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Thyroid And Depression: The T-d Relation

Prof. Dr. M. Zaman Shaikh

3 min read

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According to the Thyroid Federation International, out of nearly 300 million thyroid sufferers worldwide, only half are fully aware of their condition. With severe mood changes being one of the initial symptoms of a thyroid disorder, many patients are misdiagnosed with depression or other mental disorders and prescribed antidepressants, mood stabilizers or sedatives that worsen the underlying condition. 

What is a Thyroid Dysfunction?

The small, butterfly-shaped structure situated at the base of the neck, or the thyroid gland, manufactures and releases T4 and T3 hormones that control body weight, temperature and energy use throughout all body cells, when functioning correctly. The under- or over-production of these hormones is termed as Hypothyroidism and Hyperthyroidism respectively, either of which causes a major shift in the hormonal balance of the body; hence, affecting its productivity.

Common symptoms of Hyperthyroidism include: Anxiety, Diarrhea, Insomnia, Weight Loss, and Increased Heart Rate.

Whereas, the common symptoms of Hypothyroidism are: Fatigue, Weight Gain, Constipation, Fuzzy Thinking, Low Blood Pressure, Bloating, Depression and Slow Reflexes. 

Research depicts an alarming situation, with estimates that approximately sixty percent of hyperthyroidism patients also suffer from anxiety and sixty-nine percent of patients suffer from depression. Below, we go over the causes that lead from thyroid issue to psychological disorders.

How Thyroid Disorder Causes Psychological Symptoms

At times, depression and other psychological symptoms do not appear on their own, but are instead, induced by other common symptoms of thyroid dysfunction. For instance, hair loss and weight gain, or the inability to lose weight often contribute towards low self-esteem and distress. Furthermore, regular exposure to stressful situations might also cause or worsen an existing thyroid condition.

Sometimes, this issue might arise due to forgetfulness of taking medicine. Regular tablet consumption and even clinic visits might become a pain for some who lose motivation. Infrequent or non-uniform tablet taking might cause hormonal imbalance and amplify psychological conditions. 

For those already diagnosed, steroids prescribed to balance the thyroid often cause depressive symptoms by disrupting hormonal balance, while medication to lower heart rate and anxiety in hyperthyroidism is a known inducer of physical and mental fatigue, and depression, in many patients. Adversely, irregularly taking the prescribed medication might also imbalance the hormones, resulting in the onset of depressive psychological conditions.

How To Know Whether Its Hypothyroidism or Depression?

An underactive thyroid is most common among thyroid disorders; and while it shares many symptoms with mild to clinical depression, such as fatigue, weight gain, concentration issues and a depressed mood, observing any or all of the following signs alongside these symptoms might signal an underlying thyroid condition:

  • Sensitivity to hot and cold temperatures
  • Muscle cramps or stiffness
  • Hair and skin dryness
  • Slowed heart rate
  • Constipation
  • Hoarseness
  • Hair loss

How To Get It Tested?

Traditionally, thyroid dysfunctions are tested via two blood tests: a TSH (Thyroid Stimulating Hormone) and T4 test, in which low T4 and high TSH indicate hypothyroidism, whereas the opposite indicates Hyperthyroidism. However, most people with obvious thyroid dysfunction symptoms, including depression, fail to get an accurate diagnosis and relevant treatment, simply because their TSH levels are ‘normal’, i.e. they do not fall within the range determined for an under- or overactive thyroid diagnosis.

For this purpose, a full thyroid panel consisting of the following tests is necessary to truly rule out or confirm a thyroid problem:

  • TSH
  • Free T4 (FT4)
  • Free T3 (FT3)
  • Reverse T3 (rT3)
  • Thyroid Peroxidase Antibodies
  • Thyroglobulin Antibodies

The Treatment Plan

Taking antidepressants with a thyroid condition is highly discouraged as they only serve to fuel depression and related negative thoughts. Instead, specialty thyroid treatment can better control and, in most cases, eradicate these symptoms without the side-effects; which is why many doctors prescribe thyroid medication as a treatment option for depression and anxiety.

However, since T3 imbalance is usually considered a hyperthyroidic trait, most hypothyroid medication, such as Levothyroxine, focuses on balancing T4 and TSH levels, which is usually not enough for a complete remission of depressive symptoms in most patients. In such cases, a combination of T4 and T3-targeting medication may provide much more efficient and effective results.

Hypothyroidism and Bipolar Disorder

Marked by alternating periods of excitement and depression, sufferers of this medical condition often have hypothyroid as well. According to studies performed by various medical journals, including ‘Biological Psychiatry’ and ‘BMC Psychiatry’, high instances of acquired and genetic thyroid disorder development in bipolar patients, and vice versa, have been observed.

While thyroid medication has anti-depressive effects on most patients, the combined use of lithium (for bipolar treatment) and these medications produces adverse effects and insomnia. However, studies are being conducted on effective treatments for patients suffering from both bipolar disorder and hypothyroidism.

While depression itself is attention-worthy, if you have worsening depressive symptoms alongside other telltale signs of an over- or under-active thyroid, report to your doctor immediately, as both conditions require attention and are completely treatable. You can book an appointment with a top Endocrinologist in Karachi, Islamabad and Multan through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your thyroid issues.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Prof. Dr. M. Zaman Shaikh - Author Prof. Dr. M. Zaman Shaikh is an Endocrinologist and diabetes specialist, based in Lahore. He helps patients in diabetes management, osteoporosis management, steroid hormone problems, and general men's health issues.
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