"Early identification and treatment of hypothyroidism can prevent prolonged patient distress, ensure timely management, and improve overall quality of life."
Anxiety Symptoms in Hypothyroidism: A Case for Causation or Co-Occurrence?
Monitoring Editor: Alexander Muacevic and John R Adler
Eleftheria Dampa
Introduction
Hypothyroidism is a common clinical condition characterized by inadequate production of thyroid hormones by the thyroid gland. Hypothyroidism can be divided into three categories: primary, where the thyroid gland itself is unable to produce sufficient T3 and T4 thyroid hormones; secondary, where the pituitary gland fails to secrete adequate thyroid-stimulating hormone (TSH); and tertiary, where there is hypothalamic dysfunction that leads to reduced secretion of thyrotropin-releasing hormone (TRH). In iodine-sufficient regions, Hashimoto’s thyroiditis - an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland, leading to chronic inflammation and thyroid dysfunction over time - is the most common cause of hypothyroidism [1]. The standard practice for diagnosing hypothyroidism involves conducting thyroid function tests to assess thyroid function, with a primary focus on measuring TSH [2]. Evaluating TSH is the most reliable method for diagnosing hypothyroidism, as elevated TSH levels indicate the condition [3].
Anxiety disorders are a group of mental health conditions characterized by excessive and persistent feelings of fear, worry, and/or apprehension. These feelings can interfere with an individual’s daily activities and may be out of proportion to the actual situation or threat. Difficulty sleeping, sweating and trembling, restlessness, palpitations, tiredness, and irritability are some of the symptoms that might be present [4]. Regrettably, these symptoms and manifestations can closely resemble those of hypothyroidism, making accurate diagnosis and treatment more challenging. Anxiety itself can complicate the management of hypothyroidism. As the diagnosis of hypothyroidism relies on blood tests and a comprehensive thyroid panel, individuals may remain undiagnosed throughout their lives or mistakenly attribute their symptoms solely to anxiety. However, hypothyroidism could be responsible for the majority of these symptoms if not properly excluded first. Therefore, it is essential to rule out any underlying endocrine conditions before assigning a psychiatric diagnosis. The following case report presents a distinct situation where hypothyroidism presented with symptoms mimicking an anxiety disorder thus leading to a misdiagnosis. This draws attention to the absolute necessity of first considering and ruling out endocrine conditions in patients with symptoms resembling anxiety.
So very important. And it would have been good to know at the sudden onset of my hypo symptoms that anxiety can go hand in hand. Instinct prevented me from being honest with the GP which made for a lonely, anxious experience. Finding this forum and reading the similar experiences of other members gave me the necessary courage to tough out the bad times. And thankfully it still does.
Increased anxiety has been the worst symptom of having a thyroid condition for me. I was misdiagnosed with ‘health anxiety’ and offered antidepressants, but thanks to the support of members on this forum (shout out especially to SlowDragon ), I realised that this was related to my thyroid medication and key vitamins not being optimal.
This sentence is really relevant for myself and no doubt others on the forum ....
'it is essential to rule out any underlying endocrine conditions before assigning a psychiatric diagnosis.'
I'm sure my life would have been very different if my thyroid problems had been identified much earlier in life rather than in my 50's. I'm still titrating slowly upwards with Levothyroxine but mentally it's the best I've felt through my adult life.
so why isn’t it done? It’s exasperating. Will any GP read this or act on it? I doubt it very much. I bet it isnt part of any nice guidelines, why not?
Good someone is raising it but I bet it was known decades ago before blood tests took over from using some common sense and judgement even the blood tests aren’t the right ones no t4 no t3 no antibodies no vitamins etc. If it’s just TSH it can’t catch many cases, especially if the bar is set so high at over 10th ice I mean if that isn’t a grotesquely abnormal TSH I don’t know what is yet it’s demanded TWICE before treatment and what about forms that don’t have elevated tsh? The whole nice thyroid guidelines are guaranteed to do the converse of what this paper is pointing out. It’s insanity. They are a piece of nonsense
This is very true. My first symptoms were anxiety and of course digestion issues, as I'm sure most people here experienced.
I think the key is differentiating between Anxiety that is psychologically manifested (triggered due to actual factors e.g stress, depression) and that which is chemically induced solely due to some derangement in hormone levels.
Doctors will often label it as a psychological condition, that you should try to remove stress and take some tablets, it's an issue with your mental state, or imply you've always had it.
When in the case of Hypothyroidism (my own experience) is that you should forget about all of that and look at the chemical side. My anxiety was not situational, it could happen at any time, and had nothing to do with my mental state.
It is a complicated issue. Yes, anxiety has many possible causes but ....interestingly, if one has the Dio2 gene, anxiety may be the result, at least partly from poor conversion of T4 to T3.
Furthermore if one also has the C allele (sub-genotype) of rs225014) on Dio2, one is even more likely to experienced anxiety and depression.
The research suggests that T3 added to T4 in these cases helps enormously. Does anyone medical listen to this science-based wisdom? No, they do not!
Just add it to the huge pile of ignored research (some of it truly fabulous); particularly thyroid research. I wonder what would attract a healthy ‘eager to help’ young doctor to practise endocrinology? Nothing it would seem.
Why does this make diagnosis of thyroid issues more challenging? This is a very common condition and in my view it should almost be top of any medics radar. Eeegh! So much pain and despair could be avoided.
This sort of idiocy should be shaken out of so-called medics. It’s shameful really that this research must state the obvious.
We should be thankful I guess to these researchers stating that obvious so that alleged brainy people might be guided to understanding.
T3 has been shown to increase serotonin levels in the brain, potentially by enhancing serotonin neurotransmission and impacting the expression of serotonin receptors, suggesting that T3 can positively influence the serotonergic system, which is implicated in mood regulation, including the modulation of anxiety.
So correcting low levels of T3 can have a positive effect on mood including anxiety.
Approx 27 years ago …….When I was left 4-5 years on just 50mcg or 75mcg Levo ……my anxiety was crippling …..so much so I was eventually prescribed propranolol beta blocker by local endocrinologist. It did help adrenals take a rest…..but also slowed uptake and conversion of my limited Levo (Ft4) to active hormone (Ft3)
The only things GP or local endo tested….TSH and Ft4 looked “normal “. TSH was between 2-3 and Ft4 was 15-16 ish (12-22)
I was referred to psychologist because GP believed I had “chosen to be in wheelchair “ ……after 6 sessions psychologist gave me a glowing report….saying I was coping remarkably well will what was obviously a severe PHYSICAL condition…..I then finally got what I had been asking for ….a referral to a thyroid specialist endocrinologist …..though that took a further 6-8 months wait
arriving at this endocrine “centre of excellence “ in a wheelchair I was given a whole battery of tests including coeliac test (how odd I thought back then!) ….result of coeliac test then (and retest 20 years later) negative
Tests did however show my Ft3 was way below range
Dose Levo was very slowly increased over next 2 years to 125mcg
But background Anxiety never really went until I joined this forum, saw how important GOOD vitamin levels were and realised I perhaps had a gluten issue
for me…….cutting out gluten was the final piece in the jigsaw…….anxiety just stopped overnight
When I looked at historic tests results I found an old vitamin D test ….my vitamin D had been 12nmol. I was never told it was low or prescribed any vitamin D
And yes….heterozygous Dio2……astonishing benefits from addition of small doses of T3
"Early identification and treatment of hypothyroidism can prevent prolonged patient distress, ensure timely management, and improve overall quality of life."
I find that statement ironic. Doctors are taught to delay diagnosis and treatment for as long as possible. In my case I was considered to be an anxious drug-seeker and attention-seeker in my teens. Here I am, almost 50 years later, and that "diagnosis" has been interfering with my healthcare ever since, and doctors assume that it still applies. So getting any treatment for anything has been a battle my whole life.
i may be 'the exception that proves the rule' , but when hypo, my mental state is remarkably relaxed ... as in 'total apathy' ...... which is actually quite a pleasant change from my natural 'overthink everything' headspace.
unfortunately the wheels then start falling off my life due to feeling too cold /exhausted /comatose to get anything done ~ which then causes lots of real things to worry about.
i only seem to get anxiety when overmedicated , and even then , if i'm honest , it's more psycho/anger than true anxiety.
mind you ,i still got 'diagnosed' with 'post-natal depression' (for hiding behind trees in the woods ...no blood test given , thyroid not even considered) when the real cause was most likely 'post -partum thyroid wonky'
It is so very important to recognise that we are all individuals, with our own make-up, resulting in many and complex differences.
All the time we see these differences being mentioned. And the terrible effects when we are assumed to comply with the "standard model". And forced to act as if we do.
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