The Relationship Between Mental Health and Thyroid Diseases

Knowing the link between thyroid diseases and mental health disorders are important for

people to be aware of. This topic interests me because I myself have had a thyroid disease that I

have learned to manage after being diagnosed at 6 years old. A few years after being diagnosed

with Hashimoto’s, I was diagnosed with a mental health disorder. It took doctors a long time to

even think about the possibility of a link between the two. The research is important because I

plan to become a psychiatric nurse in the future and my hope is to educate my future patients

who may be suffering from one or more of these diseases and/or disorders.

Approximately 20 million Americans are diagnosed with thyroid problems as stated by

American Thyroid Association (ATA). The thyroid is a gland in the endocrine system; it can be

found in a person's neck taking the shape of a butterfly. The thyroid is partially controlled by the

pituitary gland as well. When thyroid levels get low typically the pituitary gland will start to

create thyroid stimulating hormones (TSH). When the pituitary gland creates hormones it allows

the thyroid to react and produce more hormones itself. A thyroid produces many hormones to

help regulate the body. Two important hormones that the thyroid gives off are triiodothyronine

(T3) and thyroxine (T4). T4 converts to T3 when an enzyme takes away one of its iodine

molecules. This process mainly occurs within the liver. The thyroid controls growth, brain

development, keeping bones healthy, the control of muscles, and lastly, it controls mood.

Although the thyroid is a very important gland, there are different types of diseases that can

affect the function and productivity.

Two of the most common thyroid diseases are Hypothyroidism also known as

Hashimoto's, and hyperthyroidism. Hashimoto's is caused when the thyroid cannot produce
enough hormones to keep the body properly regulated. A person with Hashimoto’s can

experience low energy, slower heart rate, weight gain, muscle weakness, and becoming more

reactive to cold temperatures. On the other hand, hyperthyroidism occurs when the thyroid

makes a surplus of hormones and is overactive causing problems such as fatigue, tremors, weight

loss, and heart palpitations. In order to be diagnosed with a thyroid disease such as Hashimoto’s,

a patient will need to have blood drawn and the blood will need to be tested for their hormone

levels. Doctors who are looking to possibly diagnose their patient with a thyroid disease will

order labs that test for T3 and T4 directly. Testing for T3 and T4 can then lead to testing for the

amount of TSH to determine if the patient has hyper or hypothyroidism.

Correspondingly, a person’s mental health can have a significant impact on not only their

minds but their bodies overall health as well. Often it can be hard for a person to be diagnosed

with a psychological disorder especially at a young age. Throughout the papers, there are two

main mental health disorders used for the studies conducted: Depression and Anxiety. As stated

by Anxiety and Depression Association of America, 16.1 million people are affected by major

depressive disorder (MDD) and 6.8 million by generalized anxiety disorder (GAD). To be

diagnosed with MDD you must be experiencing symptoms for more than 2 weeks. Depression is

a chronic psychological disorder that lowers someone's mood and affects a person's behavior. It

can give overwhelming thoughts of hopelessness, feeling lost, or even thoughts of suicide. The

other key mental health disorder that is focused on within the studies is GAD. Anxiety can cause

feelings of panic and worry that is based on situations or certain thoughts. The emotional

response of anxiety can occur on rare occasions or on a day to day basis.

 In addition to the functions of the thyroid and different types of psychological disorders,

the studies that I have chosen to narrow in on the link between the thyroid and mental health.

Although the thyroid does play a part in mood it is not directly stated as common knowledge that

a thyroid disease can be linked to a mental health disorder. The possibility of the direct link

between depression and anxiety to the thyroid roots from serotonin. Serotonin is a

neurotransmitter that signals the central nervous system. Serotonin regulates mood, sexual

desire, memory, sleep, temperature regulation, and sometimes social behavior. When thyroid

levels are normal and healthy, serotonin is produced more causing the brain to receive more

neurotransmitters. The brain can then regulate mood better. In article 1 (​BMC Psychiatry, 2004)

the research was conducted to identify if there is a correspondence. Anti-TPO is also known as

anti-thyroid autoantibodies. Anti-thyroid autoantibodies are a protein that is made by the immune

system that essentially attacks the body’s tissues and organs​. ​When looking at BMC Psychiatry’s

article, the first table shows the relationship between positivity anti-TPO, anti-TPO+ and mood

disorders. The first table in article 1 indicates that people who have been diagnosed with a

psychological disorder have anti-TPO+ more often than a person without anti-TPO+. The second

table within the article examines the frequency of anti-TPO+ which provides the same

conclusions in which there is a relationship that is evident.

Bmc Psychiatry had a sample size of 222 subjects. The subjects received a thorough

thyroid exam. The physical attribute of the examine was an echography, measures of T3 and T4,

they were also tested for TSH and anti-TPO levels. An echography is a tool used by radiologist.

Echographies use reflections of the ultrasonic waves to see the body internally. The study found

that 16.6% had above normal levels of anti-TPO. Patients who experienced a mood disorder
were also found positive with anti-TPO more often than patients who did not obtain a mood

disorder (Bmc psychiatry 2004).

Translational Psychiatry studied the link between SCH (subclinical hypothyroidism) and

depression. Some of the data within their research article was obtained from observational

studies. The study concluded, “Overall, this meta-analysis indicates that SCH is not linked to

depression, which was dened by a diagnosis of depression or an increase on the depressive

scale” (Translational Psychiatry). However, I feel that if the research had been done more

themselves rather than including observational findings, the outcome of the research could have

been different.

Jama Psychiatry took into account many different variables. However, the sample sizes

were small. Future research related to the topic should focus more on specific types of thyroid

diseases. If the research is more focused it can be easier to establish a very outlined study. With a

more broad study, I would have added in the component of the link between the brain directly

and its function with mood disorders. Jama psychiatry concluded, “Autoimmune thyroiditis is

associated with depression and anxiety disorders”. The information and conclusions provided

from this study are important to patients who may be seeking medical attention for the possible

link rather than having to make appointments with endocrinology and psychiatry. The

information is important for doctors as well so they can study the link on their own to help

patients.

Overall, the sample sizes were within reason however I felt that when the methods and

classifications got more detailed the sample sizes didn't quite align. ​If I were to conduct the

research myself I would narrow down the methods and up the sample sizes in each category to
create a wider ranger for study. The studies were similar but some components were very

contrast from the others. Although some of the research touched on different hormones, the

relationship in question remained the same throughout the different studies that were conducted.

In two articles they concluded that there is a relationship. On the contrary, Translational

Psychiatry concluded that “overall, this meta-analysis indicates that SCH is not linked to

depression, which was dened by a diagnosis of depression or an increase on the depressive

scale”. SCH is known as s​ ubclinical hypothyroidism.

Lastly, with further research, there could be new treatment plans and options. In my

opinion, I think this research is vital to patients who may suffer from a mental health disorder

and are unaware due to their thyroid disease or vise versa. In the future, I can suggest to patients

with a thyroid disease to keep track of their mental health and if needed help them get a referral

to psychiatry or endocrinology. I have lived with both a thyroid disease and a mental health

disorder but until doing research on my own time I was never really explained the possibility of a

link let alone even having the knowledge that mood was connected to your thyroid levels.

Another pathway that I would like to study later on is the possibility of a person being diagnosed

at a younger age. Hypothyroidism is the most common type of thyroid disease that infants,

toddlers, and teenagers are diagnosed with. The research on the relationship between the thyroid

and a psychological disorder could help diagnose more kids sooner. For example, if a child is

diagnosed with a thyroid disease and takes their medication regularly to help control the levels,

could it help prevent a mood disorder from developing? Even though genetics plays a role in

both realms, it’s important to know that the two can be linked on their own.

References
 Bocchetta, A., Traccis, F., Mosca, E., Serra, A., Tamburini, G., & Loviselli, A. (2016).

Bipolar disorder and antithyroid antibodies: Review and case series. I​ nternational journal of

bipolar disorders​, ​4​(1), 5.

Carta, M. G., Loviselli, A., Hardoy, M. C., Massa, S., Cadeddu, M., Sardu, C., ... & Mariotti, S.

(2004). The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies)

with anxiety and mood disorders in the community: A field of interest for public health in

the future. ​BMC Psychiatry​, ​4​(1), 25. doi:10.1186/1471-244X/4/25

Garber, J. (Year). About your thyroid. ​Empower​. Retrieved from

https://www.empoweryourhealth.org/Overactive-Thyroid

Siegmann, E. M., Müller, H. H., Luecke, C., Philipsen, A., Kornhuber, J., & Grömer, T. W.

(2018). Association of depression and anxiety disorders with autoimmune thyroiditis: A

systematic review and meta-analysis. ​JAMA Psychiatry​, ​75​(6), 577-584.

10.1001/jamapsychiatry.2018.2417

Soreca, I., Frank, E., & Kupfer, D. J. (2009). The phenomenology of bipolar disorder: What

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and Anxiety​, ​26​(1), 73-82. doi.org/10.1002/da.20521

Zhao, T., Chen, B. M., Zhao, X. M., & Shan, Z. Y. (2018). Subclinical hypothyroidism and

depression: A meta-analysis. ​Translational Psychiatry​, ​8​(1), 239.

doi.org/10.1038/s41398-018-0283-7