Uncovering the Complex Relationship between Thyroid Function, Depression, and Anxiety

Once little understood and rarely discussed, mental health issues have now largely been freed from the shroud of confusion and stigma that long obscured them. Over the course of the last several decades, researchers have been able to make significant strides toward identifying the origins, causes, and course of many common mental health problems such as depression and anxiety.

Today, it is widely recognized that many, if not most of these disorders have their roots in chemical imbalances within the body. This growing recognition has vastly expanded the treatment options available for individuals diagnosed with depression, anxiety, and other related mental health issues.

Common organic causes of mental health problems include factors such as hormonal imbalances, particularly during or after childbirth or menopause, deficiencies or impediments in the uptake and distribution of neurotransmitters, and hypertension. Once diagnosed, mental health issues that are caused by these health problems can often be improved or even eliminated by treating the underlying illness or disorder.

In recent years, a number of prominent researchers have begun to explore the impact of thyroid disorders on mental health. Studies that have been undertaken to evaluate the relationship between these two factors have uncovered many interesting correlations. At the current juncture, many scientists believe that thyroid malfunction could play a role in a much higher percentage of cases of mental health problems than previously estimated.

Hypothyroidism and Depression

Hypothyroidism is the most common form of thyroid disorder. The suffix “hypo-“ means slow, under, or too little, and these terms describe the type of thyroid malfunction experienced by individuals with hypothyroidism. Basically, the insufficient production of thyroid hormones causes many of the body’s normal functions to slow down, resulting in problems like fatigue, weight gain, and mental fogginess.

Not surprisingly, many patients diagnosed with hypothyroidism also experience clinical depression. With many of the body’s normal processes slowed down, the mental/emotional sphere can also be negatively impacted.

Hypothyroid patients with depressive symptoms often report being unable to shake feelings of gloom and hopelessness. In severe cases, the patient can became incapacitated by depression, experiencing paralyzing sadness that can even include suicidal ideation.

The tendency of hypothyroid patients to be at increased risk of depression has long been recognized by the medical community. Indeed, ongoing depression is one of the hallmark symptoms of the disease that often aids in diagnosing hypothyroidism. Often, treating the underlying thyroid malfunction can greatly reduce or eliminate these types of depressive symptoms.

What researchers are just beginning to discover is the extent to which the thyroid may play a role in depression in the general population. Some scientists contend that slow thyroid function that is not severe enough to merit a diagnosis of hypothyroidism may play a role in causing many cases of depression. However, at this stage, this theory has not yet been proven and remains controversial.     

Hyperthyroidism and Anxiety

Just as slow thyroid function can cause or exacerbate symptoms of depression, the dangerously heightened pace of thyroid function has been linked to anxiety. Many patients diagnosed with hyperthyroidism complain of common anxiety-related symptoms, such as panic attacks, constant worrying, irritability, and restlessness. In many cases, these signs actually help doctors diagnose hyperthyroidism.

As many as 40% of all cases of hyperthyroidism have been diagnosed in part due to an individual’s persistent symptoms of anxiety. In an estimated 5-20% of all cases of hyperthyroidism, the degree of anxiety symptoms can be classified as severe, with 1-2% of hyperthyroidism patients suffering from anxiety-related psychosis. 

Likewise, in patients who present with general anxiety disorder, physicians often evaluate thyroid function to rule out hyperthyroidism as a potential cause. Often, when hyperthyroidism is treated with an adequate course of pharmaceuticals, related anxiety problems subside.

Optimal Mental Health for Thyroid Patients

For many patients with thyroid disorders, the resulting mental health problems can be the most difficult aspect of living with the disease. However, in most cases, adequate treatment of the underlying disorder, whether it is hypothyroidism or hyperthyroidism, often greatly reduces or eliminates the anxiety or depression.  Here are some mental health guidelines to keep in mind if you or a loved one is living with a thyroid disorder:

• Adhere strictly to your prescribed thyroid treatment in order to maintain stable thyroid function and limit the possibility for variability that could negatively impact your mood.
• If you continue to experience symptoms of depression or anxiety despite adhering to your prescribed thyroid treatment, consult your physician -- additional medication may be necessary to further alleviate your symptoms.
• It may be beneficial to supplement your pharmaceutical treatment with counseling, especially if you have lived with depression or anxiety for an extended period of time. A licensed helping professional will be able to help you make a healthy transition to a life without these symptoms.
• In some cases, patients with thyroid disorders can experience depression, anxiety, or other mental health issues that are not related to their disease, especially in response to stressful or difficult life events. Don’t rule out the possibility that your thyroid may not always be to blame for situational depression or anxiety.

For Further Reading

• http://thyroid.about.com/b/a/137486.htm

• http://www.webmd.com/depression/news/20040315/atypical-depression-thyroid-link-still-alive

• http://www.thyroid.ca/Articles/EngE10F.html

Weight Loss for Hypothyroid Patients

Maintaining a healthy weight can be a challenge for any adult, as the increasing prevalence of obesity in the United States and around the world clearly confirms. The hectic modern lifestyle leaves most people little time to exercise regularly and prepare wholesome foods. Over time, drive-thru fare and takeout dinners can turn into extra pounds.

Even those who make a practice of eating right and exercising can experience difficulty maintaining a healthy weight. The aging process and related health problems often tend to promote weight gain, and over the course of a few years, these gradual increases can ultimately result in obesity. Since carrying excess weight often worsens a person’s existing health issues, the outcome can be a vicious cycle of illness and obesity from which it is very difficult to break free.

If maintaining a healthy weight can pose a formidable challenge even for healthy adults who are conscientious about sticking to a healthy diet and fitness regimen, it can feel like a frustrating debacle for those who suffer from thyroid problems. Hypothyroidism and other conditions that slow down metabolic function often cause weight gain and make weight loss difficult. But over the last several years, research has revealed new methods that may lend hope to hypothyroid patients who are hoping to lose weight.

Metabolism Woes: The Root of Hypothyroid-Related Weight Gain

The thyroid gland -- and the hormones it produces and distributes throughout the adrenal system -- help keep the body up to speed. These hormones regulate the metabolism, which is the system of processes by which energy is processed, stored, and used for fuel.

Very generally speaking, people with slow metabolisms gain weight easily and have difficulty shedding excess pounds, while those with faster metabolisms usually have little trouble staying trim, even with occasional overindulgences. Either way, your metabolic rate strongly influences the way that the body handles calories and regulates weight.

In hypothyroidism, the thyroid functions at a much slower rate than it should. This, in turn, slows down the entire metabolism, thus prompting weight gain. Indeed, one of the most widely recognized symptoms of hypothyroidism is an unusual weight gain that can’t otherwise be explained.

 Not only does hypothyroidism make it all too easy to gain excess weight, but it also renders the process of shedding those extra pounds very difficult. A metabolism that has been slowed by hypothyroidism can often be very resistant to even the most concerted weight loss efforts.

The experience of following a diet and exercise plan to the letter and still making no discernible progress has discouraged many hypothyroid patients who are trying to make a healthy lifestyle change.  After weeks or even months of little or no tangible results, many lose confidence in their ability to lose weight normally and give up altogether.

A Custom Weight-Loss Plan for Those with Hypothyroidism

While the prospect of weight loss can pose a serious challenge for hypothyroid patients, it’s not impossible. In fact, it’s mostly just a matter of convincing your metabolism to join in on the effort. Using a variety of methods, hypothyroid patients can get their metabolism up to speed and shed excess pounds, although it may take more time and effort than it does for people with normal thyroid function.

What’s the secret to weight loss success for hypothyroid patients? You don’t necessarily have to work harder, just smarter. Combining multiple tactics at the same time, you can increase the rate of your metabolism and likely begin to see results within several weeks of starting the program.

Strategies for Jump-Starting a Sluggish Metabolism and Weight Loss

The hypothyroid patient’s ideal action plan for weight loss has to be specially targeted to increase metabolic functioning. By combining several strategies to bump up the metabolism all at once, it’s more likely that your weight loss efforts will begin to be rewarded with visible results.

• Ensure that you are being treated with the proper dose of a suitable hypothyroid medication.

•  Include regular exercise in your plan to help combat metabolic resistance and increase your basal metabolic rate.

• Avoid simple carbohydrates and emphasize protein and whole grains to help overcome insulin resistance.

• Drink 64-100+ ounces of calorie-free liquids each day to help eliminate the retention bloat that can add as many five to ten pounds to your physique.

• Seek out support from fellow hypothyroid patients during your weight loss journey. Sometimes, only those who have faced the same kind of challenges can offer the comfort you’ll need to work through the inevitable difficulties of the process.

 For Further Reading

• http://www.mayoclinic.com/health/metabolism/WT00006

• http://www.suite101.com/lesson.cfm/18912/2313/2

• http://thyroid.org/patients/brochures/Thyroid_and_Weight.pdf

Normal and Abnormal Thyroid Changes During Pregnancy: Origins, Outcomes, and Treatment Options

The nine months that it takes for a human infant to fully develop represent a period of tumultuous physical change for mother and baby alike. Even for women who experience a normal, healthy pregnancy, the sheer scope of the physical transformation that is part of the process can be difficult to cope with. But for some expectant mothers, the hormonal turmoil brought on by pregnancy can actually serve to worsen emergent or existing health problems.

Hormones function as the engine that drive the physical changes and growth processes of pregnancy. In order to fuel the rapid growth of the fetus and initiate the changes in the mother’s body that will allow her to sustain the growing baby and prepare for the challenge of labor and delivery, the body’s production of a number of different types of hormones spikes significantly during pregnancy.

The thyroid is also part of the body’s network of hormone-producing glands that is known as the endocrine system. The delicately-calibrated thyroid gland is designed to respond to even minute shifts in hormone levels. As a result, the massive influx of hormones caused by pregnancy can sometimes cause variations in thyroid function during this time in a woman’s reproductive life. In some cases, a developing pregnancy can foster thyroid dysfunction in expectant mothers.

Normal Changes in Thyroid Function During Pregnancy

Because of the hormonal changes that are an inevitable part of pregnancy, it is common for thyroid function to be impacted in expectant mothers. However, for the majority of women, these changes are not severe enough to cause any noticeable health problems or pregnancy complications.

One of the most commonly cited thyroid changes during pregnancy is a slight enlargement or inflammation of the gland that mimics some of the symptoms of a goiter, which is caused by iodine deficiency. However, in developed nations, most balanced diets offer ready access to iodine, and as such, true pregnancy-related goiters are very rare. In the vast majority of pregnant women, the outcome of this inflammation is a slight, temporary enlargement of the thyroid that is usually undetectable to the naked eye.

Pregnancy-Related Hypothyroidism

A thyroid gland that does not function at the proper rate causes hypothyroidism, which is the medical term for a deficit of thyroid hormones in the body. In some cases, expectant women are diagnosed with a new case of hypothyroidism during pregnancy; in other instances, the high thyroid hormone demands of pregnancy can worsen an existing, diagnosed, or marginal case of hypothyroidism.

If a pregnant woman’s hypothyroidism goes untreated, it can have a dire impact upon the health and development of the fetus. The thyroid hormone is largely responsible for propelling neurological and physical growth, and if maternal levels of the hormone are insufficient, especially during the first trimester, the infant may suffer cognitive and physical problems as a result.

However, if the disorder is diagnosed before or during pregnancy, it can be easily remedied with a drug regimen of replacement hormones. These compounds are safe to take during pregnancy, and the dose can be adjusted to best fit the needs of each patient.

Pregnancy-Related Hyperthyroidism

Much more common -- and more serious -- is the threat of hyperthyroidism during pregnancy. This disorder prompts the thyroid gland to function at a heightened pace, producing an excess of thyroid hormone in the system that essentially speeds up many of the bodily processes. In pregnant women, it can also cause early labor, pre-eclampsia, as well as being linked to an array of birth defects in developing fetuses.

By far the most common cause of hyperthyroidism in pregnant women is Grave’s disease, which effects as many as 1 in every 1500 expectant mothers. Women who have elevated levels of the hCG hormone, which is often linked to severe morning sickness, may experience episodes of hyperthyroidism. Also, existing cases of hyperthyroidism may be worsened by pregnancy hormones, causing them to be diagnosed for the first time, although they may have existed undetected for years prior to the pregnancy.

Compared to hypothyroidism, the diagnosis and treatment of hyperthyroidism in pregnant women can be somewhat difficult. Based on the severity of the case and the patient’s medical history, doctors usually devise personalized treatment plans that fit the needs of each expectant mother. In milder cases, monitoring the situation with frequent tests may prove to be sufficient. Drug treatment may be indicated in doses small enough to avoid harm to the fetus. In severe cases, surgical removal of the thyroid may be necessary.

Starting a Family? Be Mindful of Thyroid Health Issues

If you have a past history of thyroid problems, or if relatives have been diagnosed with thyroid disease, these issues should factor into the family planning process. Experts say it is best for women to have their thyroid conditions diagnosed and well-treated before becoming pregnant to ensure the best possible outcome for the baby. Whether you are pregnant now or are just beginning to consider parenthood, you can talk to your doctor about the possibility that pregnancy-related thyroid issues may pose a problem for you.

Are You at Risk for One of These Lesser-Known Thyroid Diseases?

Beyond Hypothyroidism

Hypothyroidism -- the clinical description for an under-functioning thyroid gland -- is the most widely recognized form of thyroid disease. However, there are also many other thyroid conditions that can impact the metabolism and adversely effect one’s general health. Some of the lesser-known forms of thyroid-related conditions include hyperthyroidism, thyroiditis, and growths such as goiters, lumps, and nodules. In this article, we’ll take a look at these conditions and talk about symptoms, the diagnostic process, and new and emerging treatments.

Hyperthyroidism

In patients with hypothyroidism, the functioning of the thyroid gland slows down to a dangerously reduced pace, disrupting a broad range of metabolic processes and destabilizing the entire endocrine system. Hyperthyroidism, on the other hand, is the exact opposite of hypothyroidism -- it occurs when a patient’s thyroid functions too rapidly.

In contrast to the sluggishness, lack of mental focus, and weight gain that are the hallmark symptoms of hypothyroidism, patients with hyperthyroidism experience symptoms that are the consequence of excessively rapid thyroid function.  In effect, the body speeds up, and many of the most troubling symptoms of the hyperthyroidism result from the artificially increased pace of the body’s functions. Some of the chief symptoms associated with hyperthyroidism include:

• Anxiety, irritability, and nervousness
• Muscle weakness
• Light sleeping or insomnia
• Irregular, light menstrual periods
• Inexplicable weight loss
• Vision problems or eye sensitivity
• Increased sensitivity to temperatures, especially heat
• Enlargement of the thyroid gland
• Frequent urination and/or bowel movements

Once hyperthyroidism is suspected, an accurate diagnosis can usually be made with just a few tests that assess the level of the thyroid hormones in the blood stream.  Then, further tests are administered to determine the precise cause of the increased thyroid activity. Based on the findings from these assessments, a course of treatment is devised that will address the underlying causes of the thyroid’s hyperactivity.

By far the most common cause of hyperthyroidism is Grave’s disease. This condition, named for the Irish physician who first described the disease in the scientific literature, is caused by an enlargement of the thyroid gland that results in an overproduction of thyroid hormone in the bloodstream.

Other non-Grave’s causes of hyperthyroidism can include nodules or growths in and around the thyroid gland; thyroiditis or other types of inflammation of the thyroid gland; or the consumption of excessive doses of thyroid medication.

Based on the causes and characteristics of the patient’s case of hyperthyroidism, one of several treatments for the condition will be prescribed. Recent advances have led to the development of a wide array of pharmaceutical treatments for hyperthyroidism that treat both the condition itself, as well as its most prevalent symptoms.

For persistent cases of the condition, therapeutic doses of radioactive iodine may be administered. This therapy can effectively reduce extra thyroid cells without harming the rest of the body. For some patients with severe hyperthyroidism, a surgical removal of some or all of the thyroid gland may be necessary, although this is usually limited to patients with intractable Grave’s disease.

Thyroiditis

Another fairly common form of thyroid disease is thyroiditis, which refers to a swollen, engorged, or otherwise inflamed thyroid gland. In some cases, thyroiditis is seen in tandem with hypo- or hyperthyroidism, although it can also occur as a stand-alone diagnosis. Unlike many other conditions that involve inflammation, thyroiditis is not typically associated with an infection of the gland.

The three main subtypes of this condition are Hashimoto’s thyroiditis, De Quervain's thyroiditis, and silent thyroiditis. All involve varying degrees of swelling in the thyroid gland, which is sometimes visible to the naked eye and associated with varying degrees of discomfort. The preferred treatments for thyroiditis differ according to the causes and severity of the condition. In most cases of thyroiditis, the prognosis is good as long as the prescribed treatment is adhered to.

Thyroid Nodules and Goiters

Both thyroid nodules and goiters are relatively common thyroid disorders. While these conditions have different causes, they both involve abnormal growth patterns in and around the thyroid gland.

Thyroid nodules are small lumps of abnormal tissue growth that most frequently can be found on the outside edges of the thyroid gland.  In some cases, they can be sensed by external palpitation with the hand; in rarer cases, they can be visually detected.

Thyroid nodules are extremely common, occurring in the majority of the population, especially in the 50+ age group. Nearly all thyroid nodules are benign, escape detection, and require no treatment. For those that are cancerous or require treatment for other reasons, surgery is the most common form of treatment.

The term ‘goiter’ refers to a thyroid that is abnormally enlarged over the full span of the gland. A goiter causes profuse swelling over the entire neck area and can often be visually detected. Iodine deficiency was once a major cause of goiters. Today, adequate iodine can now readily be found in table salt and other processed food products, and problems with the regulation of the thyroid hormone have now eclipsed iodine deficiency as the leading cause of goiters. Once detected, most goiters can easily be treated with a course of prescription drugs, although in serious or severe cases, surgical removal of all or part of the gland may be indicated.

What You Can Do

As with all health conditions, thyroid problems that are detected early stand the best chance of responding well to treatment. Keep on the lookout for any signs of abnormality in the thyroid and neck region, including:

• tenderness in the area
• a feeling of pressure or fullness in your windpipe or throat
• prolonged coughing not associated with an illness
• respiratory difficulties
• shortness of breath
• difficulty swallowing

If you notice any of these symptoms, it’s important to consult with a physician to discuss the possibility that you may have a thyroid problem. Even if hypothyroidism has been ruled out, remember that there are a number of other thyroid conditions that could be causing the symptoms.

To Learn More

• http://www.nlm.nih.gov/medlineplus/ency/article/000356.htm
• http://www.mayoclinic.com/health/thyroid-nodules/DS00491
• http://www.emedicine.com/MED/topic916.htm

Is Hypothyroidism Slowing You Down?

The thyroid: A small gland with a big job

Feeling particularly fatigued, sluggish, and out of focus lately? Have you noticed that you’re putting on weight, even though your diet hasn’t really changed? Experiencing depression or other mental health problems? Rather than blaming garden-variety stress and strain as the likely culprits, you may need to check in with an endocrinologist -- an under-functioning thyroid could be causing these symptoms.

The thyroid is a small, butterfly-shaped endocrine gland that sits behind the diaphragm, in the lower area of the neck sometimes referred to as the “Adam’s apple.” Typically, the normal thyroid measures about two inches in length. But despite its diminutive size, thyroid dysfunction can result in serious health problems.

The thyroid is a key part of the endocrine system, which creates, distributes, and regulates hormones in the body. Because hormones play such a central role in the body’s ability to function properly and maintain optimal health, even minute changes in the working capacity of one of the endocrine glands can set off a chain of deficiencies, malfunctions, and adverse conditions that reverberate through the entire body.

What is hypothyroidism?

Like the other glands in the endocrine system, the thyroid generates chemical compounds known as hormones, including triiodothyronine and thyroxine, both of which help regulate the body’s metabolism. A person whose thyroid is not producing enough hormones to maintain stability in the metabolism is said to be suffering from hypothyroidism.

Hypothyroidism occurs when the thyroid’s secretion of triiodothyronine, thyroxine, and other hormones is inadequate. Because these chemicals’ job is to stabilize the metabolism, insufficient hormonal levels can actually cause the metabolism -- and a wide array of bodily processes -- to gradually slow down.

It is believed that nearly 10 million Americans suffer from varying degrees of hypothyroidism, the majority of them being women. Furthermore, many of those afflicted with hypothyroidism may be unaware of their disorder. Called “the great mimicker” by many physicians, hypothyroidism is difficult to diagnose, and its symptoms are often misinterpreted as signs of other illnesses and diseases. 

Signs and symptoms of hypothyroidism

One of the reasons why hypothyroidism often evades diagnosis is because the symptoms associated with the condition are so wide-ranging. To further complicate the issue, the exact nature and severity of the presenting symptoms often vary from patient to patient.

Because hypothyroidism causes the metabolism to slow down, many of the symptoms associated with the condition result from a gradual decline in the rate of common bodily functions. The hallmark symptoms of hypothyroidism include:  memory impairment, weight gain, general fatigue and malaise, a feeling of mental fuzziness or “brain fog,” diminished sex drive, increased sensitivity to cold, migraine headaches, slowed reflexes, skin dryness and puffiness, constipation, depression, anxiety, irritability, difficulty swallowing, shortness of breath, slowed speech, vocal hoarseness, abnormal menstrual cycles, and reproductive difficulties such as infertility.

Individuals with low thyroid functioning may present with any combination of these symptoms, depending on the exact nature and extent of their hormonal deficiency. In mild cases, few detectable symptoms may be present, making a timely and correct diagnosis unlikely.  

Causes and risk factors for hypothyroidism

The endocrine system is complex and delicately calibrated, and even minor or gradual bodily changes over time can cause dysfunctions. Doctors often have difficulty discerning the precise cause of hypothyroidism in some patients because the onset of the condition may occur gradually over an extended period of time.

The most common cause of hypothyroidism is actually a disease known as Hashimoto’s thyroiditis. This disease prompts the body’s immune system to fight the thyroid gland, as it would do if it were rejecting an intruding foreign body or an invading virus. Other immune disorders and inflammatory disorders can also impede proper thyroid function.

Genetic causes and birth defects are also cited as the cause of some cases of hypothyroidism. Insufficient pituitary gland functioning can also instigate hypothyroidism. Irradiation of the neck area has also been known to produce hypothyroidism-like symptoms, as has surgical removal of the thyroid gland.

According to epidemiological studies of diagnosed cases of hypothyroidism, the chief risk factor for the condition is female gender. Other factors that may increase an individual’s risk for hypothyroidism include obesity, an age of 50+, past thyroid problems and/or thyroid surgery, and a past history of neck irradiation, through either x-rays or radiation therapy.

Treatment and prognosis for hypothyroidism

Although there is no known cure for hypothyroidism, the condition responds very well to existing treatments. Patients who adhere to the prescribed course of medication often report no discernable symptoms and no significant diminishment in their sense of health, well-being, and quality of life. However, consistency is important in maintaining a stable metabolism -- hypothyroidism patients who discontinue their thyroid medication against doctors’ orders often experience wide fluctuations in thyroid function that can have negative long-term health effects.

In many cases, fatigue, depression, weight gain, and impaired cognitive function are simply the unfortunate results of the hectic modern lifestyle. However, these symptoms could also be a sign of hypothyroidism or another related health problem. If you’ve experienced any of these problems, check with your doctor about the possibility of a thyroid screening.

To learn more

• http://www.emedicine.com/med/topic1145.htm
• http://www.endocrineweb.com/hypo1.html
• http://www.webmd.com/hw/thyroid_disorders/hw145669.asp