Psychological impact of thyroid deregulation

Hear me out Getting your Trinity Audio player ready…

Thyroid hormones are essential for the proper functioning of almost every cell in the body, including those in the brain. When the thyroid gland produces too much (hyperthyroidism) or too little (hypothyroidism) of these hormones, it can have a profound and widespread psychological impact, often leading to a range of mental health symptoms. This connection is mediated by the hypothalamic-pituitary-thyroid (HPT) axis, a complex feedback loop that regulates thyroid hormone production and influences brain function, including neurotransmitter activity, neuroplasticity, and brain metabolism.

Here’s a breakdown of the psychological impact of thyroid deregulation:

Hypothyroidism (Underactive Thyroid)

When thyroid hormone levels are too low, body processes, including brain function, slow down. This can lead to symptoms often resembling depression or cognitive decline.

Common Psychological Symptoms of Hypothyroidism:

• Depression: This is perhaps the most common and prominent psychological symptom of hypothyroidism. Individuals may experience persistent sadness, hopelessness, loss of interest in activities, low motivation, and feelings of worthlessness. In some cases, depression can be the first symptom of hypothyroidism, leading to misdiagnosis if thyroid function isn’t checked.
• Fatigue and Lethargy: Profound tiredness and a general lack of energy are hallmarks of hypothyroidism, which can contribute significantly to a depressed mood and difficulty engaging in daily activities.
• Cognitive Impairment (“Brain Fog”):
  • Memory problems: Difficulty recalling information, forgetfulness (e.g., names, appointments).
  • Poor concentration: Trouble focusing, easily distracted.
  • Slowed thinking: Mental sluggishness, difficulty processing information, and reduced executive function (planning, decision-making).
  • Apathy: A general lack of interest or enthusiasm.
• Anxiety: While less common than depression, some individuals with hypothyroidism can experience anxiety, persistent worry, and restlessness.
• Mood Swings: Although more characteristic of hyperthyroidism, mood instability can also occur with hypothyroidism.
• In severe, untreated cases (Myxedema psychosis): This can lead to more severe psychiatric symptoms like delusions, hallucinations, and paranoia.

Mechanism in Hypothyroidism: Low thyroid hormone levels disrupt the balance of neurotransmitters crucial for mood regulation, such as serotonin, dopamine, and norepinephrine. They also slow down brain metabolism and can reduce cerebral blood flow, impacting cognitive functions.

Hyperthyroidism (Overactive Thyroid)

When thyroid hormone levels are too high, the body’s processes, including brain function, speed up and become overstimulated.

Common Psychological Symptoms of Hyperthyroidism:

• Anxiety and Nervousness: This is a prevalent and often intense symptom. Individuals may experience excessive worry, agitation, restlessness, and a feeling of being constantly “on edge.” This can sometimes manifest as panic attacks.
• Irritability and Mood Swings: Heightened emotional sensitivity, quick temper, and rapid shifts in mood are frequently reported.
• Insomnia and Sleep Disturbances: Difficulty falling asleep, staying asleep, and restless sleep due to the overstimulated nervous system.
• Hyperactivity: Feeling excessively energetic, restless, and unable to relax.
• Racing Thoughts: The mind may feel constantly active, overwhelmed with thoughts, and have difficulty focusing on one thing.
• Impaired Concentration: Despite racing thoughts, concentration and focus can be difficult due to the overstimulation.
• In severe cases (Thyroid Storm): Confusion, delirium, and even hallucinations can occur, requiring emergency medical attention.

Mechanism in Hyperthyroidism: Excess thyroid hormones overstimulate the central nervous system, leading to heightened sympathetic nervous system activity and imbalances in neurotransmitters that contribute to anxiety and agitation.

General Psychological Impact and Important Considerations:

• Mimicry of Psychiatric Conditions: Both hypo- and hyperthyroidism can mimic symptoms of primary psychiatric disorders. This highlights the critical importance of checking thyroid function tests (TSH, free T3, free T4, and sometimes thyroid antibodies) when mental health symptoms suddenly appear or are resistant to typical psychiatric treatments.
• Impact on Quality of Life: The psychological symptoms of thyroid deregulation can significantly impair an individual’s quality of life, affecting their relationships, work or school performance, and overall well-being.
• Bidirectional Relationship: Research suggests that the relationship between thyroid dysfunction and mental health can sometimes be bidirectional, meaning that chronic stress or specific mental health conditions might also influence thyroid function.
• Treatment and Prognosis: The good news is that in the majority of cases, psychological symptoms tend to improve significantly as the thyroid disorder is brought under control with appropriate medical treatment (e.g., synthetic thyroid hormones for hypothyroidism, anti-thyroid medications or other medicines for hyperthyroidism). However, improvement may not be immediate, and some individuals may still require additional support (e.g., therapy, anxiety medication) even after their thyroid levels normalize.
• Subclinical Thyroid Dysfunction: Even subclinical forms of thyroid dysfunction (where TSH levels are slightly off but T3/T4 are still within normal range) can be associated with mental health symptoms like depression and cognitive impairment.

In conclusion, thyroid deregulation has a profound and undeniable psychological impact, affecting mood, cognition, and emotional regulation. Recognizing these connections is crucial for accurate diagnosis and effective management, ensuring that the physical and mental health aspects of thyroid disorders are addressed for optimal patient well-being.

While some cultures, mindsets, and beliefs choose fatality (Maktoub in Arabic) as an escape, answer, or psychological relief to inexplicable phenomena like depression from an undiagnosed Thyroid deregulation, taking appropriate measures to alleviate the consequences is still necessary!