If symptoms such as depression, anxiety, fatigue, or inability to focus are persistent or significant, we find ourselves seeking mental health treatment. When a patient goes to see their primary care doctor or a psychiatrist and reports mental health symptoms, naturally, the solution will be some psychotropic medication such as SSRIs or a recommendation for counseling. Perhaps these interventions may provide some relief, but what happens if the underlying cause of these symptoms happens to be something else? Although there can be numerous different reasons for mental health symptoms, perhaps one of the most overlooked areas is the endocrine system, specifically the thyroid.

The thyroid is a butterfly-shaped gland located at the front of the neck. It is responsible for secreting hormones that aid in almost every function of the human body, including metabolism, the cardiovascular system, the nervous system, the digestive system, and the reproductive system. According to The American Thyroid Association, 20 million Americans have some form of thyroid disease, and further, 60 percent of those with thyroid disease are unaware of their condition.

Common symptoms of an under-functioning thyroid, or hypothyroidism, include fatigue, weight gain, cold intolerance, fertility issues in women, and dry/thin hair, to name a few. Common symptoms of an over-functioning thyroid, or hyperthyroidism, include weight loss, rapid heartbeat, sweating, or frequent bowel movements.

Interestingly, some of the most prevalent symptoms of thyroid dysfunction are actually mental and psychiatric symptoms, and these can occur without other symptoms. Some of the most common psychiatric symptoms of hypothyroidism include depression, agitation, apathy, inattention, emotional lability, fatigue, and memory impairment. Heinrich et al. (2003) discussed how significantly elevated levels of TSH (thyroid stimulating hormone) can even cause psychosis, delusions, or hallucinations.

The researchers discussed a case study of a 73-year-old woman who presented to the emergency department for auditory and visual hallucinations. All testing and labs appeared unremarkable, except her TSH, which was significantly elevated at 43.79 mU/L. After beginning thyroid replacement medication, the patient’s auditory and visual hallucinations slowly began to disappear and by week three, the patient had no further psychiatric symptoms. Psychiatric symptoms are also common with hyperthyroid patients and can include anxiety, rapid heartbeat, insomnia, restlessness, difficulties focusing, and even mania or hypomania.

Perhaps one of the most debated topics amongst thyroid patients is thyroid reference ranges. According to the American Thyroid Association, the average TSH reference range is approximately .5-4.5 mU/L. Patients who fall within this range are typically considered to have normal thyroid functioning. Interestingly, Biondi (2013) discussed how even “low normal” or STD (subclinical thyroid dysfunction) has an increased risk of coronary heart disease, metabolic syndrome, or diabetes.

This can also be true with respect to psychiatric symptoms in the “high normal” or “low normal” range. In one large thyroid support Facebook group with over 50,000 members, over half the members discussed having some mental health symptoms such as anxiety or depression with TSH ranges that were still considered “normal” albeit “high normal” or “low normal.” This brings debate over separating normal versus optimal ranges. Meamar et al. (2021) discussed the push of physicians and the National Health and Nutrition Examination Survey to reduce the TSH reference range to .4 -2.5 mU/L. This provides a more optimal range of thyroid functioning, and individuals within this range report fewer symptoms, including mental health symptoms, than the current range.

As a clinician, I encourage all of my clients to take a comprehensive approach to mental health treatment. This includes regular bloodwork and checking all major markers that can contribute to mental health symptoms, including the thyroid. Understanding the complexity of thyroid functioning and its correlation to mental health should not be overlooked. Discussing reference ranges with a physician and differentiating “normal” versus “optimal” can be the hidden answer in symptom alleviation. Further, having open conversations about cofactors that can affect the thyroid, such as iron levels or B12 levels, can also be helpful.

Overall, thyroid functioning or thyroid medication should not be viewed as a substitute for mental health treatment or psychotropic medication management, but more so part of the full mental health picture.

References

Biondi B. (2013). The Normal TSH Reference Range: What Has Changed in the Last Decade. The Journal of Clinical Endocrinology & Metabolism; 98(9): 3584-3587. doi: https://doi.org/10.1210/jc.2013-2760

Heinrich T, W., Grahm, G. (2003). Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisisted. Prim Care Compasion J Clin Psychiatry; 5(6):260-266. doi: 10.4088/pcc.v05n0603

Meamar, R., Feizi, A., Aminorroaya, A., Amini, M., Nasri, M., Tabatabaei, A., Abyar (2021). Thyroid Stimulating Hormone Reference Range: Iranian Thyroid Cohort Study. Acta Biomed; 92(5): e2021283. doi: https://doi.org/10.23750%2Fabm.v92i5.9643

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Is It Mental Health or Something Else?

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26.03.2024

If symptoms such as depression, anxiety, fatigue, or inability to focus are persistent or significant, we find ourselves seeking mental health treatment. When a patient goes to see their primary care doctor or a psychiatrist and reports mental health symptoms, naturally, the solution will be some psychotropic medication such as SSRIs or a recommendation for counseling. Perhaps these interventions may provide some relief, but what happens if the underlying cause of these symptoms happens to be something else? Although there can be numerous different reasons for mental health symptoms, perhaps one of the most overlooked areas is the endocrine system, specifically the thyroid.

The thyroid is a butterfly-shaped gland located at the front of the neck. It is responsible for secreting hormones that aid in almost every function of the human body, including metabolism, the cardiovascular system, the nervous system, the digestive system, and the reproductive system. According to The American Thyroid Association, 20 million Americans have some form of thyroid disease, and further, 60 percent of those with thyroid disease are unaware of their condition.

Common symptoms of an under-functioning thyroid, or hypothyroidism, include fatigue, weight gain, cold intolerance, fertility issues in women, and dry/thin........

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