A version of this article was initially published through Psychology Today

Thyroid and Mental Health

In our culture, we 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.”

If you struggle with lingering symptoms of depression, anxiety, mood swings, or obsessive mannerisms, it is important to consider the connections between your thyroid and mental health.

What is the thyroid?

The thyroid gland is 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 wreck havoc on the body and contribute to many challenging, and at times misdiagnosed, 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
Hyper sensitivity to cold weather
Poor circulation and numbness in hands and feet
Muscle cramps
Slow wound healing
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 high calorie diet
Light and/or inconsistent menstrual cycle

Challenges to 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 — around 60% of people with a thyroid condition will continue to live in suffering, without receiving the appropriate medical attention or care.

Further statistics show that women are 5–8 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? Why do so many thyroid disorders remain undiagnosed and/or mistreated in our current systems and models of care?

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.

Thyroid and Mental Health

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 and assessing their patients.

As noted above, symptoms of thyroid dysfunction often overlap those of mental health conditions, such as anxiety, depression, insomnia, and other mood disorders. 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.

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/or misdiagnosed.

Understanding lab tests

Unfortunately, for those of us who have been fortunate enough to detect any hidden problems in our thyroid glands, we then have to navigate through the world of lab tests.

Unless you’ve done your research wisely or see an excellent practitioner who possesses the magical powers of translating such lab tests, this process of assessing overall thyroid function can be tricky.

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.

It’s OK; try not to let these numbers/letters freak you out or drive you mad, but do consider the following:

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. When discussing what tests to perform with your provider, request for a full thyroid panel which assesses all of these important levels.

If you’ve read this post and are feeling a bit overwhelmed, that’s understandable. I totally get it. 🙂 Read parts of my own story and how I’ve coped: Coping with Autoimmune Disease: Finding the Balance Between Fighting and Letting Go.

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.