Sleep deprivation as a modulator of thyroid function: a systematic review and meta-analysis

Sleep deprivation is prevalent worldwide and is associated with multiple endocrine disturbances. Although several studies have explored the relationship between sleep deprivation and thyroid parameters, no review has synthesized existing evidence.

A systematic search of PubMed, Cochrane CENTRAL, Web of Science, and Scopus was conducted for studies published through November 2025 examining the effects of total or partial sleep deprivation on thyroid function. Studies with extractable quantitative data were considered for meta-analysis, while others were narratively synthesized per SWiM guidelines. Primary outcomes included thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4), with effect sizes calculated using Hedges' g.

Twenty-five studies met the inclusion criteria, including eight in the meta-analysis and seventeen in the narrative synthesis. Sleep deprivation was associated with a significant increase in TSH (Hedges' g = 1.49, 95% CI 0.17-2.81, p = 0.027) and fT3 (Hedges' g = 3.82, 95% CI 1.71-5.94, p < 0.001). Although fT4 levels increased, the pooled effect was not statistically significant (Hedges' g = 0.48, 95% CI 0.36-1.33, p = 0.264). TT3, TT4, and rT3 also showed no significant changes. Narrative findings were mostly consistent, with most reporting elevated TSH, while fT3 and fT4 findings were more variable. Prolonged sleep restriction studies exhibited less consistency, suggesting possible adaptation of the hypothalamic-pituitary-thyroid axis over time.

Sleep deprivation is associated with alterations in TSH and fT3, highlighting the sensitivity of the hypothalamic-pituitary-thyroid axis to insufficient sleep and emphasizing the importance of sleep history when interpreting thyroid function tests.