swollen mouth, breathing problems at night?

[JenB12]

I'm a 26 year old female with hashimotos and mild gluten intolerance. I take .075 MG of synthroid daily as well as .05 MG of cytomel. I got my Hashimotos dx about 2.5 years ago when i had unexplained fatigue and felt as though i was hung over even with out drinking. Even after a year on synthroid I felt no change to my symptoms. I believe that the fact that i had TPO antibodies was just a coincidence and not really causing my symptoms. Along with positive microsomal antibodies I also had a positive ANA at 1:320 speckled, but no other positive tests for autoimmune conditions. I sent in some samples to a lab in texas to determine if i had gluten intolerance since my brother has celiac and that also tested positive. I have been gluten free for 3 months.

The reason why I am writing here is the problem for me I think is at night. When i lay down I feel as though my mouth swells. I have a very small jaw as it is with teeth crowding in my lower mouth... but I feel like my tongue is too big for my mouth. I also feel like my airway is tight like i am breathing through a straw. I feel quite a bit pf pressure around my neck. In addition at least one side of my nose will stuff up. I typically cannot fall asleep until at the earliest 1-2 int he morning and even if i can sleep in as last as i like, i never feel rested. My doctor assured me this was my thyroid, but I have given it 2 years on thyroid medicine and i'm still feeling fatigued. I do feel as though the fatigue is better with a Gluten free diet.

Where should I go from here? my PCP in the US recommended a sleep study but I live in Puerto Rico and I can't seem to find a place that does comprehensive sleep studies. Should I see an ENT? should I see an immunologist/ allergist???

Please advise.

[Steven Y Park, MD]

It definitely sounds like you have a sleep-breathing problem, mainly due to your small jaw. Inflammation and swelling of your tongue due to reflux that's brought up from your stomach can cause your tongue to swell and leave marks on the side of your tongue (teeth marks). You don't have to be overweight or even snore to have sleep apnea. I strongly recommend a sleep study or some way of screening for and treating a possible underlying sleep apnea problem.

[JenB12]

I waned to add some things.  I'm definitely not overweight at  5'4" and 103 lbs. Also when i wake up in the morning I feel stiff and I feel like i got hit by a truck. It takes several minutes for me to become oriented, i'm almost always confused when i first wake up, and i almost always feel weak and overwhelmingly tired. However, once i am awake, i feel okay I do not feel fully awake until the afternoon, and by 1-2 PM onwards I tend to feel pretty normal.

I've never been a morning person, but for the last few years mornings are straight up painful.

Any idea what this could be or where i should go from here? Thank you for your time!