Emotions and Your Thyroid
In This Chapter
- Understanding how chemicals affect emotions
- Taking depression and anxiety seriously
- Using T3 to fight depression
- Mood swings and antibody testing
- The thyroid’s role in bipolar disorder
One of the worst aspects of thyroid disease is the havoc it can play with our minds and emotions. The physical symptoms of a thyroid problem (such as gaining weight or losing hair) are easy to spot. Mental symptoms such as clinical depression or anxiety are more subtle … and more likely to be dismissed as being the result of stress, personal issues, or “just your imagination.”
However, they’re very real illnesses. Millions of people struggle with mental disorders, and many of them could be cured if they simply realized the source of their pain was an easily treatable thyroid condition.
How Hormones Rule Us
The relationship between our intangible minds and physical bodies has been a topic of conjecture and wonder for ages. While no one understands all the nuances of the mind-body connection, it’s undeniable that your thoughts and moods are heavily influenced by the “chemical soup” that’s constantly circulating in your blood and interacting with your brain. And among the chemicals that have the biggest impact are your hormones.
If you’re a woman, you know how enormously moods can be affected by the hormonal upheavals that accompany PMS, menstruation, pregnancy, post-pregnancy, and menopause.
And if you’re a man, think back to when you became an adolescent and your thoughts suddenly started focusing on sex, and you became more aggressive. Also recall that as you grew older, your sex drive became less urgent and your attitude mellowed. These changes were orchestrated by your hormones.
More specifically, each cell in your body has multiple mini-programs built into it called receptors. When a hormone designed to generate a particular activity enters a cell containing a receptor for that activity, the hormone behaves like the ignition key in an engine and turns on the receptor. The cell then performs the appropriate action.
When it comes to thyroid hormones, among the activities that can be activated are energy production, cell growth, and the manufacturing of critical chemicals. That might not sound significant within the context of one tiny cell, but your brain is composed of billions of cells. When hormones activate a large number of receptors in your brain at the same time, the emotional effects can be overwhelming.
Unfortunately, the same holds true when brain cells that would normally be activated suddenly aren’t—for example, due to a hormone shortage caused by hypothyroidism. The painful numbness of this lack of activity has been described by some depressed patients as “the void.”
Throat Quote
Everything was black. The trees were black, the road was black. You can’t believe how the colors change unless you have it. There’s just no color. It’s scary.
—Political columnist, and depression survivor, Art Buchwald
Many people feel embarrassed or ashamed about having a disease that impacts their emotions. In the past there’s been a terrible lack of understanding about such illnesses, and a tendency to blame those who have them. Given what medical science now knows about these problems, however, there should be no more of a stigma associated with depression or anxiety than there is with having asthma or diabetes. All these conditions are the result of something gone wrong with the body’s internal chemistry—and they’re all treatable.
Diagnosing and Treating Depression
If you’re hypothyroid, one of the results of your brain having an insufficient amount of T3 can be clinical depression. While the cause is straightforward—your brain isn’t being supplied with the energy it needs—the consequences can be devastating. As many who’ve suffered this illness will attest, almost nothing compares to its special kind of pain.
Throat Quote
I once went to a psychiatrist and I said, “I’ll do anything, get me out of this.” And he said, “I know what you’re going through. When one of my parents died, I went through awful grief.”
“Do you think grief is anything like depression?” I told him.
Go with the grief, it’s better. In grief, you’re at least feeling a rich, deep feeling. In depression, you don’t even have that. It’s just that awful drone of nullity.
—TV host/author Dick Cavett, speaking about his depression
People who’ve never experienced clinical depression often mistake it for no more than sadness, and their response may be to tell you to “get over it” or “cheer up.” That’s like suggesting to someone with cancer to “just tell your cells to be healthy again.” A more pragmatic approach is needed.
The good news is if your depression stems entirely from a lack of thyroid hormone, taking thyroid medication should soon cure it. This is often so effective that it can seem like magic. However, the medication is simply providing your brain with the chemicals it needs to function properly.
One qualification is that taking T4 alone—for example, in the form of Synthroid—might not be effective. No one is sure why, but when it comes to depression what typically works best is taking T3 directly (as opposed to relying on your body to convert T4 to T3). Therefore, taking any of the following is likely to work:
- Desiccated thyroid (such as Nature-Throid), which is a natural mix of T4 and T3.
- A mix of Synthroid (synthetic T4) and Cytomel (synthetic T3).
- A mix of desiccated thyroid and Synthroid. This can make sense when you need a T4-to-T3 ratio that can’t be achieved with desiccated thyroid alone.
If your only problem was an underperforming thyroid, then once you’re on the right hormone dosage—and especially the right amount of direct T3—your depression should disappear. If your depression lifts to a degree but doesn’t go away, then there could be causes for it beyond your thyroid. In this case you should keep taking T3, but in addition pursue other treatments such as exercise, talk therapy, and/or anti-depressant medication.
For the latter, you can have your doctor prescribe a conventional antidepressant such as Zoloft, Paxil, or Prozac. Alternatively, you can try natural medicines that raise serotonin levels such as tryptophan and 5-HTP (which are available over-the-counter, but it’s best to adjust their dosages under a doctor’s supervision).
Thyroidian Tip
It’s fine to mix antidepressants and T3. In fact, many doctors use T3 as a supplement to antidepressants even when there’s no evidence of a thyroid problem. Although no one knows why, T3 frequently helps alleviate or cure the depression. In such cases what’s prescribed is Cytomel—or its generic version liothyronine—which is the only medication available that’s pure T3 (as opposed to a T4/T3 mix). As long as free T3 levels are monitored via periodic blood tests (to avoid overdosing and hyperthyroidism), there’s no downside to giving T3 a chance when conventional antidepressants have failed.
Diagnosing and Treating Anxiety
Anxiety is a frequent symptom of hyperthyroidism. As your metabolism speeds up, you’re likely to become more tense, nervous, and apprehensive about everyday events for no apparent reason. In addition, your heart may beat exceptionally fast, making you feel as if you drank a pot of coffee.
Victims of anxiety often blame their feelings on stress; but if you weren’t anxious previously and nothing notable has changed in your life, it’s wise to get tested for a physical cause—including an overactive thyroid.
Throat Quote
Anxiety is the rust of life, destroying its brightness and weakening its power.
—Anonymous
Paradoxically, anxiety can also stem from Hashimoto’s disease, which is the primary cause of hypothyroidism.
That’s because Hashimoto’s breaks down the colloid cells that make up your thyroid. The destruction of these cells progressively shrinks your thyroid until it’s unable to produce the amount of hormones you need. During the early stages of Hashimoto’s, however, every time a bunch of colloid cells are ruptured they release the thyroid hormones they were storing. This abrupt spurt of extra hormones into your body can make you temporarily hyperthyroid—which may result in feelings of anxiousness, nervousness, and/or irritability. Over time you’ll feel a gradual decline in hormones as your body returns to normal, and as your thyroid works at reduced capacity. But then the Hashimoto’s will strike again, and you’ll undergo another episode of hyperthyroidism.
This cycle of highs and lows—which is called Hashitoxicosis—is likely to create wild mood swings. If your doctor tests your TSH, T4, and T3 levels, however, they might all show up as normal, because the highs and lows often end up balancing each other out. Unless your doctor happens to take your blood during a period when the Hashimoto’s is attacking and your thyroid levels are spiking, standard blood tests may label your thyroid as functioning perfectly.
To account for this, your first blood workup should additionally cover antibodies. Since Hashimoto’s is an autoimmune disease, it’ll be detected via tests for antibodies attacking your thyroid, at which point your doctor can take a closer look via an ultrasound.
It’s actually a good idea to check for antibodies in any initial thyroid blood testing. Nonetheless, most doctors neglect this step. So if you’re experiencing mood swings, insist that antibody testing be included in your doctor’s orders to the lab.
If it turns out your anxiety is being caused by standard hyperthyroidism—for example, the autoimmune disorder Graves’ disease—then see Chapter 12 for information on treatment options.
If the cause is Hashitoxicosis, however, then your doctor will prescribe anti-anxiety medication to allow you to “ride out” the periodic attacks. Over time the Hashimoto’s will stabilize, putting you into a permanent hypothyroid state that can be managed easily with thyroid pills (see Chapters 8 and 9).
Thyroidian Tip
No one knows why, but anxiety can also be a symptom of standard hypothyroidism. This isn’t as common as anxiety stemming from an overactive thyroid, but it happens. So if you’re diagnosed as having low thyroid activity and you feel anxiety, it’s not your imagination; and the problem will probably go away once you’re on thyroid medication.
Other Mental Disorders
Thyroid symptoms can resemble a wide range of mental problems beyond depression and anxiety. For example, if you’re hypothyroid, you may become foggy and confused, and have memory lapses that resemble Alzheimer’s disease (such as forgetting if it’s summer or winter). But while Alzheimer’s is incurable and fatal, hypothyroidism can be readily managed with medication. This is especially a problem for the elderly, as roughly 25 percent of people age 75 and over are estimated to be hypothyroid; but their thyroid-related symptoms will often be misdiagnosed as age-related dementia and go untreated.
As another example, if you’re severely hyperthyroid you may experience hallucinations, delusions, and other symptoms associated with psychosis. Patients are periodically misdiagnosed as suffering from schizophrenia when they just have an overactive thyroid.
Then again, hyperthyroidism might lead you to become manic—for example, impulsive, reckless, or promiscuous, and skipping sleep for days on end until your body gives out and you “crash.” If the hormone spike is due to a Hashimoto’s attack, then soon afterward you’re likely to swing down the other direction into depression. This high/low cycle can easily be mistaken for bipolar disorder.
A particularly insidious complication with bipolar disorder is that many of the medications used to treat it—especially the newer ones, such as carbamazepine and Depakote—have side effects that include weight gain, depression, dry skin, hair loss … in other words, signs of hypothyroidism. So if your onset of Hashimoto’s is mistaken for bipolar disorder, and you go on to develop full-blown hypothyroidism, it’ll be almost impossible to tell from your symptoms; your doctor will just assume you’re experiencing the side effects of the bipolar drugs. There are patients who needlessly suffered for years for just this reason.
Considering that thyroid disease symptoms can so closely mimic both those of mental illnesses and the side effects of medications used to treat them, a wise precaution when seeing a doctor for the first time about a mental issue is to insist on having thyroid blood tests done—including antibody tests. You may find that your problems are stemming entirely from your thyroid.
Alternatively, you might really have the mental illness your symptoms indicate—but also have a thyroid problem that’s making it even worse. For example, if you have bipolar disorder, and in addition have even a slight leaning toward hypothyroidism, the latter may make you resistant to the mood stabilizers used to treat the bipolar condition. Doctors who understand this will put you on thyroid medication and adjust the dosage until your T4 and T3 levels are as perfect as possible. (This is analogous to adding T3 to antidepressants; even if your lab tests show your thyroid to be normal, the added hormones can make your medication more effective.)
One other nasty complication with bipolar disease is that one of its treatments, lithium, is chemically close enough to iodine to be eagerly absorbed by your thyroid. Over time, there’s a greater than 30 percent chance this will damage your thyroid and lead to hypothyroidism. Because of this, lithium is seldom the first choice for treating bipolar disorder. For some people, however, lithium works better than anything else. If that applies to you, have your doctor check your thyroid every 2-3 months to make sure it’s remaining healthy despite the risk posed by the medication.
The Least You Need to Know
- Millions of people are suffering needlessly from mental problems that can be cured with or helped by thyroid medication.
- Clinical depression and anxiety are real illnesses caused by chemical imbalances … and nothing to ashamed of.
- T3 is a powerful tool against depression, either by itself or working with antidepressant medication.
- If you have anxiety, ask your doctor to run thyroid antibody blood tests, because you could have a form of thyroid disease that doesn’t show up on a standard TSH test.