluid intake doesn’t reduce your number of nightly bathroom trips, consult a doctor for other possible explanations.

4. You had a couple of alcoholic drinks.

Sure, alcohol can make it easy to drift off—even when you’re, say, on a friend’s couch instead of tucked into your bed—but it also has a tendency to cause fitful sleep. This is because alcohol can play around with your sleep stages in various ways. For instance, it seems as though alcohol is associated with more stage 1 sleep than usual in the second half of the night. Remember, stage 1 sleep is the period in which you’re most likely to wake up due to environmental factors. So if you’re looking for quality, sleep-through-the-night rest, it’s worth taking a look at how much alcohol you’re consuming.

Everyone metabolizes alcohol differently depending on factors like genetics, diet, and body size. However, Alexea Gaffney Adams, M.D., a board-certified internist at Stony Brook Medicine, recommends that people stop drinking at least three hours before going to bed to give their bodies time to process the alcohol. Since drinking often happens at night, we realize that can be an optimistic time cushion. Based on your personal factors and how much you drank, you might not need that much. But having some kind of buffer—and drinking plenty of water so you’re more likely to booze in moderation—may prevent alcohol from interfering with your sleep.

Also, Dr. Gaffney Adams notes that drinking alcohol too soon before bed will make you need to pee, increasing the likelihood you’ll wake up in the night to use the bathroom. Double whammy, that one.

5. You’ve got sleep apnea.

If you find yourself jolting awake and feeling like you need to catch your breath, sleep apnea might be the culprit. This disorder slows and/or stops your breathing while you are asleep.

If you have obstructive sleep apnea, the muscles in your throat relax too much, which narrows your airway, causing your oxygen levels to drop, the Mayo Clinic explains. If you have central sleep apnea, your brain doesn’t send the right signals to the muscles controlling your breathing, again causing this potentially harmful drop in oxygen. Complex sleep apnea features characteristics of both conditions.

To diagnose sleep apnea, your doctor may have you do an overnight sleep study that monitors your breathing, according to the Mayo Clinic. The most common treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine, which is basically a mask you wear during sleep to help keep your airways open, but your doctor can help you explore the alternatives if necessary.

6. You have an overactive thyroid gland.

“This gland controls the function of several other organs,” Dr. Gaffney Adams tells SELF. When it’s overactive (also called hyperthyroidism), it creates too much of the hormone thyroxine, which can have ripple effects on many different systems in your body, according to the Mayo Clinic. Common symptoms of an overactive thyroid include trouble sleeping, an increased heart rate, sweating (including at night), anxiety, tremors, and more.

Your primary care physician or an endocrinologist (a doctor specializing in hormones) can test your blood to evaluate your hormone levels. If you do have an overactive thyroid, your doctor can walk you through the potential ways of treating it, including medications to slow your thyroid’s hormone production and beta blockers to reduce symptoms like a wild heartbeat.

7. You ate right before bedtime, or you didn’t eat recently enough before you went to sleep.

“Eating too heavy of a meal too close to bedtime can make it difficult to fall asleep or stay asleep,” Dr. Aouad says. One potential reason behind this is acid reflux, which is when your stomach acid moves up into your throat and causes painful nighttime heartburn. And if you eat food right before bed that makes you gassy, the resulting abdominal pain could drag you out of dreamland, too.

On the flip side, going too long without eating before you sleep can also cause this type of insomnia, Dr. Aouad says. There’s the simple fact that your growling, crampy stomach can wake you up. Hunger could also mess with your blood sugar while you sleep, especially if you have diabetes. Going too long without eating can provoke hypoglycemia, which is when your blood sugar drops too low. This can lead to restless sleep, per the Cleveland Clinic, along with issues like weakness or shaking, dizziness, and confusion. Although hypoglycemia can happen to anyone, it’s much more likely in people with diabetes. If you have the condition, work with your doctor on a plan for keeping your blood sugar stable, including during sleep.

8. You have restless legs syndrome.

Restless legs syndrome, or RLS, may make your lower extremities feel like they are throbbing, itching, aching, pulling, or crawling, among other sensations, according to the National Institute of Neurological Disorders and Stroke (NINDS). If you have RLS, you’ll also feel an uncontrollable urge to move your legs. These symptoms are most common during the evening and night and become more intense during periods of inactivity, like…you guessed it, sleep.

Experts aren’t totally sure what causes RLS, but it seems as though there’s a hereditary factor in the mix, according to the NINDS. Researchers are also investigating how issues with dopamine, a neurotransmitter your muscles need to work correctly, may cause RLS. Sometimes there are other underlying issues bringing about RLS as well, such as iron deficiency.

After diagnosing you with RLS via questions and lab exams, your doctor may prescribe medications to increase your dopamine levels or other drugs, such as muscle relaxants. They may also be able to counsel you on home remedies to soothe your muscles, like warm baths.

To sum it up, there are a bunch of possible reasons you are waking up at night. Some are pretty easy to change on your own, others not so much.

If you think all you need to do to fix this is tweak a habit, like falling asleep with the TV on or chugging a liter of water before bed, start there. If you’ve done everything you can think of and still don’t see a change, it’s worth mentioning your nighttime wakeups to an expert who can help you stay put after you drift off.


7 Period Problems You Shouldn’t Ignore

Read this if your red tide wipes you out.

There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.

But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.

1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.

The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).


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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.

Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.

The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.

Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.

Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.

2. Your period brings days of pain that make it practically impossible to leave your bed.

Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.

There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.

Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.

3. You never know when your period is going to show up.

Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.

Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.

On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.

Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.

PCOS and uterine polyps be behind irregular bleeding, too.

4. Your period decides not to show up for a while.

While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.

“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.

It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.

5. You’re dealing with a lot of unexpected spotting between periods.

There are times when this is normal, like if you’ve just started a new type of birth control, or even if you’re pregnant (spotting can be totally fine during pregnancy), Dr. Minkin says. But if nothing in your life has changed and you start spotting between periods, call your doctor for an appointment.

It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.

If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.

More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.

6. You experience debilitating mood issues before your period.

When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)

But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.

“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.

Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)

Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.

7. You have excruciating migraines before or during your period.

If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.

It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.

If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.

No matter what your period problem may be, you don’t have to suffer in silence.

You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.

If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.

Thyroid disorders may increase mortality risk in peritoneal dialysis

Patients undergoing peritoneal dialysis with hypothyroidism or hyperthyroidism may have a higher risk for mortality, study data show.

Connie M. Rhee, MD, MSc, of the Harold Simmons Center for Kidney Disease Research and Epidemiology, division of nephrology and hypertension at the University of California, Irvine Medical Center in Orange, California, and colleagues evaluated data from a large national dialysis organization on 1,484 adults undergoing peritoneal dialysis who underwent one or more thyroid-stimulating hormone measurements from 2007 to 2011.

Thyroid status was divided into five categories: overt-hyperthyroid (TSH, < 0.1 mIU/L), subclinical-hyperthyroid (TSH, 0.1 mIU/L to < 0.5 mIU/L), low-normal (TSH, 0.5 mIU/L to < 3 mIU/L), high-normal (TSF, 3 mIU/L to < 5 mIU/L), subclinical-hypothyroid (TSH, mIU/L 5 to < 10 mIU/L) and overt-hypothyroid (TSH, 10 mIU/L)

Seven percent of participants had hyperthyroidism, 18% had hypothyroidismand 75% were euthyroid as defined by baseline TSH levels.

Through a total of 1,953 person-years of follow-up, there were 258 deaths for a rate of 132 deaths per 1,000 person-years. A higher risk for death was associated with TSH levels less than 0.1 mIU/L and 5 mIU/L or more.

Compared with participants who were euthyroid, participants with hyperthyroidism (adjusted HR = 1.69; 95% CI, 1.09-2.62) and hypothyroidism (adjusted HR = 2.08; 95% CI, 1.56-2.78) had a higher risk for mortality.

“Our study found that both hypothyroidism and hyperthyroidism were independently associated with higher mortality in a national [peritoneal dialysis] cohort, consistent with data in the hemodialysis population,” the researchers wrote. “Given the high prevalence of thyroid functional disease and exceedingly high mortality of the dialysis population, further studies are needed to determine the underlying mechanisms by which thyroid functional disease impacts mortality, whether thyroid hormone modulating therapies ameliorates mortality risk, and the precise TSH targets associated with improved outcomes in the dialysis population.” – by Amber Cox

Methimazole normalizes liver function tests in patients with hyperthyroidism

Participants with hyperthyroidism and abnormal liver function tests can safely be treated with methimazole.

Treatment may result in normalizations of increased aspartate aminotransferase and alanine transerase levels, according to Dan Niculescu, MD, PhD, of Carol Davila University in Bucharest, Romania.

Niculescu and colleagues evaluated all patients (62 women) with newly diagnosed overt hyperthyroidism (65 Graves’ disease; 11 toxic nodular; four toxic adenomas; three amiodarone-induced thyrotoxicosis) between 2012 and 2014 to determine the evolution of liver function tests in patients with overt hyperthyroidism of different etiologies treated with methimazole.

All participants were started on methimazole between 10 mg and 60 mg per day; the dose was gradually tapered based on clinical judgment. At baseline, 6 weeks, 4.5 months and 10 months after starting methimazole treatment, TSH, free thyroxine, aspartate aminotransferase and alanine transferase were measured.

Abnormal liver function tests were found in 32.5% of participants at baseline; however, there were no significant clinical differences between participants with normal and abnormal liver function tests.

The highest level of alanine transferase was 3.6 the upper limit of normal (ULN) and the highest level of aspartate aminotransferase was 2.5 the ULN.

Treatment with methimazole resulted in a rapid (6 weeks) significant decrease of median serum levels in participants with abnormal liver function tests. There were no differences in alanine transferase and aspartate aminotransferase levels at the 1.5-, 4.5- and 10-month evaluations between participants with initially normal or abnormal liver function tests. Aspartate aminotransferase and alanine transferase serum levels over the ULN were found in 17.9% of participants with initially normal liver function tests and 11.1% of participants with abnormal liver function tests in a last observation carried in the treated participants.

“Methimazole treatment resulted in a rapid decrease of aspartate aminotransferase and alanine transferase serum levels in patients with abnormal liver function tests, suggesting that hyperthyroidism was the cause of liver dysfunction,” Niculescu said. “However, as methimazole treatment induced mild elevation of liver function tests in patients with baseline normal hepatic function, the global percentage of abnormal liver function tests decreased more slowly.” – by Amber Cox

Antithyroid drug use in early pregnancy increased birth defect risk.

The treatment of hyperthyroidism during pregnancy with both methimazole/carbimazole and propylthiouracil was linked to birth defects, but the type of malformations differed, according to recent study findings.

The prevalence of birth defects was greater among children exposed to antithyroid drugsduring early pregnancy (propylthiouracil, 8%; methimazole/carbimazole, 9.1%; methimazole/carbimazole and propylthiouracil, 10.1%; P<.001), according to data. Researchers did not see an increased risk for birth defects in infants born to mothers treated with antithyroid drugs before or after pregnancy (no antithyroid drugs, 5.4%; nonexposed, 5.7%;P<.001).

“It is imperative to treat overt hyperthyroidism in pregnant women, but the use of [antithyroid drugs] in early pregnancy should be limited when possible,” the researchers said. “For the present, it may be optimal to shift women planning pregnancy from [methimazole/carbimazole] to [propylthiouracil] before pregnancy.”

The researchers used the Danish nationwide register-based cohort study, including 817,093 children live-born from 1996 to 2008 to determine how the use of antithyroid drugs used in early pregnancy increased the prevalence of birth defects.

Patients were assigned to the following groups:

  • Propylthiouracil (n=564);
  • Methimazole/carbimazole (n=1,097);
  • Methimazole/carbimazole and propylthiouracil (n=159);
  • No antithyroid drugs during pregnancy, but taken before or after pregnancy (n=3,543); and
  • Nonexposed females (n=811,730).

Data indicate that mothers who were assigned both methimazole/carbimazole (adjusted OR=1.66; 95% CI 1.35-2.04) and propylthiouracil (OR=1.41; 95% CI, 1.03-1.92) with maternal shift between methimazole/carbimazole and propylthiouracil during early pregnancy (OR=1.82; 95% CI, 1.08-3.07) demonstrated an increased prevalence of birth defects, researchers wrote.

In particular, methimazole/carbimazole and propylthiouracil were associated with urinary system malformation, and propylthiouracil with malformations in the face and neck region.

Moreover, choanal atresia, esophageal atresia, omphalocele, omphalomesenteric duct anomalies and aplasia cutis were common in methimazole/carbimazole-exposed children (combined, adjusted OR=21.8; 95% CI, 13.4-35.4), according to data.

Further studies are warranted to confirm these results, researchers wrote.

  • There is concern over whether carbimazole/methimazole or propylthiouracil is the most appropriate antithyroid drug to use when treating hyperthyroidism in pregnant women. Traditionally, propylthiouracil has been preferred, as it was felt to be associated with a lower risk for congenital abnormalities. However, concerns regarding propylthiouracil use have arisen owing to the rare complication of propylthiouracil-induced hepatitis in pregnancy, which can have catastrophic consequences.

    This study is very important, as it substantially adds to our current knowledge of birth defects associated with antithyroid drug exposure for carbimazole/methimazole and propylthiouracil. This study crucially highlighted that both carbimazole/methimazole and propylthiouracil were associated with an increased risk for birth defects. However the birth defects associated with propylthiouracil may be less common and severe than those associated with carbimazole/methimazole. Of particular note was that, in the small number of women who switched from carbimazole/methimazole to propylthiouracil during the first trimester, there was no obvious amelioration in the risk for birth defects. This implies switching to propylthiouracil during the first trimester may be too late to prevent carbimazole/methimazole-associated abnormalities. This would support the argument that in women considering pregnancy, propylthiouracil should be used instead of carbimazole/methimazole, as swapping in the first trimester may be too late. However, further studies are needed.

    The use of robust national registry data provided the very large population required to identify rare but clinically important outcomes and also protected against differential recall of exposure between carbimazole/methimazole and propylthiouracil-treated pregnancies. This is a particular strength as traditional reporting methods may be biased by clinicians’ preconceptions regarding these antithyroid drugs.

    • Peter N. Taylor, MRCP
    • Welsh clinical academic trainee in diabetes and endocrinology
      Thyroid Research Group
      Institute of Molecular and Experimental Medicine
      Cardiff University School of Medicine

Hormone Imbalance,Thyroid Regulation & Bipolar Disorder.

Here are two reasons to care about thyroid:

1. There is a clear connection between the process of thyroid hormoneregulation and bipolar disorder.  The problem is, this connection is only just now beginning to become evident, and how the connection works is basically a mystery.  Two studies recently showed a strikingly high rate of autoimmune-caused thyroid problems in people with bipolar disorder, far more than you would expect to find.Vonk, Kupka  Thyroid problems are more common in the complex forms of bipolar disorder (mixed states and rapid cycling) than in classic bipolar manic patients.Chang  Signs of thyroid auto-immunity are much more common in people with anxiety and depression, particularly the forms of anxiety which don’t easily fit into typical “anxiety disorder” labels.Carta

2. Two studies have shown that people with bipolar depression were less likely to get better if they had low thyroid levels, whereas the ones with higher levels responded pretty well.Cole, Frye . The same phenomenon was recently shown even in “unipolar” depression.Gitlin.  These three studies are the basis for a treatment approach you could consider, particularly if depression is your main problem:  gently pushing your thyroid status over toward the “hyperthyroid” end of normal, if you happen now to be toward the hypothyroid end of normal (the lab testing we use to place you on this spectrum is explained below). Update 4/2008: this approach, using just a little bit of the standard form of thyroid hormone — T4, explained below — was recently tested directly.  The results were very positive, but it was a preliminary test with no control group.Lojko

Update 10/09: another research team recently concluded that “reduction in thyroid function can exacerbate bipolar symptoms even in euthyroid subjects.” Frye In other words, people who are in the normal range (“euthyroid”) can see their bipolar symptoms getting worse if their thyroid levels get low, even if that reduction leaves them still in the normal range.

(Finally, you should also know that some people think the standard lab testing for thyroid status does not do a good job of figuring out who’s “normal” and who’s not.  In other words, they think that people who are not normal, who are low on thyroid hormone, will actually test “normal” using the standard measures.  More on that controversy below).

Most doctors will not raise this option of adding thyroid unless you are clearly already low. It certainly isn’t the first thing to try for depression. But if you have tried several approaches and are considering what to do next; and if you have enough “bipolarity” to make antidepressants a concern, then it might be worth considering this approach, for this reason:  as long as you and your doctor are careful, and don’t bump you right up into hyperthyroidism, there is no risk in trying this approach — just a series of bloodtests, which a lot of people hate. And there is some risk if you end up hyperthyroid.

That is all supposed to sound pretty weak, as a justification for this approach.  It is weak.  But some people with bipolar depression need to know of every option they might try before turning to antidepressants, as explained in the essay entitled Antidepressants That Aren’t Antidepressants. If that’s not you, don’t go carrying this thyroid page to your doctor, she might scoff at you, as there is a long history of unsupported use of thyroid hormone and you don’t want to get branded as “one of those people”.  Even so, the relationship of mood and thyroid is extremely complex, almost mysterious.

Let’s take a quick look at that complexity before turning back to why you might want to learn more about thyroid and bipolar disorder. There are reports linking the entire stress hormone system (here are some basics on stress and depression) to changes in thyroid function.  This part is really complicated.  The short version, translating from two amazing reviews of stress and mental health, is that stress hormones interfere with the production of thyroid hormone and with the conversion of thyroid hormone to its active form. Tsigos, Charmandari

It is also clear that people whose symptoms look the kinds of “bipolar disorder” explained on this website, have thyroid problems — and family members with thyroid problems — at a greater rate than would be expected.  Is that because the thyroid problems somehow actually cause “bipolar”-like symptoms?  Could it be that some of what looks like “bipolar” is actually a thyroid problem?  There may be some such folks.  In addition, there are clearly cases which seem to be “bipolar disorder” for sure, that get better with thyroid hormones as part of the treatment.  In many of these cases it is clear that thyroid hormone was not enough, by itself, to make mood “normal”.  So, for now I think it is safe to say that bipolar disorder has something to do with thyroid regulation in many cases, though not the majority; and that treating with thyroid alone is only rarely going to lead to full remission of symptoms (with a few notable exceptions…).

So, you need to know about thyroid and bipolar disorder for several reasons:

1. There is some relationship between the two, though poorly understood.

2. You need to make sure your thyroid is okay before you begin treatment for bipolar disorder, because

  • if it’s not okay, you might not respond fully to treatment; and
  • it’s usually pretty easy to get your thyroid hormone in the right place, which by itself could help your symptoms somewhat.

3. Thyroid hormone is sometimes used as a treatment for bipolar disorder, even if your thyroid is “normal” (by lab tests, anyway).

4.  And finally, lithium commonly interferes with the thyroid system, so you’ll need to understand a bit about thyroid if you’re going to take lithium.


 Source: http://holyhormones.com




Subclinical hyperthyroidism unrelated to overall, CV mortality.

The associated health risks for subclinical hyperthyroidism in patients aged at least 65 years are not entirely clear. However, data presented at the 82nd Annual Meeting of the American Thyroid Association suggest that the disease was not linked to overall or cardiovascular mortality.

“[Older patients with subclinical hypothyroidism] They are a group with a high prevalence of subclinical thyroid dysfunction and a high prevalence of comorbidities that make their management more complex,” researcher Anne R. Cappola, MD, ScM, associate professor of medicine at Penn Medicine and physician at the Perelman Center for Advanced Medicine in Philadelphia told Endocrine Today.

Cappola said there are two clinical implications.

“One, thyroid function testing should be repeated in older people with subclinical hyperthyroidism to confirm testing prior to initiating management. Two, older people with subclinical hyperthyroidism are at increased risk of atrial fibrillation,” Cappola said.

The Cardiovascular Health Study (CHS) was used to examine the 5,009 community-dwelling patients aged 65 years and older who were not taking thyroid medications. According to data, the serum thyroid-stimulating hormone and free thyroxine concentrations were measured in banked specimens at visits between 1989 and 1990, 1992 and 1993, and 1996 and 1997.

Within the CHS, researchers identified 70 patients with an average age of 73.7 years (60% women, 24% not white) with subclinical hyperthyroidism based on their first TSH measurement. They studied the persistence, resolution and progression of the disease during a 2- to 3-year period.

Using Cox proportional hazard models, researchers were able to determine the link between subclinical hyperthyroidism and CV risk and total mortality after more than 10 years of follow-up, with 4,194 euthyroid patients used as a reference group.

According to data, of the patients with subclinical hyperthyroidism who participated in follow-up thyroid testing or were taking thyroid medication at the time of follow-up (n=44), 43% persisted; 41% became euthyroid; 5% progressed to the point of overt hyperthyroidism; and 11% began taking thyroid medication.

“Our study provides additional supportive data in both estimates of persistence of subclinical hyperthyroidism and risk of cardiovascular effects,” Cappola said.

  • Source: Endocrine Today.






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