Thyroid Disease and Mental Health

Thyroid Disease and Mental Health

Hello, people! Welcome back to the blog. We’re continuing with our look at thyroid disease, and this week will be focused on its links with mental health conditions. 

Thyroid hormones regulate metabolism in every organ of the body, including of course the brain, which contains one of the highest concentrations of thyroid hormone receptors of any organ. These hormones are essential for brain development and maturation, as well as for function throughout life. Neurons are more sensitive to thyroid abnormalities than other cells, so it comes as no surprise that thyroid disease commonly results in various clinical manifestations affecting mental health/ function. In fact, the majority of people with thyroid dysfunction will develop cognitive, mood, and/ or emotional symptoms, it’s mainly a matter of degree. If that’s the case, where do thyroid symptoms end and psych symptoms begin? In recent years, we’ve learned they’re more connected than we once thought.

People with an overactive thyroid, hyperthyroidism, can suddenly feel tense and anxious. They may experience bouts of impatience or overactivity, panic attacks, and extreme sensitivity to noise. Are these symptoms of their thyroid disease? That sounds a bit like anxiety. People with an underactive thyroid, hypothyroidism, may feel overwhelmed, disinterested, and tearful. They can experience a progressive loss of memory and appetite, a dulling of personality, difficulty concentrating, and a lack of interest and mental alertness. Sounds a whole lot like depression. People with both thyroid disorders commonly suffer from mood swings, short temper, and difficulties in sleeping. And generally speaking, the more severe the thyroid disease, the more severe the mood changes. They can be the result of abnormal or rapidly changing thyroid levels, or it can even be a side effect of treatment.  For example, if you have hyperthyroidism and take beta blockers to slow down your heart rate, this can make some people feel less mentally alert, depressed, and fatigued.

A review of the literature estimates that up to 60 percent of people diagnosed with hyperthyroidism also have clinical anxiety, and up to 69 percent of people diagnosed with hypothyroidism are also clinically depressed. As you can imagine, misdiagnosis can become a problem. When thyroid conditions are misdiagnosed as mental health conditions, that can leave you with symptoms that may improve, but a disease that still needs to be treated.

There can be a lot of overlap in symptoms. Thyroid disease is often at the top of my list of differential diagnoses with many new patients, especially women of menopausal age. It can be a confounding riddle, especially in times of crisis, if patients are unaware that they may have either condition. I’ve seen patients in emergency rooms for new onset of severe psychotic symptoms- auditory and visual hallucinations- and it turns out to be severe hypothyroidism. It’s usually a woman in her 50’s who’s been suffering through various symptoms for years, but assumed it was associated with menopause. In years past, even physicians would take a wait and see approach before doing labs. Today we’re better understanding the progression of illness and the links that exist between conditions.

Common Symptoms

Hyperthyroidism and Clinical Anxiety

Hyperthyroidism and Bipolar Disorder

Insomnia, anxiety, elevated heart rate, high blood pressure, mood swings, irritability

Hyperthyroidism can produce symptoms similar to those seen in cases of clinical anxiety. It can also produce symptoms of mania that are more or less identical to the mania symptoms found in people with bipolar disorder. We also know that people with bipolar disorder have increased risk for developing hyperthyroidism. And lithium, a drug used to treat bipolar disorder, can aggravate or trigger hyperthyroidism. Good to know.

Common Symptoms

Hypothyroidism and Depression

Hypothyroidism and Cognitive Dysfunction

Bloating, weight gain, memory loss, difficulty processing information, fatigue

Hypothyroidism symptoms have a lot in common with those of clinical depression as well as cognitive dysfunction- meaning memory loss and difficulty organizing thoughts. In fact, there’s fairly recent evidence that thyroid hormone replacement medication may be helpful for treating depressed patients, even those with normal thyroid function. German researchers found that high doses of thyroxine improved the symptoms of 17 depressed patients who had not responded to multiple antidepressant drugs. Half of them recovered, and only one failed to improve. 

Autoimmune Thyroiditis (AIT) 

aka Hashimoto’s Hypothyroidism or Disease

Hashimoto’s disease is the most common cause of hypothyroidism, and affects about 10 percent of the population. It primarily affects middle aged women, but can also occur in men and women of any age, and in children as well. AIT means the person’s immune system is creating antibodies that mistakenly attack their own thyroid, leading to chronic inflammation, which interferes with hormone production. This leads to a potentially severe drop in thyroid hormone levels, and the person feels exhaustion and tension, and all the symptoms of hypothyroidism, up to psychosis- myxedema madness. 

AIT often goes undiagnosed because symptoms are attributed to menopause, as women aged 30 to 50 are the most common sufferers, or to depression and anxiety. If you have AIT and seek psych treatment, make sure your psych provider knows you have AIT, you can receive more effective treatment by being able to choose antidepressants that are less likely to cause weight gain. And you should also know how your antidepressant effects selenium levels, which can help with inflammation. Patients with depression and anxiety disorders should consider having a full thyroid panel with antibodies to test for AIT. And for patients with AIT, a screening for psych symptoms is recommended. Early administration of appropriate treatment- antidepressants and hormone replacement- provides a distinct advantage to patients. 

Recent studies have quantified links between AIT and depression, anxiety, and bipolar disorder. If you have AIT, you’re 3.5 times as likely to suffer from depression and  2.3 times as likely to suffer from anxiety. Inversely, more than 40 percent of people diagnosed with depression also suffer from AIT, and the same is true for 30 percent of people diagnosed with anxiety. And AIT is an endophenotype of bipolar disorder, meaning that both conditions have the same genetic origin.  

The main message today is that if you have thyroid disease or a mental health diagnosis, be sure to inform all of your physicians, be aware of the links between the two conditions, keep an eye on your symptoms, and consider screening for the linked condition as early as possible to initiate treatment if needed. 

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Thank you and be well people!

MGA