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Hypothyroidism and Mental Health

Mental health symptoms are common in hypothyroid patients.
Hypothyroidism and Mental Health

Thyroid hormones affect your brain as much as they affect your body.

According to a 2018 study published in JAMA, there is a strong correlation between depression, anxiety, and thyroid disease, particularly thyroid disease caused by autoimmune disorders such as Hashimoto's or Graves' disease.

What is hypothyroidism? 

The thyroid is the butterfly-shaped gland at the base of your neck. It produces hormones that regulate your body's energy use, along with many other vital functions.

As part of the endocrine system, the thyroid gland makes and stores hormones that help regulate the body's metabolism in the form of blood pressure, blood temperature, and heart rate.

When your thyroid hormone production drops, your body processes slow down and change. Hypothyroidism affects virtually every system in your body.

Connection between mental health and thyroid function

Emotional or mental health symptoms are common in patients with thyroid dysfunction. People with subclinical hypothyroidism may experience anxiety, irritability, poor concentration, or slow information processing. A study published in Molecular Psychiatry showed that 20.5% of hypothyroid patients suffer from depression.

Research suggests that the hypothalamic-pituitary-thyroid axis is involved in the development of depression. This axis, as its name suggests, depends on the hypothalamus, the pituitary gland, and the thyroid gland to regulate metabolism and respond to stress. The hypothalamus releases thyrotropin-releasing hormone (TRH). TRH stimulates the pituitary gland to produce thyroid-stimulating hormone (TSH). TSH, then, stimulates the thyroid to produce thyroid hormones thyroxine (T4) and triiodothyronine (T3). These thyroid hormones then create a feedback loop with the hypothalamus. 

Often, a person with depression has thyroid hormone levels that measure outside the normal range. This imbalance in thyroid hormone levels can alter neurotransmission in the brain leading to mood disorders like depression. 

Overlap of symptoms

Since hypothyroidism usually develops slowly, and early symptoms may be nonspecific or minor, it's not surprising that doctors often overlook the diagnosis. Many signs of hypothyroidism mimic the symptoms of depression, which sometimes leads to a misdiagnosis or missed diagnosis. 

Common symptoms of hypothyroidism include: 

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Dry, scaly, or flaky skin
  • Weight gain
  • Muscle aches, tenderness, or stiffness
  • Pain, stiffness or swelling in your joints
  • Irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Impaired memory
  • Enlarged thyroid gland (goiter)

hypothyroidism mental health

Those who have overlapping symptoms may want to consult the care of both a thyroid specialist and a mental health professional to optimize their management. 

Testing your thyroid

People believed to have a thyroid condition should screen for depression and anxiety symptoms, and people thought to have depression or anxiety should similarly test for thyroid status. 

Many labs look only at Thyroid Stimulating Hormone (TSH) to assess thyroid health.  Elevated TSH level indicates that the thyroid gland is underproducing thyroid hormones.

However, TSH screening alone may be misleading. We believe it is critical to also measure free triiodothyronine (fT3), free thyroxine (fT4), and TPO antibodies to get a full understanding of your thyroid function.  For instance, elevated TPO antibodies may indicate the presence of an autoimmune condition. 

Treating the connection

Common treatments for depression include talk therapy and antidepressant medication, as well as strategies for relaxation. In many cases, the diagnosis is correct, and the treatment appropriate and successful. But, if a person diagnosed with depression also has an underactive thyroid gland, then they are missing a critical piece in their treatment plan.

In many cases, thyroid hormone replacement therapy helps to improve emotional or mental symptoms if the thyroid is the cause of the problem. 

Levothyroxine, a synthetic form of T4, is the most commonly prescribed thyroid hormone replacement drug. However, each of us is unique with individual sensitivities. Our bodies will not all react the same way to a specific medication or dosage. We suggest working with your care team to determine which treatment option is right for you based on your symptoms, history, and lab results. 

Note about the effect of psychiatric drugs on the thyroid gland 

Lithium, a natural element drug, is one of the most widely used and researched medications for mood stabilization. One side effect after long-term use of lithium may be a state of hypothyroidism. We suggest regular monitoring of your thyroid function during long-term lithium therapy.

Additional methods for management

There are additional methods to stabilize your mental wellness to complement your thyroid medication:

Balance your blood sugar

Blood sugar swings significantly impact our emotions. Eat more frequent meals to avoid the ups and downs between, and consider increasing your healthy fats while limiting your carbohydrates.

Cut the stimulants

Stimulants like caffeine or alcohol can affect our mood. For some, a genetic variation of the adenosine receptor (a protein) influences how we react to caffeine. Caffeine also forces the liver to make more glucose, which, as mentioned above, affects our blood sugar balance. Try a cup of hot lemon water or golden milk instead. 

Supplement with selenium

Research suggests that selenium intake may elevate mood and decrease anxiety. More selenium in your diet may help lower TPO antibodies, and reduce stress, depression, and tiredness. Seafood and organ meats are the best food sources of selenium. 

Try relaxation techniques

Stress and anxiety cause your cortisol levels to shoot up, which triggers the fight-or-flight response. Find a practice that helps you to calm your central nervous system each day. Try yoga, deep breathing, massage, or a warm bath. 

In conclusion, mental health disturbances may accompany hypothyroidism. Early detection and holistic treatment of your thyroid condition is of the utmost importance. 

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