Over 10 million Americans suffer from hypothyroidism in the United States. According to 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.
Other studies suggest that roughly 45% of people diagnosed with depression may also experience thyroid disease. For anxiety disorders, 30% of patients may have thyroid disease as well. Looking at this another way, 60% of patients with hyperthyroidism experience anxiety, and anywhere from 31% to 69% of patients with hypothyroidism experience depression.
Many of the common symptoms of hypothyroidism mimic the symptoms of depression, which sometimes leads to misdiagnosis or a missed diagnosis. People experiencing fatigue, weight gain, trouble focusing, a general feeling of malaise or depression, and joint or muscle pain may be diagnosed with clinical depression.
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 who is diagnosed for depression also has an underactive thyroid gland, then they are missing a critical piece in their treatment plan.
The flip side of thyroid disease mimicking the symptoms of some types of mental illness, is that thyroid disease itself can trigger those very symptoms. An overactive thyroid can produce states of nervousness and irritability; and an underactive thyroid can make you sluggish, tired, and lacking energy to do the things you normally enjoy - all symptoms of depression.
Given that over 60 million Americans will experience some form of mental illness in their lifetime, and that depression is one of the most common forms of mental illness, that adds up to quite a lot of people who may not receive the proper treatment. People might be stuck for years taking medication that isn’t effective, or that exacerbates symptoms. (Remember, though, not everyone who has anxiety or depression also has thyroid disease, and you never want to alter your medication for those conditions without talking with your doctor.)
On her blog, Hypothyroid Mom, Dana Trentini explores stories of people who people who were treated for depression or other mental illnesses, but were not treated for thyroid illness. One woman wrote to Dana and shared her story of being treated for bipolar disorder, admitted to a mental health ward, and being steps away from receiving electroshock therapy before learning that a family member had been diagnosed with thyroid disease. This information prompted her doctors to finally check her thyroid hormone levels. Four years after her diagnosis of mental illness, she was diagnosed with thyroid disease.
The good news is that proper diagnosis and treatment can provide noticeable relief to symptoms!
Though it isn’t always the practice of physicians to test for thyroid function in people with symptoms of anxiety or depression, it is considered, by those who work in the field, to be the best practice in assuring proper treatment. The lesson here is that if you experience symptoms of, or receive treatment for anxiety or depression, you may want to be proactive in also being tested for thyroid function.
Many labs look only at Thyroid Stimulating Hormone (TSH) on a blood test to assess thyroid health. This hormone is produced by the pituitary gland in the brain and signals the thyroid gland to produce its hormones. If the TSH level is higher than normal, that indicates that the thyroid gland is slow on its production. The pituitary gland pumps out more TSH to try to get the thyroid back in gear.
However, a TSH screening alone may be misleading. Sometimes those levels are normal when, in fact, the amount of the two main thyroid hormones (T3 and T4) are low. Measuring Free Triiodothyronine (fT3) and Free Thyroxine (fT4) can offer a more complete picture. Additionally, there are cases when TSH and T4 and T3 levels are within the normal range, but TPO antibodies are elevated, indicating an autoimmune thyroid condition. For this reason, it's important to get a complete blood panel.
The most commonly prescribed thyroid hormone replacement drug is levothyroxine, which is the synthetic form of thyroxine hormone (T4).
If only there was one medication that worked for all of us - but the reality is that we each react differently to the different treatment options. Thyroid disorders can be complicated, so often finding the right treatment and right dosage can be highly personal, and the standard treatment doesn’t always work. In fact, some scientists estimate that up to 10 percent of people (that’s over one million people) with hypothyroidism report feeling tired, sluggish, and depressed despite taking synthetic hormones.
Your Paloma practitioner works closely with you to comprehensively understand your symptoms, and to monitor and adjust your treatment plan.
Just as with many other conditions, if you suspect your depression or anxiety is linked to your thyroid, you want to become informed about both conditions, so that you can advocate for yourself.
Remember! Not all doctors will initially check for a thyroid condition, but many will agree to blood tests based on a patient request. We know that it’s not always easy to question your doctors, but persistence, confidence, and the right treatment could make you feel a whole lot better.
You can take matters into your own hands by ordering an at-home blood test kit currently available in most states.
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