Summary Question of the study
Hypothyroidism is a predisposing factor for obstructive sleep apnoea. There are only few data about the influence of goitre itself and therapeutic recommendations. Reports on a tongue goitre in OSA do not exist.
Case report
A 55-year-old man had an at least 2-year history of obstructive sleep apnoea. Six weeks before sleep studies, the patient developed daytime sleepiness, sudden sleep, and an increase in weight (20 kg). Endocrinological tests showed a severe hypothyroidism (TSH 178 μg/mL) with Hashimoto thyroiditis. Polysomnography revealed a severe sleep apnoea (AHI 53/h, apnoea time up to 110 s, minimal desaturation 58%). CT scans showed a tongue goitre with calcifications. Therapy included L-thyroxin and CPAP (15 mbar). When the patient reached the euthyroid state, CPAP pressure decreased but the indication for therapy persisted.
Conclusion
Obstructive sleep apnoea can be caused or aggravated by hypothyroidism. In this case, therapy should include hormone replacement and the initiation of n-CPAP therapy. Once the patient has reached the euthyroid state, the indication for n-CPAP therapy should be re-evaluated.