Have you ever wondered why we feel the way we do? If you've been feeling mentally off lately, the answer might not be in your head, but rather in your thyroid gland.
As an integrative psychiatrist, I can tell you that the small, butterfly-shaped gland at the base of your neck does a lot more than you might realize, and its function is intricately connected to your mental health.
Thyroid 101: A Quick Recap
Your thyroid is part of the endocrine system and plays a pivotal role in metabolism by producing and secreting the hormones thyroxine (T4) and triiodothyronine (T3). These hormones influence everything from your heart rate to your mood.
Here's a simplified version of what happens:
The pituitary gland, located in the brain, produces thyroid-stimulating hormone (TSH) that signals the thyroid gland to produce T4. T4 then circulates throughout your body and converts into T3, the active form of thyroid hormone, in your body tissues. But stressors like caloric restriction, emotional stress, or chronic illness can cause T4 to convert into an inactive form called reverse T3 instead.
Thyroid Disorders: More Common Than You Think
It might surprise you to know that thyroid disorders are not uncommon - we see this frequently at Driftless Integrative Psychiatry. In fact, 1 in every 7 people has a low-functioning thyroid. They can go unnoticed because many symptoms of thyroid dysfunction overlap with mental health conditions like depression and anxiety. You might feel fatigued, have difficulty concentrating, or struggle with mood swings. These symptoms are very general so hypothyroidism often gets missed - or thyroid function is seen as "normal" with conventional lab testing and references.
Interestingly, several studies suggest a significant correlation between mental health disorders and thyroid dysfunction. Research has found that those diagnosed with depression, bipolar disorder, and schizophrenia have a higher risk of developing thyroid disorders (see the references at the end of this post).
Stress, Thyroid Function, and Your Mental Health
Chronic stress is a well-known culprit for various health issues, including thyroid disorders. Prolonged stress leads to an increase in cortisol, the body's primary stress hormone. Over time, high cortisol levels inhibit the conversion of T4 to active T3, leading to an underactive thyroid.
Moreover, adrenal glands, which produce cortisol, can get overworked during periods of chronic stress, leading to adrenal insufficiency or "burnout." Low cortisol levels can lead to cognitive deficits, depression, fatigue, hormonal imbalances, reduced memory, sleep disturbances, and weight gain, among other symptoms. Elevated cortisol can also lead to mental health symptoms, such as irritability, insomnia, and weight gain.
Managing Thyroid Health
If you're experiencing symptoms that suggest thyroid dysfunction, it's important to talk to your integrative healthcare provider. A comprehensive assessment will involve more than just checking your TSH levels, it should include checking your free T4 and free T3, and if indicated, TPO (thyroid peroxidase) antibodies and Reverse T3 levels too.
When it comes to treatment, levothyroxine (also known as L-T4) is the standard thyroid hormone replacement therapy. But it's not one-size-fits-all, and some people continue to experience symptoms despite treatment. In such cases, combined therapy using both T4 and T3 might be beneficial.
In treating thyroid conditions, an integrative approach is often necessary to investigate upstream causes including changes in one's environment such as toxins, infections, gut health, and inflammation as well as adrenal function. We assess adrenal dysfunction through salivary cortisol testing. We may need to help support the adrenal gland first, which produces cortisol and regulates our stress response, in order to adequately heal thyroid function.
The body functions as a complex interconnected system, so treating conditions like thyroid disease often requires a holistic approach that considers more than just the thyroid itself. Here are a few components that might be involved in this broader approach:
Adrenal Health: Supporting adrenal health could involve stress management techniques, certain dietary changes, and possibly supplements or medications, depending on the specifics of a person's situation.
Environmental Factors: If environmental toxins are suspected to be contributing to thyroid problems, strategies might include lifestyle changes to reduce exposure, and possibly detoxification therapies.
Inflammation and Immune System Health: Strategies for managing inflammation might include dietary changes, supplements, stress management, and medications.
Gut Health: Strategies for supporting gut health could include probiotics, dietary changes, and potentially other treatments. It's important to note that food can cause antigenic effects - someone eating food they are intolerant to can lead to chronic stress, autoimmune effects, and inflammation.
Nutritional Status: Nutritional support could involve dietary changes and possibly supplementation. Food first is always a good approach. For instance, selenium supplementation can reduce anti-thyroid antibodies, while zinc supplementation can increase free T3 in hypothyroid patients.
It's important to remember that everyone's situation is unique, and what works for one person might not work for another. Be wary of any "Thyroid Protocol". Therefore, any treatment approach should be individualized and undertaken under the guidance of a qualified healthcare provider.
Lifestyle changes also play a crucial role in managing thyroid health. This might include addressing stress through mindfulness practices (such as Mindfulness Based Stress Reduction), breathwork, energy work, or yoga. A gluten-free diet has been shown to be beneficial if you have positive TPO antibodies, as well as eliminating artificial sweeteners and drinking more water.
Wrapping Up: Your Health, Your Choice
Thyroid health isn't an isolated element—it's interconnected with your overall physical and mental wellness. Therefore, it's essential to consider a holistic approach to health and wellness that includes regular check-ups, a balanced diet, stress management techniques, and personalized medical care under the auspices of functional medicine and integrative psychiatry.
Remember, the "normal" thyroid hormone range may not be optimal for everyone. It's vital to listen to your body and take necessary steps to maintain your health.
Mental health doesn't fit neatly into brain function and psychiatry alone. A whole-body, whole-person approach is essential, particularly for those who with mental health symptoms, including the evaluation of thyroid and hormone function.
Further Reading:
Kelly, T., Lieberman, D. Z. (2009). "The Use of Triiodothyronine as an Augmentation Agent in Treatment-Resistant Bipolar II and Bipolar Disorder NOS". The Journal of Clinical Psychiatry, 70(8), 1132–1135. https://doi.org/10.4088/JCP.08m04207.
This study discusses the use of triiodothyronine (T3) in the treatment of bipolar disorder, indicating the role of thyroid function in mood regulation.
Ittermann, T., Völzke, H., Baumeister, S. E., Appel, K., & Grabe, H. J. (2015). "Diagnosed thyroid disorders are associated with depression and anxiety". Social Psychiatry and Psychiatric Epidemiology, 50(9), 1417–1425. https://doi.org/10.1007/s00127-015-1045-1.
This study demonstrates the association between diagnosed thyroid disorders and both depression and anxiety.
Hage, M. P., & Azar, S. T. (2012). "The Link between Thyroid Function and Depression". Journal of Thyroid Research, 2012, 1-8. https://doi.org/10.1155/2012/590648.
This review article provides a comprehensive look at the connection between thyroid function and depression.
Fountoulakis, K. N., Kantartzis, S., Siamouli, M., Panagiotidis, P., Kaprinis, S., Iacovides, A., & Kaprinis, G. S. (2006). "Peripheral thyroid dysfunction in depression". The World Journal of Biological Psychiatry, 7(3), 131–137. https://doi.org/10.1080/15622970600554731.
This paper highlights how peripheral thyroid dysfunction can be present in depressive disorders, reinforcing the connection between thyroid function and mental health.
Lin, C. L., & Yang, Y. K. (2011). "Schizophrenia and Thyroid Disorders". The Primary Care Companion For CNS Disorders, 13(5). https://doi.org/10.4088/PCC.11br01184.
This article presents the link between schizophrenia and thyroid disorders, emphasizing the importance of thyroid function in patients with psychiatric conditions.
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