By Karla Robinson, MD
The Thyroid and Your Mood
It is estimated that over 40 million people suffer from anxiety disorders in this country. However, what many don’t realize is that anxiety may be the first signs of a thyroid disorder. Thyroid disease is a category of illnesses that are typically characterized by the thyroid gland being either overactive or underactive. Anxiety can be a common symptom of hyperthyroidism or overactive thyroid.
The thyroid gland is a small, two-lobed, butterfly shaped gland that can be found in the front and midline position of the neck. The job of the thyroid gland is to produce hormones that regulate the body’s metabolism. The activity of the thyroid is normally controlled by the pituitary gland found in the brain which secretes TSH (thyroid stimulating hormone) and stimulates the gland to produce the thyroid hormones T3 and T4. These hormones are then useful in determining how the body uses and stores its energy in the process of metabolism.
Hyperthyroidism or the overproduction of thyroid hormones can occur by a variety of means. The most common cause is Grave’s Disease. In Grave’s Disease antibodies are produced that stimulate the thyroid, causing it to be overactive. The gland itself will often enlarge and excess thyroid hormones are then released affecting multiple organ systems. The result can be mood disorders, increased cholesterol, heart disease, eye disease, fertility problems, and muscle weakness. Other causes of hyperthyroidism include thyroid nodules (small growths) that produce thyroid hormone, inflammation of the thyroid gland (thyroiditis), and thyroid hormone replacement as is found in the treatment of hypothyroidism or underactive thyroid.
Recent estimates reveal that up to 5% of people in this country have an overactive thyroid and many aren’t aware they are living with it. Some common symptoms of hyperthyroidism include high anxiety, insomnia or difficulty sleeping, tremors or shakiness, heat intolerance, increased sweating, increased and/or irregular heart rate, unexplained weight loss, and menstrual irregularity. Additionally, Grave’s Disease can sometimes result in eye and/or vision problems leading to bulging of the eyes, dry eyes, blurry or double vision, and blindness.
Hyperthyroidism can be easily diagnosed through tests measuring the thyroid stimulating hormone (TSH) and thyroid hormone (T4) levels in the blood. If the TSH level is low and the T4 level is high, hyperthyroidism can be confirmed. Further imaging and/or testing may then be needed to determine the actual cause of the overactive thyroid gland. This is necessary in determining the proper course of treatment.
Treatment is usually aimed at decreasing the amount of excess thyroid hormone circulating. Treatments may certainly vary depending on the cause and severity of hyperthyroidism as well as other factors like age, and medical history. There are three forms of treatment including medication, radiation, and surgery.
Medications such as beta-blockers are often used to control the uncomfortable symptoms of hyperthyroidism that accompany high levels of thyroid hormone. Although they don’t target the thyroid hormone levels directly, they are often useful in improving the quality of life while undergoing more definitive treatment. Anti-thyroid drugs are often used as a brief treatment prior to radiation or surgery, or they may be used as singular treatment while determining if these more aggressive treatments are necessary. For some, hyperthyroidism can go into a state of remission where radiation treatments and surgery can be avoided altogether.
Radiation is typically given in the form of radioactive iodine. It is generally very effective in destroying the thyroid tissue completely over the course of 2-4 months. This often results in the necessity of lifelong thyroid hormone replacement to prevent symptoms of hypothyroidism or underactive thyroid.
Given its location, when the thyroid becomes enlarged (typically termed as goiter) as a result of its overactive state it can cause difficulty swallowing, shortness of breath, or cough. Surgery is often the treatment of choice if the thyroid gland is very large and causing obstructive problems. Additionally, if there is a strong suspicion of thyroid cancer, surgery is usually recommended.
Anxiety is one of the most common symptoms of an overactive thyroid. If you have been struggling with anxiety, notify a physician. A simple blood test can reveal if your thyroid gland is healthy.
This was printed in the April 22, 2012 - May 5, 2012 Edition