The first issue is adjustment of the thyroid ills to achieve normal thyroid blood tests, but we can discuss this more tomorrow. The other considerations are whether there are other conditions that may be causing her symptoms. There are some other metabolic conditions that can cause these symptoms, such as adrenal disease, but these conditions are far less common to present as daytime drowsiness. It is more common for daytime sleepiness to be due to conditions that interfere with getting adequate sleep. In some of these conditions, there is a decrease in the number of hours of sleep, but in others, the problem is that the sleep that does occur is not able to achieve deeper levels of sleep that are restorative. For example, a common condition to cause daytime drowsiness is sleep apnea. People with sleep apnea will usually appear to sleep for a full night, but they are unable to get into a normal amount of the deeper levels of sleep. There are also two types of sleep apnea - obstructive and central sleep apnea. Obstructive sleep apnea
is much more common in overweight people, although it can occur in people of normal weight. Central sleep apnea is not associated with excessive weight. The proper test to evaluate for these conditions would be a sleep study, or polysomnogram, which can detect these common conditions as well as other less common primary disorders of sleep. There are a variety of conditions that interfere with getting a good number of hours of sleep. Some are physical conditions, such as acid reflux, which frequently will get worse when lying down, and others are mental health conditions, such as depression or anxiety. So, after first addressing the thyroid blood tests, which we can discuss more tomorrow, the next test that I would typically consider would be a sleep study, unless there are other findings on history and physical examination that would suggest another medical condition. If I can provide any clarification about these conditions, please let me know. Otherwise, we can discuss the thyroid blood tests tomorrow.