Stresses and Hypothyroidism

How Are Stresses and Hypothyroidism Related?


Whilst there is no specific evidence that any particular type of stresses and hypothyroidism are interconnected, there is nevertheless a body of research that supports theories that they are.  Various types of stresses for example may affect the thyroid’s ability to produce those all-important thyroid hormones, causing the condition to develop.  It’s also thought that stress in addition to other health issues can aggravate the underlying thyroid health of an individual.

What Is Stress?

Stress is a natural response that happens when we encounter a situation that we perceive to be dangerous, or challenging. It increases our alertness, and provides us with additional energy for fight or flight.   It’s part of our basic survival instinct if you like.

Adrenal Stresses And Hypothyroidism

One of the first things that happens when we encounter a stressful situation is the release of a number of adrenal stress hormones like cortisol.  These hormones are important to our flight / fight instinct because they provide us with the mechanisms we need to either fight or flee.   Increased energy, increased alertness, diminished pain response and so on.   The release of all these hormones is controlled by the hypothalamus, which signals the pituitary gland to tell the adrenal glands to produce them because danger is looming.

We are very good at prioritising activities. When we’re short on proteins for example our body prioritises which processes will receive the limited supply of protein, which is invariably the life sustaining ones.   Those that are not life sustaining, like hair and nail growth, are cut off from supply. It’s the same deal when we’re stressed. The presence of stress hormones in the blood redirects most of our essential processes to the function of survival. Anything not immediately required for that purpose is put on hold, including our thyroid and thyroid hormone distribution.

At the same time, the elevated level of stress hormones tells our hypothalamus that we have enough for the moment. The hypothalamus passes this on to the pituitary gland, which stops producing hormones – all hormones, both stress and all non-life essential like TSH.  Normally as soon as the stress passes, stress hormones levels drop and other functions resume. No harm done!

However, our modern society presents us with a continuous stream of stress situations, forcing the adrenal glands to constantly produce stress hormones.  Eventually it can’t keep up and starts to slow down itself.  This is adrenal fatigue. It’s a similar situation with the pancreas, insulin and blood sugar. Constantly having to push out insulin to deal with high levels of blood sugar eventually causes the pancreas to start shutting down, causing type 2 diabetes.

Interesting Questions about Thyroid:

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.

How is Thyroid Disease Treated?

If you have thyroid disease, your doctor can discuss which treatment is right for you. The two basic goals for treating thyroid disease are to return thyroid hormone levels to normal and to remove potentially cancerous lumps. Treatments include radioactive iodine, antithyroid drugs, beta-blocking drugs, thyroid hormone pills, and surgery. There are several types of treatment:

  • Radioactive iodine is used to shrink a thyroid gland that has become enlarged or is producing too much hormone. It may be used on patients with hyperthyroidism, a goiter, or some cases of cancer.
  • Surgery is normally used to remove a cancer and may also be used to remove a large goiter.
  • Thyroid hormone pills are a common treatment for hypothyroidism, for patients with a goiter, and for patients who have had thyroid surgery. The pills provide the body with the right amount of thyroid hormone.
  • Anithyroid drugs and beta-blocking drugs are used to treat hyperthyroid patients.
What About Nodules?

What are hot and cold nodules?

Thyroid nodules do not function like normal thyroid tissue. A thyroid image (scan) done with a radioactive chemical shows the size, shape, and function of the gland and of thyroid nodules. A nodule that takes up more of the radioactive material than the rest of the gland is called a hot nodule.

A nodule that takes up less radioactive material is a cold nodule. Hot nodules are seldom cancerous, but less than 10% of all nodules are hot. Cold nodules may or may not be cancerous. All lumps should be checked by your doctor.

How do doctors test nodules for cancer?

Your doctor can use several tests to find out whether or not a thyroid lump is cancerous.

  • A thyroid image or scan shows the size, shape, and function of the gland. It uses a tiny amount of a radioactive chemical, usually iodine or technetium, which the thyroid absorbs from the blood. A special camera then creates a picture, showing how much iodine was absorbed by each part of the gland.
  • In needle aspiration biopsy, a small needle is inserted into the nodule in an effort to suck out (aspirate) cells. If the nodule is a fluid-filled cyst, the aspiration often removes some or all of the fluid. If the nodule is solid, several small samples are removed for examination under the microscope. In over 90% of all cases, this testing tells the doctor whether the lump is benign or malignant.
  • Ultrasound uses high-pitch sound waves to find out whether a nodule is solid or filled with fluid. About 10% of lumps are fluid-filled cysts, and they are usually not cancerous. Ultrasound may also detect other nodules that are not easily felt by the doctor. The presence of multiple nodules reduces the likelihood of cancer.

How are nodules treated?

Nodules that are thought to be benign are usually observed at regular intervals. Some patients may be advised to take thyroid hormone pills. In certain instances, the nodule may be surgically removed because of continuing growth, pressure symptoms in the neck, or for cosmetic reasons.

Fluid-filled cysts that come back after several aspirations may need to be removed.

If the testing shows a nodule that is, or might be, malignant (cancerous), your doctor will recommend surgery. (You should discuss special situations, such as pregnancy, with your doctor.) The goal of surgery is to remove as much of the cancerous tissue as possible. If the cancer is found in the early stages when it is still confined to the thyroid gland, the surgery is almost always successful. With papillary cancer, patients usually do well after treatment, even if the cancer has spread to the lymph nodes in the neck.

The surgeon starts by removing one lobe of the thyroid. This specimen is tested during surgery (frozen section) to tell the surgeon whether it is benign or malignant. If it is malignant, most or all of the thyroid is removed. If the cancer has spread, lymph nodes in the neck may also have to be removed. In addition, in patients with either papillary or follicular cancer, radioactive iodine therapy may be needed six weeks after surgery to destroy any remaining cancerous tissue.

What happens after surgery?

After surgery, patients must stay in the hospital for one to three days. They may also need to take some time off from work (one to two weeks for a desk job; three to four weeks for physical labor). Most patients do not have any trouble speaking or swallowing, and they report minimal pain after the surgery. In patients with thyroid cancer, a scan may be done approximately six weeks after surgery to detect any residual thyroid tissue that needs to be treated with radioactive iodine.

Patients with thyroid cancer will need to take thyroid hormone their entire lives. Some patients who have had a noncancerous nodule removed will also be advised to take thyroid hormone pills. These may prevent new nodules from forming in the remaining portion of the thyroid gland.

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

Stresses And Hypothyroidism – Adrenal Fatigue And Its Effect On The HPA

The hypothalamic-pituitary-adrenal (HPA) axis is a complex network for regulating temperature, immune system, mood, energy usage, digestion, and reaction of a body to stressful conditions. Continual adrenal stresses result in continual reduced pituitary and hypothalamic functions.  As thyroid hormone production is regulated by these organs, their depression also affects thyroid function.

The predominate thyroid hormone secreted by the thyroid glands is thyroxine (T4), which is inactive.  It needs to be converted to triiodothyronine (T3).  Impact of stresses on the hypothalamic-pituitary-adrenal axis not only depress thyroid, pituitary and hypothalamic functions but also obstruct the conversion of T4 to T3.  T3 is converted to reverse T3 instead.  RT3 is the inactive form of T3 and can’t be used, severely affecting cellular uptake of glucose and hence cellular metabolism.

Adrenal stresses also have the capability to weaken major immune barriers in a human body.  These immune systems include the GI tract, lungs and blood brain barrier.  The function of these immune barriers is to block entry of foreign objects in the bloodstream and brain.  When the immune system has been weakened large proteins and other antigens can easily enter the blood or brain. When this condition persists, the body becomes easy prey for diseases like Hashimoto, which is a cause of hypothyroidism.

Stresses And Hypothyroidism – Estrogen Levels

In response to a stress condition, one of the hormones secreted by the adrenal glands is cortisol. When adrenal glands keep producing large quantities of cortisol for long periods as a result of prolonged stresses, it results in a decrease in the liver’s ability to remove excess estrogen from the blood.  The presence of excessive estrogen elevates levels of a protein called thyroid binding globulin (TBG).  TBG binds to thyroid hormone molecules at they move through the body.  When attached to TBG like this thyroid hormones are inactive and need to be separated from it to become active. Therefore higher levels of TBG mean lower level of active thyroid hormones, which is hypothyroidism.

In light of the above it can be concluded that prolonged stresses and hypothyroidism are definitely related.  Therefore maximum effort should be made to reduce these stresses. Experts have developed several stress management techniques to assist with this process. In addition, relatives and friends can also help a person under stress by providing a relaxed environment and removing as much stress as possible.