Hypothyroidism and Anxiety
The term anxiety refers to psychiatric disorders that involve extreme worry, fear, nervousness, and apprehension.
These disorders have a considerable impact on a patient’s quality of life.
Bearing in mind that psychological health is connected to physical health and wellbeing, in this article we’re going to explore the relationship between anxiety and hypothyroidism.
Symptoms of anxiety
Signs and symptoms of anxiety vary from one person to another. Plus, your symptoms may also depend on the type of anxiety (see below) you have. That being said, some common symptoms of anxiety include:
- Difficulty focusing and thinking clearly
- Feelings of panic, dread, and danger
- Gastrointestinal problems such as constipation or diarrhea
- Heavy sweating
- Hyperventilation or rapid breathing
- Insomnia
- Lethargy or weakness
- Muscle twitching or trembling
- Nervousness
- Rapid heart rate or palpitations
- Restlessness or being tense
Types of anxiety
Contrary to the popular belief anxiety is not a single disease. Instead, it is an umbrella term for various conditions.
Before we begin to discuss the link between hypothyroidism and anxiety, we need to learn more about the latter. Anxiety disorder involves the following categories[1]:
- Post-traumatic stress disorder (PTSD) – develops after a person is exposed to a traumatic ordeal or event
- Generalized anxiety disorder (GAD) – involves tension, exaggerated worry, and chronic anxiety
- Panic disorder – characterized by repeated and unexpected episodes of panic and fear that can be very intense. Panic attacks are coupled with physical symptoms involving heart palpitations, chest pain, abdominal distress, shortness of breath
- Obsessive-compulsive disorder (OCD) – indicated by repetitive behaviors or compulsions and obsessions or unwanted, recurrent thoughts
- Social anxiety disorder (SAD) – also known as social phobia, indicated by exaggerated self-consciousness and overpowering or tremendous anxiety in everyday social situations
How common is anxiety?
Saying “I’m anxious” isn’t the same thing as actually having anxiety. That said, anxiety is more prevalent than most people think.
In 2017, the National Institute of Mental Health reported that about 19.1% of American adults had some form of anxiety disorder in the past year. Similarly to depression, occurrence of anxiety disorders was more common in women than men with a ratio of 23.4% vs. 14.3% respectively.
Numbers show that 31.1% of American adults develop some type of anxiety at one point or another in their lifetime[2].
According to the available data, GAD affects 6.8 million adults or 3.1% of the US population, but only 43.2% of affected patients receive treatment. About 6 million people or 2.7% Americans have panic disorder while 15 million people have SAD.
In addition, 7.7 million adults have PTSD while 2.2 million adults have OCD[3]. Keep in mind that numbers could be higher since many people don’t seek doctor’s help for symptoms they experience.
Anxiety in hypothyroid patients
Hypothyroidism, or underactive thyroid gland, has a major impact on your overall health including psychological wellbeing. That is why its potential relationship with anxiety shouldn’t come as surprise.
Although scientists have explored the link between the two on numerous occasions, there is still a need for further research to uncover all mechanisms that connected hypothyroidism and anxiety.
Bathla M. et al investigated the prevalence of both anxiety and depression in hypothyroid patients. Their study included a total of 100 patients with hypothyroidism whose anxiety levels were measured by Hamilton scale for anxiety (HAM-A) and depression assessed via Hamilton depression rating scale (HDRS).
Findings revealed that women were more likely to suffer from hypothyroidism and patients with this condition exhibited either depressive symptoms or anxiety.
Gender prevalence is one of many things that both hypothyroidism and anxiety have in common – women are more frequently affected than men. Bathla and his team concluded that thyroid hormones play a significant role in behavior, mood, and cognition.
The correlation between thyroid status and psychiatry disorders is a major source of concern mainly because dysfunction of the butterfly-shaped gland can initiate psychiatric comorbidities[4].
Not all studies reached the same conclusion. Engum A. et al analyzed data of 30,589 subjects ages 40-89 with thyroid issues and found no statistical association between the presence of anxiety and thyroid dysfunction[5].
That being said, Almeida C. et al found that subclinical hypothyroidism has a considerable link with psychiatric disorders primarily increased frequency of depression and anxiety symptoms compared to euthyroidism[6].
Thyroid hormones and anxiety
The impact of anxiety on thyroid hormones is not researched as well as it should be, but the evidence does exist. Gonen M.S. et al found that subclinical thyroid dysfunction enhances anxiety in patients with both hyper- and hypothyroidism.
Mood changes associated with anxiety have a negative impact on a patient’s quality of life.
The same group of scientists explained, in their review, that although normal in range average thyroid hormone profile of hypothyroid subjects was still lower than in euthyroid persons. People with hypothyroidism had different levels of free T4 (fT4) than their counterparts with the healthy gland.
What’s more, disturbances in fT4 could be the cause of mood disturbances in hypothyroid patients with anxiety[7].
Kikuchi M. et al also discovered that anxiety disorder is linked with some alterations in thyroid hormone levels. This particular research focused on panic disorder and found that the more severe panic attacks, the higher the levels of TSH.
Additionally, the severity of anxiety correlated negatively with fT4[8]. As you’re already aware, hypothyroidism is characterized by insufficient production of thyroid hormones.
Why are anxiety and hypothyroidism connected?
As shown throughout this article hypothyroidism and anxiety are associated with one another. You’re probably wondering why that happens.
The reality is that more research is required to elucidate all the mechanisms that connect hypothyroidism and anxiety, but some links are obvious.
Besides alterations in fT4 which could cause mood changes, as mentioned above, other factors also play a role. For instance, thyroid hormones are associated with regulation of GABA[9] and serotonin[10].
Gamma-aminobutyric acid (GABA) is a neurotransmitter responsible for calming the central nervous system. On the other hand, serotonin is a neurotransmitter known as a “happy chemical” and it plays a vital role in mood, memory, sleep, appetite, and other functions.
Bearing in mind that thyroid hormone plays a role in regulation and creation of these neurotransmitters then levels of these hormones can affect your mood. When thyroid doesn’t function properly and production of its hormones becomes abnormal, it disturbs neurotransmitters involved in mood and behavior and causes anxiety.
Norepinephrine, epinephrine, and cortisol are also connected to thyroid hormones. Cortisol and other hormones regulate stress response and your body’s ability to respond to it.
Adrenal glands are most severely affected by stress which explains the increased risk of anxiety in patients with hypothyroidism as this state is strongly associated with elevated stress levels too.
Weight gain and anxiety
Weight gain is one of the most common symptoms of hypothyroidism. Evidence shows that body composition is closely related to thyroid hormones because they regulate thermogenesis, basal metabolism, and participate in the metabolism of glucose and lipids or fats.
Thyroid hormones also play a role in your food intake and fat oxidation. Hypothyroid people experience a decrease in thermogenesis and a slower metabolism.
As a result, they tend to have a bigger BMI and a higher prevalence of overweight or obesity[11] than their healthy counterparts.
Why is this important? While weight gain is not a symptom of anxiety, it is still connected with these psychiatric disorders. March 2018 issue of the journal Menopause had an interesting discovery.
You see, a team of scientists found that overweight women are more likely to develop anxiety. The study is the first of its kind to demonstrate that waist-to-height ratio could be the indicator of anxiety risk. Women with a higher waist-to-height ratio were more likely to have anxiety than those whose with a healthy weight[12].
It is particularly important to mention that overweight or obese individuals can display behaviors resembling those associated with anxiety disorders.
These behaviors can also stem from insecurity and feeling “out of place” due to negative body image. Gaining weight due to hypothyroidism can have a negative impact on a patient’s mental health and aggravate their anxiety.
Managing anxiety
Hypothyroidism induces a multitude of symptoms which have a significant influence on your quality of life.
This thyroid state can also increase your risk of anxiety or aggravate it. That said, you can feel better with a proactive approach.
There is no need to put up with it and wait for anxiety to go away on its own when there’s a lot you can do to feel better and calmer. Below, you can see some easy tips and tricks to make it happen.
Take deep breaths
Anxiety can make lead to panic attacks which cause shortness of breath. Unfortunately, difficulty breathing can make your anxiety even worse and it seems like this symptom will never end.
When you are in a stressful situation or you feel anxious, stop what you’re doing and just take a few deep breaths. Don’t try to inhale and exhale as soon as possible, focus on every breath you take and you’ll feel more serene.
Meditate
Meditation is one of the best ways to improve your psychological health and wellbeing. The ancient practice coming from India revolves around proper breathing techniques and freeing your mind.
While meditating you’re not thinking about your problems or anything around you. You just focus on your breaths or some other focal point while excluding the world around you. This can be incredibly therapeutic.
Eat a well-balanced diet
Everything you eat can either improve your health or ruin it. This isn’t just about physical health, but mental wellbeing too. Modifying your diet goes a long way. For example, it can aid weight management, help lower stress, allow you to manage symptoms of hypothyroidism more effectively.
On the other hand, unhealthy foods don’t deliver much-needed nutrients and they have no positive impact on your health. Instead of junk food, opt for healthier alternatives.
Some foods that are well-known for their potential to aid anxiety management[13] are salmon and other fatty fish, chamomile, turmeric, dark chocolate, yogurt, green tea, almonds, blueberries, citrus fruits, bananas, and others.
Exercise
Physical activity is a wonderful way to relieve your frustrations and feel much better instantly. Exercise boosts your energy levels, aids weight management, alleviates stress, and it helps you navigate your emotions into something productive so you can deal with them more effectively.
It’s needless to mention that regular exercise has a positive effect on hypothyroidism. If your fitness levels are not as high as you’d like them to be, start small to ease into the idea of physical activity.
Conclusion
Anxiety is such a frequently used word nowadays, but it is misunderstood. While most people think anxiety is just nervousness or that it’s a single disease, the reality is that anxiety is a term that refers to multiple disorders.
Hypothyroid individuals are at a higher risk of anxiety and the connection between underactive thyroid gland and anxiety is scientifically proven. More research is needed to learn more about this subject.
References
[1] What are the five major types of anxiety disorders? U.S. Department of Health and Human Services https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html
[2] Any anxiety disorder, National Institute of Mental Health https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
[3] Facts and statistics, Anxiety and Depression Association of America https://adaa.org/about-adaa/press-room/facts-statistics
[4] Bathla M, Singh M, Relan P. Prevalence of anxiety and depressive symptoms among patients with hypothyroidism. Indian Journal of Endocrinology and Metabolism. 2016;20(4):468-474. doi:10.4103/2230-8210.183476. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911835/
[5] Engum A, Bjoro T, Mykletun A, Dahl AA. An association between depression, anxiety, and thyroid function – a clinical fact or an artefact? Acta Psychiatrica Scandinavica 2002 Jul;106(1):27-34 https://www.ncbi.nlm.nih.gov/pubmed/12100345
[6] Almeida C, Brasil MA, Costa AJL, et al. Subclinical hypothyroidism: psychiatric disorders and symptoms. Revista Brasileira de Psiquiatria 2007 Jun;29(2). Doi: 10.1590/S1516-44462007000200013 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462007000200013
[7] Gonen MS, Kisakol G, Cilli AS, et al. Assessment of anxiety in subclinical thyroid disorders. Endocrine Journal 2004 Feb;51(3):311-5. https://pdfs.semanticscholar.org/79dd/74067318568bf41c765ceb2f3c1f6682304c.pdf
[8] Kikuchi M, Komuro R, Oka H, et al. Relationship between anxiety and thyroid function in patients with panic disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2005 Jan;29(1):77-81. Doi: 10.1016/j.pnpbp.2004.10.008 https://www.ncbi.nlm.nih.gov/pubmed/15610948
[9] Wiens SC, Trudeau VL. Thyroid hormone and gamma-aminobutyric acid (GABA) interactions in neuroendocrine systems. Comparative Biochemistry and Physiology 2006 Jul;144(3):332-44. Doi: 10.1016/j.cbpa.2006.01.033 https://www.ncbi.nlm.nih.gov/pubmed/16527506
[10] Bauer M, Heinz A, Whybrow PC. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Molecular Psychiatry 2002;7(2):140-56. Doi: 10.1038/sj.mp.4000963 https://www.ncbi.nlm.nih.gov/pubmed/11840307
[11] Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian Journal of Endocrinology and Metabolism. 2016;20(4):554-557. doi:10.4103/2230-8210.183454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/
[12] Arroyo KJ, Ramos-Torres G, Mezones-Holguin E, et al. Association between waist-to-height ratio and anxiety in middle-aged women: a secondary analysis of a cross-sectional multicenter Latin American study. Menopause 2018 Mar. Doi:10.1097/GME.0000000000001089 https://journals.lww.com/menopausejournal/Abstract/publishahead/Association_between_waist_to_height_ratio_and.97603.aspx
[13] 6 foods that help reduce anxiety, Healthline https://www.healthline.com/nutrition/6-foods-that-reduce-anxiety
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