It is said that 1 in 8 women will experience thyroid troubles at some time in their life. 

Did you know that Oprah Winfrey herself faced thyroid troubles for many years?

After meeting five different doctors about her symptoms, she received various diagnoses - as well as some terrible advice. One doctor even told her she would have to “embrace hunger" to handle her hypothyroidism. 

Her journey finally led to a moment of tremendous controversy on national television. 

In 2007, she invited a doctor onto her show. The doctor argued that low thyroid was connected to unexpressed emotions. Millions of women viewers across the country were taken aback. Could their repressed anger and anxiety have been the root cause of their disorder?

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The media pounced on Oprah for promoting "bad medicine." Conventional medicine was quick to label it as "quackery." There certainly is plenty of quackery parading as science. But is there any scientifically proven relationship between mind and body?

The Mind-Body Connection

Science indeed acknowledges a deeper, body-mind connection. The systems in our body are complex and intricate. There are nuanced interconnections between every part of our system. 

As an example, what are the physiological changes that occur in the system due to anger? 

Anger is the “fight” in flight-or-fight response. A bout of anger is related to increased hormones. Specifically: adrenaline (epinephrine), cortisol, and norepinephrine. Out of these, cortisol influences the thyroid the deepest. Excess cortisol suppresses TSH (thyroid stimulating hormone). This causes the thyroid to create less of its important hormones. Continuous stress makes cortisol release chronic. It eventually tips the scale toward autoimmune disease. (More about stress and GERD treatment in this post Link to https://www.anshulguptamd.com/stress-gerd/)

Nature has designed "stress" in the body as a short-lived phenomenon. Short blasts of stress are the body’s mechanism to face danger. But our modern world is filled with continuous stressors. We are always under threats, demands, and problems that can’t be solved. A constant barrage of negativity from various media sources increases this sense of “problem.”

When the body has no respite from stress, thyroid function becomes suppressed. Eventually, this can turn into an immune response and damage the thyroid itself. 

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How emotions affect thyroid?

Now, back to the original question- how do emotions impact the thyroid? How does the body-mind connection work?

Do you ever feel your life is spiraling downwards? Well, your thyroid feels the same way. To understand this, let us look at something called “IL-6” or cytokine interleukin-6. Specifically, let us examine its connection with anger. 

IL-6 tends to increase when we are under stress. A study that involved adults over 50 found: higher feelings of anger and frustration had higher levels of IL-6. 

The function of IL-6 is related to immune response. A key dimension of thyroid disorders is an autoimmune dysfunction. When the body is producing too much IL-6, there is an immune system imbalance. This imbalance sets the basis for autoimmune disorders.

Do thyroid disorders develop because of increased IL-6? Or does the increase in IL-6 occur because of thyroid disease? It could be both. But when anger boosts IL-6 production, IL-6 demands that the body attacks its own cells. This indicates that anger may have a direct impact on how hormones and immune responses interact with the thyroid. Particularly, with thyroid imbalances that stem from autoimmunity.  

It's important to note that both Hashimoto’s

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Thyroiditis and Graves’ disease involve higher than normal levels of IL-6.

Some Eastern healing systems consider the thyroid to be related to your “voice” - your emotional expression. Traditional Chinese medicine actually considers a hoarse voice as a symptom of thyroid dysfunction. This may be related to unexpressed emotions, like anger. “Swallowing anger” sends the poison right down to your gut - which is the command center of your immune system! Learning to process, acknowledge and resolve emotions are key to thyroid health. 

Bottom line: The body and mind are connected in more ways than one. 

To get to the root of one’s thyroid imbalance, one must seek expert medical consultation.

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Thyroid and mental health

Thyroid patients often describe their condition as “feeling crazy.” Feeling foggy, forgetful, anxious, and depressed is a common part of thyroid disorders. But, is the opposite also true? Can a person’s mood affect their thyroid? 

In fact, there is no debate about it anymore. Your mood affects your thyroid. Patients with anxiety and depression have been found to have abnormal levels of thyroid hormone in the blood. (Check out more on Female Hormone Disorder Treatment.)

Interestingly, the opposite is also true. Your thyroid also affects your mood. Mood symptoms of hyperthyroidism or an overactive thyroid include anxiety, nervousness, and irritability. Mood symptoms of hypothyroidism include depression and fatigue. 

That is why thyroid patients often first consult psychiatrists about their symptoms. It is the most obvious first sign of a thyroid disorder.

Here are some specific details of thyroid disorders and their corresponding psychological impacts.

FIRST RECOGNITION

The connection between hypothyroidism and mental health was first acknowledged in 1888. It was established by the Committee on Myxedema of the Clinical Society of London. They studied 109 patients with myxedema (a physical condition in hypothyroid patients). Half of the patients had what was eventually known as “myxedema madness.” A series of delusions and hallucinations. This was the first term that acknowledged the relationship between the thyroid (body) and the mind. An overactive thyroid can produce a lack of patience, depression, and episodes of mania. 

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HASHIMOTO’S AND MENTAL HEALTH

Thyroiditis is an auto-immune disease often caused by stressful life events. This includes puberty, giving birth, or menopause. Hashimoto’s is also often misdiagnosed as simply a mental health condition. In Hashimoto’s, the body’s immune system sees the thyroid as a foreign body. It begins to attack and kill thyroid cells. When cells are destroyed, they release their stored thyroid hormones. This process is what causes the classic hyperthyroid symptoms of anxiety, panic attacks, racing heart, and sweating hands.  High levels of thyroid antibodies are present in patients with Hashimoto’s encephalopathy (disorder associated with HT). It can cause brain alterations and result in lower psychological well-being. This is why patients are often misdiagnosed with psychiatric conditions. Serious personality changes are also common. This includes emotional instability, depression, anxiety, or failure to comprehend basic concepts. 

Thyroid and depression

What effect do psychiatric problems have on the thyroid? The connection between thyroid and mental health is so intertwined. Some medical professionals have found it difficult to distinguish between the two.  

DEPRESSION

In the United States, depression has a lifetime risk of occurrence of 20%. There is a 3.3 times higher chance of developing clinical depression symptoms in hypothyroid patients (Siegmann et al, 2018). Symptoms of hypothyroidism are similar to those of depression. 

The connections between hypothyroidism and depression were first described in 1825. A study noted that thyroid disease resulted in increased “nerve strokes.” Metabolic abnormalities in the brain which result in disordered neurotransmission, behavior, and cognition play a role in the manifestation of depression. Some doctors even state that one of the reasons for depression is because of a weakened metabolic action of thyroid hormones in the brain.

In a recent study, researchers introduced glandular thyroid hormones into depressed patients. Interestingly, their recovery from depression went faster, due to these thyroid hormones. (It’s important to note that these patients were not clinically diagnosed with hypothyroidism.)

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POSTPARTUM DEPRESSION (PPD)

Women with PPD have been found to have thyroid inflammation after childbirth. Some PPD patients were cured of symptoms after treating TSH or thyroid-stimulating hormones. 

Moreover, there is a thyroid connection with borderline personality disorder (including postpartum depression). The psychotic and depressive syndromes of the disorder have been linked with increased antithyroid antibody titers. 

BIPOLAR DISORDER

Autoimmune thyroiditis was proven to be related to BD in a 2007 study (Vonk et al.). 

During the depressed phase of Bipolar 1 disorder, patients were sensitive to thyroid fluctuations. A later study was conducted on 291 subjects with bipolar disorder. Some had manic episodes and some had depressive ones (Zhao et al., 2021). They found that there were significant differences in thyroid functions between the two. 

Further, the mood-stabilizing medicine Lithium has an effect on the thyroid. The medicine is often prescribed in the treatment for BD. But it has been associated with thyroid disorders, goiters, and (rare cases) Grave’s disease. Quetiapine and valproic acid, (used in BD treatment), have an impact on thyroid function as well. For these reasons, a patient undergoing treatment for BD should also check thyroid levels. Otherwise, the problem may come in another form. The very medications prescribed for BD can create mood swings due to hormone imbalances.

Connections between mental health and the thyroid have been thoroughly researched and documented. But it can be complex to determine the cause and effect. One may see it as the “chicken and egg” conundrum. 

Examining the connection between anxiety and the thyroid also reveals many nuanced observations. 

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Anxiety and Thyroid: What’s the Connection?

A study that evaluated 44,388 participants found that: people with thyroid conditions had higher levels of anxiety and depression. 

Anxiety plagues 60% of people with hyperthyroidism and 30% of those with hypothyroidism. 

Anxiety can occur in both under and overactive thyroid conditions. It is more common in hyperthyroidism. If the thyroid becomes dysfunctional, it may trigger a neurotransmitter imbalance. This can result in generalized anxiety disorder (GAD), panic attacks and agoraphobia (fear of public/crowded spaces). 

However, panic attacks due to thyroid disorders are often misdiagnosed. Thyroid patients experiencing shortness of breath, racing heart etc., could be confused with heart palpitations in a panic attack. These symptoms could occur because the thyroid and heart function are closely linked. Grave’s disease, an immune system disorder, is also often misdiagnosed as a panic disorder. 

In 2020, Dr. Juliya Onofriichuk (Kyiv City Clinical Hospital) found that patients going through panic attacks showed signs of an inflamed thyroid gland. This was the case even when thyroid function and levels are within normal categories.

This study illustrates the complex relationship between anxiety and the endocrine system. For this reason, expert advice in thyroid conditions is most crucial.

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Thyroid on your mind? How thyroid hormones affect your brain and vice versa

There is a reason why thyroid patients complain of brain fog, memory problems, mood changes, and depression. (Check out this post for more information)

The human brain has the highest expression of thyroid hormone receptors of any organ. It receives signals from the pituitary gland. The pituitary in turn receives instructions from its boss, the hypothalamus. When hypothalamus releases more or less TRH or Thyroptin- Inducing Hormones, it signals the pituitary gland in the brain to release more or less TSH. (insert a diagram or image showing hypothalamus/pituitary gland in brain) 

Every cell in your body has a thyroid receptor. So any disruption in thyroid hormone levels can affect any part of the entire body. The reason why it has such a profound connection with the brain is that it has many interactions with neurotransmitters or brain chemicals.

Here are a few:

• DOPAMINE: Low thyroid hormone patients can have decreased dopamine. Dopamine helps to increase TSH. When dopamine is low, it is a vicious cycle. When one has a dopamine imbalance, it causes a lack of motivation and energy, memory problems, issues with learning and impulsive behavior. 
• SEROTONIN: When serotonin is low, it leads to depression and low thyroid hormones. This leads to decreased serotonin levels and increased turnover of serotonin in the body. So: it not only reduces serotonin levels, but what you have is quickly eliminated. Like dopamine, serotonin is connected with TSH levels from the pituitary gland. Serotonin issues are linked to sleep issues, digestive issues, carb cravings and mood changes.
• GABA: Considered the most important inhibitory neurotransmitter, GABA can become low in a developing brain or high in an adult brain when thyroid issues are present. It is seen as a "soothing" and calming chemical in the brain. An imbalance in GABA levels includes anxiety, sleeping issues, addictive behavior and depression.

The importance of working with a physician who understands thyroid and the neurotransmitters in your brain is paramount. Dr. Gupta works with you to arrive at the right treatment plan. One which addresses all aspects of a thyroid disorder.

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Mental Health issues in Thyroid Disorders: Solutions 

It is clear that both mental health issues and thyroid disorders are intimately connected. This understanding helps us to see that we need to approach the entire situation from both sides. We have to address mental health directly. We also have to address the thyroid disorder directly. It may seem like an endless loop, but we can take steps toward a freer and more balanced life. 

• Reduce Stress. However stressful the chronic condition feels, it ultimately can be managed. Derive hope from the fact that thyroid hormone treatment works very well for millions of people around the world. Indulge in activities which help you stay centered and stress-free. Perhaps a walk, a meditation course, or even a new hobby like art or music. 
• Attitude! The mind-body connection reveals how disorders translate from the mind to the body and vice versa. But this connection also means that a positive, nurturing attitude toward your body can go a long way in your healing process. In fact, it is of paramount importance. Take care of yourself. 
• Sleep: Thyroid disorders can often make a person cranky and easily frustrated. Falling asleep at night can be more difficult than falling asleep during the day. A faulty circadian rhythm is also considered a source for thyroid imbalances. Try keeping a strict sleep schedule, with fixed timings. Keep your evenings as a ‘wind down’ time where your body and mind move into relaxation mode. Think soft music and self care routines. 
• Exercise: Work up a sweat either at the gym, through aerobic exercise or even a new dance routine. It helps to rev up metabolism and get rid of extra weight you may gain during the disorder. Exercise releases natural hormones which is a natural mood enhancer. As this article demonstrates, thyroid and mood regulation go hand in hand. The doctor will help with treatment - the moods can be taken care of through lifestyle changes.  
• Yoga and Meditation: Yoga and meditation address both Thyroid and Mental health. The positive effect of meditation is mediated by the endocrine system. Particularly, the impact is on the hypothalamus and pituitary gland. Evidence indicates that changes associated with endocrine function following meditation improve mental health. 
• Meditation is also a powerful tool for improving thyroid health. Research has shown that the practice of daily meditation can boost levels of key hormones and neurotransmitters. This includes: melatonin, serotonin, GABA, the adrenal hormone DHEA, and growth hormones.
• Moreover, adrenal fatigue can worsen or trigger hypothyroidism. Meditation also helps the adrenal glands by lowering elevated cortisol levels. 
• Eat Healthy Foods: As a common side effect of thyroid issues is weight gain, keep a diet which is low in fat and rich in fruits and veggies. Moreover, this type of diet will keep your energy levels high. Junk foods which tend to make your body sluggish also deplete your energy. The body needs tremendous energy to heal itself, so an appropriate diet is tremendously supportive. 

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Supplements for Anxiety and Depression

While a healthy diet is important, it is also essential to consume supplements with specific nutrients to improve your condition. 

Here is why:

• A general “healthy” diet may not include the specific nutrients required for a particular condition. Unknowingly, one may even consume foods which cause damaging effects, instead of helping it!
• Our food is no longer as nutritious as it used to be. Many people who are accustomed to a healthy diet believe they are getting all nutrients. However, through testing it is determined that they are low on several nutrients. 
• Due to industrialized agriculture, our soil is deficient in many nutrients which in turn translates to the food on our plate. 
• Another important factor is that different bodies will utilize these nutrients in different ways. This is largely dependent on genetic variations which affect our body’s ability to process minerals and vitamins. Moreover, patients require larger quantities of those nutrients and vitamins. This is why supplements are a must. 

Here are some supplements which can support the system through anxiety and depression. 

• Magnesium - Magnesium helps in relaxation. It stimulates production of melatonin and serotonin. This results in a mood-boost and better sleep. 
• Vitamin-D3- Low Vitamin-D levels are associated with increased symptoms of depression and anxiety. Vitamin-D has antioxidant properties and is hence important in mood disorders.
• Vitamin-B12 and B9- Together, these vitamins help to metabolize serotonin - a key hormone in mood regulation. 
• Omega-3 - Studies have shown that Omega-3 can create an antidepressant effect in cases of anxiety and depression.

As mentioned above, the nutrient level that we receive from our diet is slowly depreciating. Hence, a general multivitamin (which includes the above supplements) can also improve anxiety and depression symptoms.  

Please note that the above is a general list of supplements that are advised for anxiety and depression. However, before adding supplements to your dietary regime, it is strongly advised to consult with a physician.

For thyroid-specific supplements, check out this article

Importance of Functional Medicine in your Healing Journey

As illustrated through this article, the connection between anxiety, depression, and thyroid is complex and nuanced. Arriving at a diagnosis and treatment by only examining surface symptoms is often erroneous. 

We have seen thyroid patients come to us after years of receiving many kinds of misdiagnoses and ineffective treatment. This is because conventional doctors look only at symptoms, instead of digging deep for the root cause.  

On the other hand, functional medicine doctors get to the root of the thyroid disorder. They examine all aspects of a person and arrive at an effective treatment plan. Our treatment plans include dietary and lifestyle changes, customized for each patients’ unique needs. 

Dr. Anshul Gupta has worked with countless thyroid patients and helped them recover through customized functional medicine treatment plans. 

Reach out today for a free evaluation call and take the first step toward your healing journey. 

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