Anxiety

Anxious? Depressed? Consider the Thyroid

This small, somewhat neglected organ has much to say about our mental health.

Posted Oct 24, 2020

If you struggle with lingering symptoms of depression, anxiety, mood swings, or obsessive mannerisms, have you ever considered your thyroid? Ever wonder what sort of impact this small, somewhat "neglected" organ may have on your mental health?

What is the thyroid?

The thyroid gland is a butterfly-shaped organ that weighs less than an ounce, located in the lower, front area of the neck. This small gland controls many important functions within the body, including energy production, body temperature, and even brain chemistry (Kharrazian, 2010).

Despite its small size, the thyroid plays a major role in key bodily functions that can affect our mental and physical health. If left untreated, thyroid dysfunction can wreak havoc on the body and contribute to many challenging symptoms.

Types of thyroid dysfunction

The two main types of thyroid dysfunction include hypothyroidism, which occurs when the thyroid gland does not produce enough thyroid hormone, and hyperthyroidism; occurring when the thyroid gland produces too much thyroid hormone.

Common symptoms of hypothyroidism, or low thyroid function, may include:

  • Fatigue 
  • Insomnia
  • Feelings of nervousness and/or emotional distress 
  • Night sweats 
  • Heart palpitations and trembling 
  • Weight gain despite adhering to a low-calorie diet
  • Depression
  • Constipation
  • Hypersensitivity to cold weather
  • Poor circulation and numbness in hands and feet 
  • Muscle cramps
  • Slow wound healing 
  • An excessive amount of sleep required to function properly
  • Chronic digestive problems
  • Itchy, dry skin
  • Dry or brittle hair, or hair that falls out easily

Common symptoms of hyperthyroidism, or an overactive thyroid, may include:

  • Nervousness
  • Irritability
  • Increased sweating
  • Heart racing
  • Hand tremors
  • Anxiety
  • Difficulty sleeping/insomnia
  • Thinning of skin
  • Fine, brittle hair
  • Weakness in muscles
  • Frequent bowel movements
  • Loss of weight despite a high-calorie diet
  • Light and/or inconsistent menstrual cycle

Challenges in diagnosing and treating thyroid dysfunction

According to the American Thyroid Association, more than 12 percent of the U.S population will develop a thyroid condition during their lifetime, and up to 60% of those with thyroid disease will remain unaware of their condition. That's right — 60% of people with a thyroid condition may continue to live in suffering, without receiving the appropriate medical attention or care.

Additional statistics show that women are five to eight times more likely than men to have a thyroid problem, and one in eight women will likely develop a thyroid disorder at some point during their life.

You may be wondering, "Why is this the case? And why do so many thyroid disorders remain undiagnosed and/or mistreated?"

In an interview with Dr. Victor Bernet, FACP, Dr. Bernet states that the numbers are so high regarding untreated thyroid disease because people often attribute emerging symptoms of thyroid dysfunction to something else. An elderly person with hypothyroidism, for example, may misattribute symptoms of fatigue or memory loss to normal aging. Dr. Bernet also discusses how clinically significant cases of thyroid dysfunction are often missed because of the lack of screening for thyroid disease in the U.S.

Blurred lines: The overlap between mental illness and thyroid dysfunction

In addition, thyroid dysfunction can mimic and/or accompany symptoms of mental disorders, which can lead to delayed or missed diagnosis (Estabrook & Heinrich, 2013).

According to Dowben et al. (2012) as referenced in Nyström et al. (2011), "Thyroid illnesses, while quite common in the general population, are among the most often over-looked culprits in the rogues’ gallery of physical infirmities that may cause emotional suffering in our patients." Practitioners encourage mental health and medical providers to "remember the thyroid" and to keep overall physical health in mind when treating patients.

Multiple studies highlight the connections between certain mental health diagnoses and thyroid problems. For example, Bunevicius et al. (2005) confirm a high prevalence of mood and anxiety disorders in women with hyperthyroidism caused by Graves' disease, which is the most common cause of hyperthyroidism. Graves' disease is often associated with anxiety, depression, mania, and at times, certain psychiatric symptoms.

Ittermann et al. (2015) point to an association between thyroid disorders, including hyperthyroidism and hypothyroidism, and clinically significant symptoms of anxiety and depression. Results from their study indicate a connection between untreated hyper and hypothyroidism with Major Depression (12-month prevalence) and recurrent MDD episodes.

The need for more widespread testing

When certain mental health symptoms emerge, it's important to assess for any underlying medical conditions, including thyroid dysfunction, when initiating treatment. As noted above, many people are believed to struggle with thyroid dysfunction, yet a large portion of these cases often go untreated and undiagnosed.

To make things a bit more complicated, the testing process for assessing thyroid function can also be tricky and rather confusing to understand. When it comes to testing for thyroid dysfunction, there are different ranges and diagnostic strategies to consider. There's the TSH; referring to the "thyroid-stimulating hormone," the FT3; measuring the amount of triiodothyronine, and the FT4; which measures the level of free thyroxine.

Many providers primarily focus on TSH measurements when assessing thyroid function, although researchers have uncovered limitations in this approach (Hoermann & Midgley, 2012). In order to receive more accurate test results, it is often important to assess the interplay between TSH, FT4, and FT3, not just the TSH.

In our current culture, we may often view symptoms of mental ill-health as signs of a defective brain, which can lead to a misdiagnosis and/or mistreatment. Yet all too often, as stated in a Harvard Mental Health Letter, "other organs can be the source of the problem." In cases where treatment-resistant mental health symptoms persist, may we remember to thoroughly assess the thyroid, and consider ways to nurture this somewhat neglected, yet vital organ.

References

American Thyroid Association. General Information. Retrieved on October 20, 2020 from: https://www.thyroid.org/media-main/press-room/

Bermudes, R. (2002). Psychiatric illness or thyroid disease? Don't be misled by false lab tests. Current Psychiatry. 2002 May;1(5):51-61. Retrieved from: https://www.mdedge.com/psychiatry/article/66128/somatic-disorders/psychiatric-illness-or-thyroid-disease-dont-be-misled

Bunevicius, R., Velickiene, D., & Prange, A. J., Jr. (2005). Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves’ disease. General Hospital Psychiatry, 27(2), 133–139. https://doi-org.pallas2.tcl.sc.edu/10.1016/j.genhosppsych.2004.10.002

Dowben, J. S., Steele, D., Froelich, K. D., Vance, D. E., & Keltner, N. L. (2012). Biological Perspectives: Remember the Thyroid. Perspectives in Psychiatric Care, 48(2), 65–69. https://doi-org.pallas2.tcl.sc.edu/10.1111/j.1744-6163.2012.00329.x

Estabrook, K.R., Heinrich, T. W. (2013). Hypothyroidism: An Important Diagnostic Consideration for the Psychiatrist. Psychiatric Times. Volume 30:7. Retrieved on October 24, 2020 from: https://www.psychiatrictimes.com/view/hypothyroidism-important-diagnostic-consideration-psychiatrist

Hoermann, R., & Midgley, J. E. (2012). TSH Measurement and Its Implications for Personalised Clinical Decision-Making. Journal of thyroid research, 2012, 438037. https://doi.org/10.1155/2012/438037

Ittermann, T., Völzke, H., Baumeister, S., Appel, K., Grabe, H., Völzke, H., Baumeister, S. E., & Grabe, H. J. (2015). Diagnosed thyroid disorders are associated with depression and anxiety. Social Psychiatry & Psychiatric Epidemiology, 50(9), 1417–1425. https://doi-org.pallas2.tcl.sc.edu/10.1007/s00127-015-1043-0

Jones, V. (2010). Expert explains thyroid diagnosis, treatment and common red flags. ACP Internist. Retrieved on October 24, 2020 from: https://acpinternist.org/archives/2010/01/thyroid.htm

Kharrazian, D. (2010). Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal. Elephant Press LP. Carlsbad, CA.