Depression, Anxiety & Thyroid Disease
Thyroid Disease and Mental Health Issues
Robyn Koumourou 2021
Depression and anxiety are common psychological disorders affecting the general population, but the prevalence of these conditions increases in those suffering with chronic diseases, and thyroid disease is no exception. Varying forms of depression, anxiety disorders, and loss of intellectual abilities have been commonly found in patients with hypothyroidism and hyperthyroidism, and even those with subclinical conditions who are diagnosed with Hashimoto's or Graves' disease. The prevalence of these
mood disorders, including manic depression, are higher in those with a diagnosed thyroid condition than in the general population. Overall, thyroid disease does impact brain function, affecting a person's mood, mental and emotional state.
Depressive Disorders and Causative Factors
One in 4 people suffer with some form of mental illness, and half of those experiencing anxiety disorders early in life go on to develop more serious depressive disorders later in life. More than one out of every 10 people battling depression commits suicide.
Depression and chronic anxiety are common but serious mood disorders that affect a person's ability to feel, think, make decisions, eat, work, sleep and handle basic daily activities. These disorders can be crippling and rob a person of living a normal life.
Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. These include:
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psychological stress and trauma
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social/cultural background and lifestyle
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biological/chemical imbalances and chronic diseases
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brain injuries
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genetic predispositions
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endocrine, nervous system and immune system abnormalities
What is often overlooked is the gut/liver/brain connection, and the influences of diet, nutrition, underlying infections and environmental toxins.
So when it comes to diagnosing and treating someone displaying mental and emotional symptoms, a doctor will need to investigate many possible triggers and causes, and consider the person's health status, medical conditions, family history and life experiences. It can never be assumed that all cases of mental illness are due to brain dysfunction alone, as there are so many factors that can impact upon our psychological health.
Thyroid's Impact on Brain Function
Most people associate thyroid conditions with a long list of physical symptoms, but may not consider that psychological or mental complaints could be due to a thyroid disorder also. Our nervous system relies on correct levels of thyroid hormone for normal brain and body function. The brain is particularly vulnerable to changes in thyroid hormone levels, as it is the most metabolically active organ in the body, requiring large amounts of energy. Thyroid hormones, particularly T3, have regulatory effects on crucial neuromodulators, like serotonin, dopamine and noradrenaline. Any slight deficiency or excess in thyroid hormone will cause alterations in brain chemistry, and for some individuals, this can have vast repercussions on their mental and emotional health.
Depression as a Symptom, and not a Cause
Every thyroid patient presents differently, having their own cluster of symptoms. Some thyroid patients experience mainly physical symptoms with little effects on their emotional and mental state, while others may have predominantly psychological symptoms with only a few physical ailments that may indicate thyroid dysfunction. However, it's unlikely that anxiety or symptoms of depression would be the only evidence of thyroid disease. This is why further investigation with thorough testing and clinical analysis needs to be done.
When a doctor first encounters the many signs and symptoms of a thyroid condition he or she may think that the physical manifestations are the result of an underlying mental disorder. Sadly, this happens far to often, and antidepressants are given as the first port of call. This is not good medical practice. The truth is, the symptoms of many chronic diseases have a psychological and emotional component and many elements can mimic mental illness. The depression that is experienced is actually a 'symptom' resulting from the underlying thyroid imbalance and disease process, and not the 'cause' of the mental, emotional and physical presentations.
Unfortunately, medications for depressive disorders, administered too quickly, often mask the true underlying condition, and the true cause is overlooked, or not addressed. With regard to thyroid disorders, psychotropic drugs often make little difference, or non at all, and may actually make a thyroid condition worse by interfering with thyroid hormone synthesis. Therefore, further investigation into underlying causes and conditions is vital for the correct diagnosis and appropriate treatment. Doctors should carefully consider the interactions and side effects of various mood altering drugs especially if thyroid disease or another illness is suspected or discovered.
Patients with Hypothyroidism, and Hashimoto's Thyroiditis, often present with unrelenting fatigue, depressed mood, lack of motivation, and a general loss of interest in life. Patients with Hyperthyroidism, and Graves' Disease, often present with, heightened anxiety, irritability, mood swings, and generalized restlessness. Occasionally, a thyroid patient may display symptoms that mimic manic depression (bipolar disorder) and find that their condition does not improve until their thyroid hormone imbalance is corrected.
Many patients with thyroid dysfunction experience chronic anxiety and varying forms of depression, from mild or moderate mood changes, to more severe clinical depression and psychotic disorders.
All of the above scenarios contribute to overall stress, and stress, whether internal or external, will only further exacerbate a thyroid condition, and worsen anxiety and depression as a result. Generally, the more severe the thyroid condition is, the more pronounced the anxiety and depression.
HYPOTHYROIDISM
How does an underactive thyroid gland affect a person's mental and emotional state?
As the body slows down due to insufficient thyroid hormone, so too does the brain, and alterations in brain chemistry occur. The early signs of slower brain function may appear as the following: tiredness, poor concentration and memory loss, slowness of thought processes, difficulty putting words together, being easily confused or overwhelmed, general “brain fog”, and flat or low mood.
As a hypothyroid condition progresses, a person suffering with subclinical or overt hypothyroidism may experience greater mood swings and irritability, less patience, and be generally more emotionally volatile. They may display a loss of interest and enthusiasm for life, be less talkative, and more grumpy, sluggish, and indecisive. They may appear to others to be lazy, or even be labelled a hypochondriac, due to their fears or gloomy outlook on life. To top it all off they may be poorly coordinated and clumsy, and be slower in their reflexes and reactions. Unfortunately, a doctor simply looking at these symptoms may diagnose the patient with depression, seeing them as purely psychosomatic. Treatment with antidepressants may have little effect if the underlying thyroid condition has not been discovered and addressed appropriately.
The most commonly reported symptoms of hypothyroidism (underactivity) are often those associated with anxiety and depressive disorders. These may present as the following:
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Unrelenting fatigue and exhaustion, symptoms of CFS
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Unmotivated and lethargic, with a decreased interest in life
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Poor memory and concentration, difficulty staying focussed
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Indecisiveness, disorganised thinking and confusion
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Negative thoughts, easily overwhelmed and excessive worrying
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Inability to cope with and handle basic daily activities
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Anxious, sensitive and easily startled
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Irritable, overly emotional, and teary
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Poor reflexes and slow responses
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Persistent aches and pains and digestive disturbances (constipation), IBS
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Weight gain and loss of appetite
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Headaches, migraines
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Irregular heart rhythm, increased or decreased blood pressure, chest pain, cold intolerance and decreased sweating
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Excessive sleep, sleep disturbances and chills
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Breathlessness, difficulty swallowing and dry mouth
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Numbness and tingling, dizziness, faintness
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Depressed mood: persistent sadness, feelings of emptiness, worthlessness, hopelessness, shame, guilt, and pessimism
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Pronounced psychological symptoms with more severe forms of hypothyroidism - exaggerated fears, panic attacks, overwhelming feelings of being trapped, irrational fears of going to die, deliriousness, hallucinations, hearing voices, schizophrenic or psychotic episodes, and thoughts of death and suicide in severe cases of hypothyroidism.
If the diagnosis of thyroid hormone insufficiency is not made early and treatment is delayed, brain function will continue to deteriorate. When thyroid hormone therapy is instigated, it may halt the process but bring little improvement. A patient may need further interventions to reduce brain function deterioration and correct any chemical imbalances.
HYPERTHYROIDISM/THYROTOXICOSIS
How does an overactive thyroid gland affect a person's mental and emotional state?
As the body and brain speed up due to an excess of thyroid hormones, many hyperthyroid patients initially experience new found surges of energy, excitement, productivity, and sometimes euphoria. They may wonder why everyone around them is so slow in thinking and action, and feel that they can take on the world. However, passionate and exuberant bouts of creativity may be followed by sudden crashes into depression, fatigue, and weakness. As hyperthyroidism worsens, dramatic swings in energy and mood, from extreme highs to debilitating lows can begin to occur on a regular basis. Feelings of irritability, nervous anxiety and being out of control increase, and a manic form of behaviour and depression can set in. Many patients describe major mood swings and having overly-emotional reactions, like extreme impatience, and irrational and aggressive outbursts of anger.
The most commonly reported symptoms of hyperthyroidism (overactivity) are often those associated with anxiety and depressive disorders. These may present as the following:
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Difficulty concentrating and staying focussed
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Racing thoughts, talking fast, and disorganised thinking and confusion
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Poor memory and difficulty making decisions
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Restless, jumpy, and can't sit still
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Irritable, anxious, nervous, irrational worry
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Headaches, migraines
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Short bouts of energy, followed by fatigue, exhaustion, and generalised weakness
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Persistent aches and pains, cramps and digestive disturbances (diarrhoea), IBS
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Significant weight changes, overeating or loss of appetite
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Generalised anxiety due to hypermetabolism, accompanied with an elevated heart rate, increased blood pressure, heat intolerance, excess sweating, and shakiness
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Being on edge and easily startled, with exaggerated reflexes and responses
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Heart palpitations, chest pain, panic attacks with sweats and chills
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Breathlessness, difficulty breathing and dry mouth
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Numbness and tingling, dizziness, faintness
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Restless sleep, night sweats and insomnia
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Depression: flat mood, feelings of worthlessness, hopelessness, shame, guilt, and a pessimistic outlook
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Pronounced psychological symptoms with more severe forms of hyperthyroidism - manic behaviour, exaggerated fears, overwhelming feelings of terror and going to die, deliriousness, out of body experiences, hallucinations, hearing voices, schizophrenic or psychotic episodes, and thoughts of death and suicide.
In severe or long term cases of uncontrollable thyrotoxicosis, including emergency episodes of 'thyroid storm', the risks of permanent brain damage, life-long psychological disorders, stroke and cardiac arrest are greatly increased.
The Divide between Endocrinology and Psychology
The effects of thyroid hormones upon the mature brain have not been widely acknowledged by Endocrinologists and Psychiatrists alike
1. The effects of thyroid hormones upon the mature brain have not been widely acknowledged by Endocrinologists and Psychiatrists alike. "It is well established that thyroid hormones are essential for both the development and maturation of the human brain, affecting such diverse events as neuronal processing and integration, glial cell proliferation, myelination, and the synthesis of key enzymes required for neurotransmitter synthesis. Thyroid deficiency during the perinatal period results in irreversible brain damage and mental retardation. However, despite this accepted body of knowledge and in disregard of the clinical and therapeutic observations in association with affective illness, the action of thyroid hormones in CNS function in adults has not been widely acknowledged by general endocrinologists." https://www.nature.com/articles/4000963
2. The TSH test became the "scientific" golden standard test for diagnosing and treating thyroid disease and was believed to hold all the answers for thyroid patients and doctors alike. Medical students were given little training regarding thyroid conditions and only superficially taught how to clinically recognise and diagnose thyroid disease and its repercussions on other systems of the body, including the brain. Unfortunately, the reliance solely on TSH (and a computer generated response) as the final word, have left many patients misdiagnosed, mismanaged and poorly treated. Physical and mental symptoms have often been seen as purely psychosomatic, with antidepressants becoming the 'go to' to fix everything.
3. In general practice, subclinical patients with TSH levels mildly above or below the normal reference range, or normal TSH with clinical symptoms of thyroid dysfunction, are treated primarily by their general practitioner. In many cases no treatment is initiated until thyroid levels are abnormal enough, or when symptoms become more pronounced. Only those patients with more severe thyroid conditions receive treatment by an endocrinologist. Therefore, many endocrinologists are not in tune with the majority of thyroid patients suffering with mild to moderate thyroid disease and the myriad of symptoms it can bring.
4. Until recently, there has been a poor understanding of the interactions and effects of endocrine hormones upon the mature brain, CNS and neurotransmitters, affecting mood and behaviour. Studies and investigations into the effects of thyroid hormone abnormalities on psychological health are revealing strong connections with many debilitating anxiety and depressive disorders. Optimising patients' thyroid hormone levels often brings complete restoration of psychological and cognitive functions and debilitating anxiety and depression are relieved.
5. There is often a lack of screening and diagnostic tests in areas of medicine that overlap. Psychiatry has its standard tests that focus on the brain as the causative factor in mental health conditions. Endocrinology has its diagnostic tests that focus on endocrine glands and their hormones. The interrelationship between hormones and brain chemistry, and chronic health conditions should be considered to help clarify the root causes and contributing factors upon mental health symptoms.
6. Thyroid hormone metabolism within the brain, organs and peripheral tissues is poorly understood. The assumption being that circulating blood hormone levels will be sufficient and adequately utilised in all cells throughout the body. The brain, compared with local tissues and organs, requires different amounts of thyroid hormones and has different mechanisms to control thyroid hormone metabolism. In peripheral tissues, T4 concentrations far exceed those of T3, whereas in the brain, T4 and T3 concentrations are in more equal ratios. The brain requires adequate levels of T3 hormone to maintain normal brain function. Nuclear receptors for T3 are widely distributed throughout different regions of the brain, and deiodinase processes vary from tissues to tissue to maintain healthy biological activity . The interdependence between norepinephrine, serotonin and dopamine pathways with thyroid hormone metabolism is slowly becoming better understood with the improvement in medical technology.
[Bauer M, 2002, Mol Psychiatry] https://www.nature.com/articles/4000963
7. There is a lack of awareness that in order to treat anxiety and depressive disorders through the serotonin pathway, optimal thyroid function is an important part of the equation. For patients treated for depression, where serotonergic antidepressants have been unsatisfactory or made little difference, the supplementation with T4 or T3 hormones has been a successful augmentation strategy. In a neuropsycho pharmacology study, Bauer et al stated: "augmentation of conventional antidepressants with high-dose T4 proved to have excellent antidepressant effects in approximately 50% of severely therapy-resistant depressed patients." [Bauer M et al.,1998] https://www.nature.com/articles/1395162
Medical Studies
Can the effects of abnormal thyroid hormone levels, or even the presence of thyroid autoantibodies, contribute to anxiety and depression?
"Some studies of hyperthyroid patients found that symptoms of anxiety and depression disappeared within months of starting anti-thyroid drug treatment [2,14,15], indicating that increased levels of thyroid hormones may contribute to anxiety and depression [2,16,17]. Others found that symptoms persisted despite successful anti-thyroid drug treatment [11,18,19,20,21], indicating that anxiety and depression might be related to other aspects of hyperthyroidism, such as thyroid autoimmunity, rather than thyroid hormone status. Elevated levels of thyroid peroxidase antibodies (TPOAb) have been directly related to anxiety and depression in some [19,22,23] but not in all studies [24]. Only one study has investigated the influence of thyroid-stimulating hormone (TSH) receptor antibodies (TRAb) on anxiety and depression, and found a significant association between TRAb and anxiety [25]."
https://www.karger.com/Article/FullText/365211
CASE STUDY
A 59 year old came to her doctor after suffering for 30 years with constant migraines, severe arthritic pain, brain fog, panic attacks, heart palpitations and episodes of irrational overwhelming fear. These constant symptoms contributed to suicidal thoughts, and no doctor in the past had been able to help her. She explained that she felt like she was covered in a blanket of debilitating depression. In her late 20's she had been told she had post natal depression, and then given a diagnosis of manic depression years later and placed on Lithium. This helped to calm down some of her symptoms but the migraines and depression remained. After more than 30 years of physical and mental health issues a doctor finally picked up that she had an overactive thyroid gland and was diagnosed with Graves' disease. To her amazement, after a year on anti-thyroid medication, her migraines and depression were virtually non existent and she felt more alive than ever before.
However, her doctor left her on high dose Lithium therapy, and after 6 months her migraines and depression began to creep back and she slowly developed Chronic Fatigue Syndrome (CFS). For another 6 years she was left with debilitating symptoms, and was constantly told that her thyroid function was normal, based on her TSH result alone.
Finally she went to a new doctor, who immediately recognised her symptoms were due to low thyroid function, and her test results confirmed it, TSH: 3.69 (0.5 - 5.0), fT4: 14 (11 - 23), fT3: 3.0 ( 3.5 - 6.7). He understood that Lithium reduces thyroid hormone production and conversion, particularly affecting T3 levels, and realised that Lithium had subdued her hyperthyroidism in the past, but was causing hypothyroidism and her CFS symptoms now. Simply taking her off Lithium only partially resolved her health issues. She was then started on natural desiccated thyroid (NDT) extract, which contains both T4 and T3, to increase her thyroid hormones to acceptable levels. Again, to her amazement her symptoms disappeared and she felt like life was worth living again. Her thyroid levels had to be maintained in optimal ends of the ranges to keep her migraines and depression at bay, and she has been well ever since.
Medical Trials with T3 on Depressed Patients
The addition of T3 to improve outcomes for patients with treatment-resistant depression has proven extremely beneficial
The addition of T3 to improve outcomes for patients with treatment-resistant depression has proven extremely beneficial. Patients with or without diagnosed thyroid disease responded positively when T3 was added to their antidepressant drug treatment and their symptoms resolved. This raises the question of the possibility that underlying hypothyroidism, not being picked up in standard blood testing, could have been the main contributing factor to the depression in the first place.
Another hypothesis on the beneficial action of T3 upon the brain, was in regard to the balance of the ratios between the hormones T4 and T3, especially when T4 levels are high and T3 levels are low.
"With respect to thyroid hormones, several older studies reported that the addition of low-dose (25–50 μg/day) triiodothyronine (T3) induced an acceleration of the response to tricyclic antidepressants. Later, the addition of T3 to conventional antidepressants was found to be highly effective in treatment-resistant depressed patients in some studies, but not all. An interesting hypothesis on the mechanism of action of T3 was put forward by Joffe et al. (1984, 1995), namely, that depression is a state of relative T4 excess and that T3 acts by lowering the serum concentrations and subsequently also the brain concentrations of T4 via inhibition of thyroid-stimulating hormone (TSH) secretion." https://www.nature.com/articles/1395162
Recommendations for Management of Depressive Disorders in Psychiatry
Psychiatry has come along way when it comes to depression associated with thyroid disorders. Recommendations for investigation, evaluation and management usually include the following:
• Review of family history on thyroid disease
• Consider clinical signs and symptoms
• Return thyroid hormones to optimal levels within the reference ranges, based on the healthy population, according to the NACB guidelines. TSH value to lower margin, and circulating free T4 and free T3 values to mid or upper quarter of the normal ranges. A TSH >3 mIU/mL should cause suspicion of a failing gland.
• Awareness of psychotropic drug interactions and side effects
• Consider history of inadequate response to psychopharmacologic interventions
• Investigate psychiatric patients with subclinical hypothyroidism— especially those with incomplete responses to psychotropic therapy. Treating with thyroid hormones should be considered first and foremost. The following are some of the criteria that should prompt consideration for thyroid hormone replacement:
"Indeed, even though the normal range for TSH is generally listed at between 0.35 mIU/mL and 4.50 mIU/mL, it is likely that the “most normal” range is between 0.5 mIU/mL and 2.50 mIU/mL. It is for this reason that the target TSH in the management of hypothyroidism is within this latter range... Lastly, it is important to understand that normal ranges are calculated based on the 2.5th to 97.5th percentiles of the distribution of values measured in the population tested. Therefore, 2.5% of people with completely normal thyroid function will have a TSH slightly below the listed normal range (and 2.5% slightly above the normal range)."
[Sheehan M., 2016] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321289/
"Free T3 levels in the lower 20% of the laboratory’s normal range are cause for pause in a patient with a mood or psychotic disorder and any of hypothyroidism’s clinical stigmata, even if thyroxine and TSH concentrations are normal."
[Geracioti., 2006] https://www.mdedge.com/psychiatry/article/62439/identifying-hypothyroidisms-psychiatric-presentations
It sometimes appears that Psychiatry has a better understanding of the effects of chronic illnesses upon mental health which is often overlooked by many general practitioners and Endocrinologists. With regard to thyroid disease, all of the above highlight the importance of careful clinical evaluation, the accurate interpretation of full TFT blood work, understanding a patient's health history, and aiming for optimal management according to the NACB guidelines.
CASE PRESENTATIONS
Psychscenehub: 'Thyroid and Mental Health - Role of Thyroid Gland in Depression, Anxiety and Psychosis? - Is the TSH enough to diagnose Thyroid Dysfunction?' A doctor's case presentations:
Case 1: "A postmenopausal woman with a diagnosis of treatment-resistant paranoid schizophrenia was on high dose typical antipsychotics. Her symptoms included depressive symptoms, delusions of nihilism and persecution. On clinical assessment, she showed signs and symptoms of hypothyroidism with her TSH level at 4.5 (normal lab range in the hospital was 0.5-5) with normal T4 and T3.I initiated Thyroxine based on her clinical presentation, and she responded to thyroid replacement of 50mcg in a matter of a week with her delusions remitting completely in two weeks. Furthermore, we were able to reduce the typical antipsychotic dose which led to further improvements in mood."
Case 2: "A 22-year-old female who was being treated for depression with citalopram continued to complain of poor energy levels and ongoing low mood. On history taking she had a number of symptoms of hypothyroidism, most notably thinning of hair with hair loss, fatigue and menstrual abnormalities; all of which have been exacerbated after her first pregnancy. Her TSH levels were 2.3 with normal T3 and T4 (but at the lower end of normal).I considered the hypothesis of possible hypothyroidism based on the clinical picture and prescribed a two week trial of 50 mcg of Thyroxine as an augmentation agent with the Citalopram. She showed a dramatic improvement in a week and particularly reported a decrease in her fatigue and improved motivation.
The response in both cases is noticeably striking due to the rapidity of response. Note that in the two cases, the TSH levels were within the normal lab range, yet they responded. These are in fact just two of several cases that respond brilliantly to Thyroid Replacement Therapy (TRT) when a careful clinical assessment reveals signs and symptoms of hypothyroidism. Monitoring of the TSH to avoid hyperthyroidism and close collaboration with the GP and if possible an endocrinologist is important."
https://psychscenehub.com/psychinsights/thyroid-gland-and-psychiatry/
Drug Effects and Interactions
An awareness of the interactions of psychotropic medications on brain chemistry and their effects on thyroid hormone synthesis and metabolism is extremely important when treating anyone with mental health issues.
The following is a PubMed review on the adverse effects on thyroid function by psychotropic drugs:
"Phenothiazines, which are antipsychotics, mainly alter iodine capture, complex and deactivate it, as well as decrease thyroid-stimulating hormone's (TSH's) response to thyroid-releasing hormone (TRH). Nonphenothiazines, typical antipsychotics, can induce the formation of thyroid autoantibodies and can elevate TSH levels. Atypical antipsychotics may decrease TRH-stimulated TSH. Tricyclic antidepressant drugs complex with iodine and thyroid peroxidase and deactivate them, induce deiodinase activity and interfere with the hypothalamo-pituitary-thyroid (HPT) axis by decreasing TSH response to TRH. The main effect with other antidepressant drugs is a decrease in circulating thyroid hormone levels. Lithium inhibits thyroid hormone release and increases TRH-stimulated TSH, inducing goiter, clinical and subclinical hypothyroidism, and hyperthyroidism. Carbamazepine mainly reversibly decreases serum thyroid hormone levels. Other psychotropic drugs such as valproic acid, benzodiazepines, opiates, anticholinergic and antihistaminergic drugs, and stimulants have minor interferences with thyroid functions.
Conclusion: Patients receiving lithium, phenothiazines, and tricyclic antidepressants TCA should be closely monitored for the development of thyroid function abnormalities. Only patients at risk for developing thyroid function abnormalities should be monitored when they receive typical and/or atypical antipsychotic drugs, nontricyclic antidepressant drugs, and carbamazepine. No specific recommendations are proposed as toward thyroid function monitoring for patients receiving any other psychopharmacologic drug."
https://pubmed.ncbi.nlm.nih.gov/21996646/
Overall, for thyroid patients who continue to suffer with abnormal levels of anxiety or depression, despite having their thyroid condition treated optimally, they may require an antidepressant medication to improve their brain function and reduce their mental and emotional symptoms. A doctor needs to be wise in their choice of psychotropic drugs and dosages given, and be aware of interactions and side effects for those with thyroid conditions. A close monitoring of a patient's clinical response, and serum hormone levels is vital, and if thyroid symptoms return, adjustments need to be made.
Holistic Treatment Protocol
There can be many different factors that contribute to mental conditions, and not everyone will require psychotropic drugs to relieve their symptoms.
When addressing mood disorders, a multifaceted treatment regime that includes a whole body approach, has always had greater success than simply relying on mood altering medications. Not everyone suffering with depression will require psychotropic drugs, especially if the root causes of the illness are found and treated specifically.
The most beneficial treatment protocols that improve both thyroid function and associated depressive disorders include the following:
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A healthy diet of whole foods
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Correcting nutritional deficiencies
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Avoiding foods/substances which cause an allergic or intolerant response
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Improving gut and liver health
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Reducing oxidative stress and inflammation
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Supplementing with natural substances and herbal adaptogens
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Increasing regular exercise
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Changing lifestyle to reduce stress
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Taking up hobbies
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Improving social circles and engagement with others
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Embracing cognitive behavioural therapy and life coping strategies
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Identifying and treating other health issues, such as, underlying infections, autoimmunity and chronic illnesses.
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Addressing endocrine (hormonal) system, considering adrenal insufficiency, oestrogen dominance and blood sugar controls.
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Administering thyroid medications — such as medication that blocks the body's ability to produce new thyroid hormone or replaces missing thyroid hormone — this usually improves both emotional and physical symptoms caused by thyroid disease.
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Ensuring that a patient is 'euthyroid' (normal thyroid function), but not simply according to blood test results within a broad reference ranges, but through clinical presentation and optimising TSH, T4 and T3 levels to a person's individual setpoints.
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Optimising key thyroid nutrients to improve thyroid hormone synthesis, conversion and utilisation, by considering iodine, iron, zinc, selenium and Vitamin D levels.
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Investigating and addressing low T3 syndrome, or poor T4 conversion, with the administration of synthetic T3 (Tertroxin) or Natural Desiccated Thyroid extract (NDT, aka Armour thyroid) according to a patient's responsiveness.
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Considering natural and conventional psychotic medications or substances - these are life saving for some, and reduce the severity of symptoms. Chemical altering drugs, however, should only be used when the severity of the condition warrants it, and when a person is unresponsive to other interventions. https://www.health.harvard.edu/mind-and-mood/pain-anxiety-and-depression
In the majority of cases normalising thyroid hormone levels through conventional and holistic approaches will restore brain function to normal and the symptoms related to behaviour, the mind and emotions will resolve.
Summary
Depression, anxiety, and a loss of intellectual ability may be the most prominent concerns that bring some people to their doctor. The patient and doctor alike may focus mainly on these psychological problems and not consider other bodily changes as significant. The use of antidepressants, which may be beneficial in some cases, may actually mask the presence of thyroid disease in patients whose depression is secondary to thyroid dysfunction. Sometimes anxiety and depression are viewed as the cause of many physical and mental health problems, and not as symptoms of a pre-existing condition.
Abnormalities in thyroid hormone levels can affect various neurotransmitters within the brain, causing significant changes in mood, cognitive function and pain sensitivity. A thyroid gland disorder should never be overlooked in anyone who suffers with depression or anxiety, and should be viewed with a high level of suspicion when accompanied by other physical changes. Careful investigation of family history and clinical symptoms, along with thorough lab work, may be more revealing of the actual cause, and lead to a more accurate diagnosis.
Thyroid disease can cause a whole gamut of mental and emotional signs and symptoms, from mild degrees of apathy and anxiety, to serious forms of depression and mental illness. In the majority of cases normalising thyroid hormone levels through conventional and holistic approaches will restore brain function to normal, and the symptoms related to behaviour, the mind and emotions will resolve. There is light at the end of the tunnel.
So, never give up when it comes to your mental health or your thyroid condition. Educate yourself, seek out a variety of specialists for their expertise, and find a doctor who will work with you and fight for you. Keep pushing forward, one step at a time, until you find 'your normal'. And, never let anyone tell you to just accept your lot in life and that nothing can be done to bring change.
References:
CAN THYROID DISEASE AFFECT MY MOOD?
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/expert-answers/thyroid-disease/faq-20058228
THYROID ADVERSE EFFECTS OF PSYCHOTROPIC DRUGS
https://pubmed.ncbi.nlm.nih.gov/21996646/
RELATIONSHIP BTW PSYCHOTROPIC DRUGS AND THYROID FUNCTION
https://pubmed.ncbi.nlm.nih.gov/9571980/#:~:text=Some%20widely%20used%20psychoactive%20drugs,steps%20of%20thyroid%20hormone%20biosynthesis.
TREATMENT OF REFRACTORY DEPRESSION WITH HIGH-DOSE THYROXINE
https://www.nature.com/articles/1395162
THYROID HORMONES, SEROTONIN AND MOOD: OF SYNERGY AND SIGNIFICANCE IN ADULT BRAIN
https://www.nature.com/articles/4000963
BIOCHEMICAL TESTING OF THE THYROID; TSH IS THE BEST AND, OFTENTIMES, ONLY TEST NEEDED - A REVIEW FOR PRIMARY CARE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321289/
L-THYROXINE AUGMENTATION OF SEROTONERGIC ANTIDEPRESSANTS IN FEMALE PATIENTS WITH REFACTORY DEPRESSION
https://pubmed.ncbi.nlm.nih.gov/17289154/
PAIN, ANXIETY AND DEPRESSION
https://www.health.harvard.edu/mind-and-mood/pain-anxiety-and-depression
DEPRESSION AND ANXIETY ARE MORE PREVALENT IN PATIENTS WITH GRAVES' DISEASE THAN IN PATIENTS WITH NODULAR GOITRE.
https://www.karger.com/Article/FullText/365211#:~:text=Results%3A%20In%20Graves'%20disease%20levels,%25%20(p%20%3D%200.131)
THYROID AND MENTAL HEALTH - ROLE OF THYROID GLAND IN DEPRESSION, ANXIETY AND PSYCHOSIS? - IS THE TSH ENOUGH TO DIAGNOSE THYROID DYSFUNCTION.
https://psychscenehub.com/psychinsights/thyroid-gland-and-psychiatry/
NATIONAL INSTITUTE OF MENTAL HEALTH
https://www.nimh.nih.gov/health/topics/depression/
CLINICAL DEPRESSION, MAJOR DEPRESSIVE DISORDER, MAYO CLINIC
https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770
© Robyn Koumourou 2021