The Connection Between Hypothyroidism and Anxiety

Stress and anxiety.  The two terms are commonly used interchangeably but are they actually the same thing?  As it turns out, they’re not.  Anxiety is an ongoing state affecting our mental health whilst stress is a temporary physical reaction to a particular situation or stimulus. However, ongoing stress ie chronic stress can directly contribute to anxiety. Hyperthyroidism is commonly associated with anxiety but hypothyroidism and anxiety can occur together as well.

Symptoms Of Anxiety:

Some of the signs that may indicate you’re suffering from anxiety include:

  • Confusion
  • Continual worry
  • Fear
  • Muscle tension
  • Palpitations
  • Physical weakness
  • Poor memory
  • Problems concentrating
  • Shortness of breath
  • Sweaty hands
  • Stomach upsets
  • Unable to relax

Types Of Anxiety

Anxiety is an umbrella term that covers a range of disorders, notably:

  • Generalized anxiety disorders
  • Phobias – social phobia and simple phobias
  • Panic disorder
  • Obsessive-compulsive disorder (OCD)
  • Posttraumatic stress disorder (PTSD)

Interesting Questions about Thyroid:

What are the signs and symptoms of hypothyroidism?

Possible effects of hypothyroidism are:

  • slow heart rate (less than 70 beats per minute)
  • elevated blood pressure
  • feeling slow or tired
  • feeling cold
  • drowsy during the day, even after sleeping all night
  • poor memory
  • difficulty concentrating
  • muscle cramps, numb arms and legs
  • weight gain
  • puffy face, especially under the eyes
  • husky voice
  • thinning hair
  • dry, coarse, flaky, yellowish skin
  • in children, short height
  • constipation
  • heavy menstrual flow
  • milky discharge from the breasts
  • infertility
  • goiter (an abnormal swelling in the neck caused by an enlarged thyroid gland).
What About Thyroid Cancer?

Are all thyroid lumps cancerous? How common is thyroid cancer?

Thyroid lumps (also called nodules) are growths in or on the thyroid gland. They occur in 4%-7% of the population. A thyroid nodule might cause your voice to become hoarse, or it could make breathing or swallowing difficult. However, it usually produces no symptoms and is discovered incidentally by you or your physician

More than 90% of these lumps are benign (not cancerous) and do not need to be removed. Thyroid cancer is found in only about 15,000 people each year and causes about 1,210 deaths per year. The most common form (papillary cancer) moves very slowly, and treatment is almost always successful when the cancer is detected early. A less common form (follicular cancer) also moves relatively slowly. Two less frequent forms of thyroid cancer (undifferentiated, or anaplastic, and medullary) are more serious.

Who can get thyroid cancer?

Anyone can get thyroid cancer. However, one group in particular has a higher risk: people who have had radiation to the head or neck. From the 1920s to the 1960s, x-ray treatments were used for an enlarged thymus gland, inflamed tonsils and adenoids, ringworm, acne, and many other conditions.

At that time, doctors thought the x-rays were safe. About 1 million Americans received the treatment, and some of these people will get thyroid cancer up to 40 or more years after receiving the treatment. We now know that radiation therapy to the head or neck increases the chance of developing thyroid cancer later in life. (Radioactive iodine treatments and x-rays used for testing do not increase the risk of cancer.)

Others at higher risk include a child or elderly person with a lump (nodule) in the thyroid. If a man has a thyroid nodule, it is more likely to be cancerous than if a woman has one.

Radioactive Iodine

How does radioactive iodine work?

The thyroid gland absorbs iodine from the blood. When radioactive iodine enters your thyroid, it slowly shrinks the gland over a period of weeks or months.

The treatment is safe, simple, convenient, and inexpensive. It is usually given only once, rarely causes any pain or swelling, and does not increase the risk of cancer. However, it must be avoided during pregnancy or nursing, and patients should not become pregnant for at least six months after treatment.

When is radioactive iodine used?

Radioactive iodine is the most common treatment for hyperthyroidism. It does not require hospitalization. About 90% of patients need only one treatment. They usually start getting better in three to six weeks, and most are cured within six months.

This treatment may also be used after surgery for certain thyroid cancers. Radioactive iodine dissolves any cancerous tissue that could not be removed by surgery. The dose of radioactive iodine is larger in this case, and patients usually stay in the hospital for a day or two.

What can be expected with radioactive iodine treatment for hyperthyroidism?

  • It is usually given in liquid form or as a capsule. The dose can range from 4 to 29 millicuries.
  • It is tasteless.
  • There are almost never any side effects. In some rare cases, there can be an inflammation of the thyroid gland causing a sore throat and discomfort.
  • Radioactive iodine not taken up by the thyroid gland is excreted in urine and saliva. There is no evidence that the small amount of I131 excreted in the urine and saliva is harmful. Nonetheless, prudent nuclear medicine experts have recommended a wide variety of precautions. While these recommendations are sometimes confusing and inconsistent, it may be appropriate to take a few simple measures to avoid unnecessary exposure of infants and children to I131. Treated patients should rinse out their glasses or cups and eating utensils immediately after drinking and eating. The toilet should be flushed immediately after use, and the rim of the bowl should be wiped dry, if necessary.
  • It is advisable to drink two to three extra glasses of water a day during the four- to seven- day period following radioactive treatment so that radioactive material will not collect in the bladder for a long period of time.
  • Because radioactive iodine passes into breast milk, breast feeding mothers are asked to wean their babies before treatment.
  • It typically takes six weeks before thyroid hormone production is noticeably reduced. The average length of time for the thyroid hormone levels to become normal is about three to four months. If thyroid levels are not considerably reduced six months after treatment, the doctor might suggest repeating the treatment. Ninety percent of the time only one treatment is required; however, it might take as many as three attempts. The patient could be advised to take beta-blocking drugs and other medications the doctor believes are necessary until normal thyroid hormone production is restored.
  • Many patients treated with radioactive iodine become hypothyroid. This may happen within weeks, months, or years of treatment. Therefore, patients should be aware of the signs and symptoms of hypothyroidism, and their physicians should monitor their thyroid hormone levels regularly. When the patient becomes hypothyroid, thyroid hormone replacement begins and continues for life-one pill a day.

Have more questions? Need more answers? Check our Full Thyroid FAQ

Why Can Hypothyroidism And Anxiety Go Together In Some People?

Aside from the obvious connection, which is that dealing with hypothyroidism and worry about the symptoms can cause long-term or chronic stress leading to anxiety, there are also physiological connections between the two disorders.

Thyroid hormones are involved in the production and regulation of neurotransmitters in the brain. When levels of thyroid hormone drop there is usually an associated drop in the production of these neurotransmitters resulting in symptoms like depression that is typical of thyroid disorders like hypothyroidism. If allowed to go unchecked, these along with stress caused from dealing with other symptoms of hypothyroidism can contribute to chronic or long-term stress, which in turn is a contributing factor for anxiety.

What are Neurotransmitters?

Neurotransmitters are chemicals in the brain and central nervous system that regulate a number of processes including mood and emotions. The four major neurotransmitters involved in mood and emotion regulation are:

  • GABA and Seratonin – these are calming neurotransmitters
  • Dopamine and Norepinephrine are stimulating neurotransmitters

Normally these chemicals keep each other in balance so our moods and emotions are kept on an even keel. However, when abnormalities in other parts of the body that are directly related to production and regulation of these chemicals happens ie thyroid dysfunction, it can throw this finely tuned checks and balancing system out of whack.

Whilst hyperthyroidism is the thyroid disorder most commonly associated with anxiety, some hypothyroid patients also experience anxiety. Certain professionals believe it’s most likely the result of a combination of these associated neurotransmitter imbalances coupled with ongoing worry and stress about the effects of hypothyroidism on their health and coping with the debilitating symptoms they’re experiencing. As we’ve already mentioned, long-term or chronic stress can eventually lead to anxiety, which is an acknowledged mental disorder.

Treating Anxiety

If you have hypothyroidism and anxiety that is associated with thyroid hormone problems then treating the thyroid disorder should restore neurotransmitter production and function as well as reduce the physical symptoms that may be contributing to the underlying stress.   If the anxiety continues even after thyroid hormone replacement therapy has reduced the symptoms then you should speak to your doctor about exploring other probable causes.

Donna Morgan

Donna Morgan

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