Hypothyroidism, one of the most common endocrinological conditions associated with anxiety (Hall, 2002), is a state in which the body does not produce enough of the thyroid hormone (EndocrineWeb.com, 2005). One of the most common causes of hypothyroidism is autoimmune thyroiditis, also known as Hashimoto’s thyroiditis, which is an inflammation of the thyroid gland caused by an individual’s own immune system. This inflammation will damage or destroy cells, leaving them incapable of producing an adequate amount of hormones (2005). However, there are other causes, for i.e. individuals that do not produce enough hormones due to a problem with the pituitary gland (2005).
The main diagnostic tool for hypothyroidism is a blood test; if the thyroid hormone (TH) level is below normal range, then a patient most likely has hypothyroidism (EndocrineWeb.com, 2005). Normally, an individual will have a high thyroid stimulating hormone (TSH) level along with a low TH level because the pituitary gland is trying to overcompensate for the lack of TH created (2005).
There is a wide range of severities within hypothyroidism, and the severity of symptoms does not always correlate with the severity of the disorder (EndocrineWeb.com, 2005). Some common physical symptoms are fatigue and lethargy, diminished libido, headaches, weakness, cold intolerance, and dry skin; physical signs include thin, course hair, pallor, brittle nails, and a slowed pulse (Hall, 2002). Once the disease progresses, vision and hearing deficiencies, weight gain, inability to sweat, muscle cramps, and several other symptoms often arise.
Psychiatric symptoms, such as anxiety, are often the first indicators of hypothyroidism (Hall & Lowrance, 2002, & 2006). Anxiety disorders occur in approximately 30-40% of patients with emerging acute hypothyroidism (Hall, 2002). Severe anxiety attacks, panic attacks, and “free floating anxiety”, or a continuous feeling of being on edge, are all common anxiety reactions when hypothyroidism is developing (Lowrance, 2006).
Hall (2002) reports the rapidly changing hormone levels in hypothyroidism is a key factor in the development of anxiety symptoms. Patients with myxedema, a condition caused by hypothyroidism which involves blunting of the intellect and senses, thickening skin, and labored speech, present with progressive anxiety accompanied with generalized anxiety (2002). Delusions, hallucinations, paranoia, and extreme restlessness mixed with lethargy are all common in individuals with myxedema. Patients with more gradual drops in hormone levels still present with anxiety symptoms, but normally have a type of “chronic anxiety”.
Lowrance (2006) reports in Hashimoto’s Disease that anxiety symptoms can be attributed not only to the abnormal thyroid levels, but also to the autoimmune disease process. Anti-thyroid-peroxidase and anti-thyoglobulin, two anti-thyroid antibodies, can cause depression and anxiety symptoms even before hormone levels are out of the normal range (2006). Lowrance states, “Researchers describe the anxiety symptoms from autoimmune hypothyroidism, as being caused by the gland’s attempts to ‘sputter back to life’ as it begins to fail and in attempt to fight off the autoimmune attack. The actual medical term for this is ‘Hashitoxicosis’ and patients will have it to varying degrees but usually…causes significant anxiety symptoms.”
When psychiatric clinicians are initially analyzing a patient, medical conditions must be considered before a diagnosis is made. Some subtle differences may alert a clinician of the differences between psychologically caused and medically caused anxiety disorders. For instance, medically induced anxiety disorders often show instability in the duration and severity of panic attacks or anxiety (Hall, 2002). In addition, patients with anxiety disorders that form prior to the age of eighteen or after the age of 25 and who have a negative personal and family history of anxiety should be closely analyzed for an underlying medical condition (2002). Hall reports that anywhere from 10-40% of medical patients with anxiety disorders are thought to have an organic etiology for their symptoms.
The importance of taking medical conditions into consideration when diagnosing psychiatric patients is great. If the anxiety disorder is truly organically induced, a patient will not recover psychologically without treatment of the physical disorder. Because emotional symptoms often arise before any physical symptoms in hypothyroidism, both patients and clinicians often make the mistake of attributing the disorder to a mental health problem. While psychiatric drugs alone cannot cure the psychological symptoms involved during hypothyroidism and may in fact make the situation worse, drugs that treat the hypothyroidism will normally cure the anxiety symptoms, as well as the medical condition. Lowrance (2006) exclaims, “Remember, thyroid diseases are a major cause and possibly the most common ‘medical cause’ of emotional symptoms!”
The articles presented by EndocrineWeb.com (2005), Hall (2002), and Lowrance (2006) provide both solid explanations and examples for anxiety symptoms presented in hypothyroidism. Though the exact medical etiology is debatable and may involve a combination of factors, the high correlation of anxiety symptoms in patients with hypothyroidism supports the organic basis of psychological symptoms. Some symptoms of anxiety may be brought upon by the stress of having the disorder; but considering anxiety symptoms often precede any physical symptoms, this seems unlikely to be the sole cause.
EndocrineWeb.com. (2005). Hypothyroidism. Retrieved October 17, 2006 from http://www.endocrineweb.com/hypo1.html
Hall, Richard. (2002). Anxiety and Endocrine Disease. Retrieved October 17, 2006 from http://www.drrichardhall.com/anxiety.htm
Lowrance, Jan & Jim. (2006). Anxiety and Depression Symptoms in Thyroid Disease. BellaOnline. Retrieved October 17, 2006 from http://www.bellaonline.com/articles/art41515.asp