Thyroid Deficiency and Mental Health


At least 13 million Americans suffer from thyroid disorders, and in more than 80% of cases, the problem is an underactive thyroid gland — hypothyroidism. The condition is more common in women, and the rate rises with age, reaching 20% in women over 65. The interest for mental health is that thyroid deficiency may be associated with cognitive and emotional disturbances, and thyroid hormones may be useful in the treatment of depression.

Sitting at the base of the throat, the thyroid gland produces hormones that regulate basal metabolic rate, the speed at which our bodies burn food for energy. The thyroid gets its directions from the hypothalamus, at the base of the brain, by way of the pituitary gland. On a signal from the hypothalamus, the pituitary sends thyroid-stimulating hormone (TSH) into the bloodstream. It travels to the thyroid gland and causes the release of thyroxine (T4), which is partly converted into triiodothyronine (T3). Through a feedback mechanism, the hypothalamus determines when levels of T4 and T3 are low and alerts the pituitary to supply more TSH.

In a person with hypothyroidism, the thyroid gland does not fully respond to TSH, so levels of T3 and T4 remain low while TSH accumulates in the blood. The most common cause is an autoimmune disease, Hashimoto’s thyroiditis, but the symptoms can also result from an infection, from cancer, or from treatment of an overactive thyroid (hyperthyroidism) with surgery, radiation, or medications.

Clinical hypothyroidism is identified by an abnormally high level of TSH and abnormally low levels of thyroid hormones. It is treated with a synthetic form of thyroxine, taken in a pill. Subclinical thyroid deficiency, which has few or no symptoms, is defined as abnormally high TSH with normal thyroid hormone levels. Experts disagree on whether and when it requires treatment.

The symptoms of hypothyroidism are variable and sometimes hard to pin down. They may include fatigue, sluggishness, cold intolerance, weight gain, constipation, muscle or joint pain, thin and brittle hair or fingernails, reduced sexual drive, high blood pressure, high cholesterol, and a slow heart rate. Patients may also have problems with concentration and memory.

Some of these symptoms also occur in depression or other psychiatric disorders, and there may be links between hypothyroidism and depression, although the evidence is conflicting and doubtful.

In an Italian study, 36 women with mild hypothyroidism performed poorly on neuropsychological tests and psychological rating scales. After six months of standard treatment with thyroxine, their mood and verbal fluency improved.

But findings have been inconsistent, especially in studies with larger numbers of participants. In one such survey, Canadian researchers found that the only psychiatric disorder associated with thyroid disease was social anxiety disorder (social phobia). In a study of more than 300 people over age 60 who came to internal medicine and psychiatry clinics, some of them for depression and others for symptoms suggesting abnormal thyroid activity, researchers found a high rate of depression among those with subclinical hypothyroidism but not those with clinical hypothyroidism.

So the influence of thyroid deficiency on mental health remains uncertain. Findings may conflict because studies have selected patients and evaluated depressive symptoms and thyroid function by different standards.

There’s better evidence that thyroid medication may be helpful for depressed patients, even those with normal thyroid function. Canadian researchers found that added thyroxine helped patients with major depression who did not respond to selective serotonin reuptake inhibitors.

Researchers at Massachusetts General Hospital in Boston administered either thyroxine or the mood stabilizer lithium to 142 patients whose depression had not improved despite earlier treatment. About 25% of those taking thyroxine improved, compared with 16% of those taking lithium.

Examining all the findings so far, an expert panel has concluded that there is not enough evidence to associate TSH levels with psychiatric symptoms or to recommend thyroxine treatment for depressed patients. But there may be just enough evidence to explore these possibilities further — and to recommend tests of thyroid function in seriously depressed patients.

Are You Running On Empty? Thyroid Deficiency Syndrome


Feeling tired? Mentally dull? Depressed? Perhaps a little Constipated? Are you cold when everyone else is warm or comfortable? Gaining weight? Losing your hair? Have dry skin? Brittle nails? Do your joints ache? Is your blood pressure too low? Slightly high cholesterol? Have you lost interest in sex?

If any of this sounds like you, you may have thyroid deficiency syndrome.

Thyroid deficiency syndrome means that your thyroid gland, which sits like a bow tie around the front of your neck, just below the Adam's apple, is churning out less thyroid hormone than the body needs. Normally the thyroid combines two tyrosine molecules, each with two atoms of iodine to produce thyroxine, also known as T4 (so named because each molecule contains four iodine atoms.) When functioning properly the body converts T4 to triiodothyronin, or T3, which is the major active thyroid hormone. Some T2 and T1 are also formed, although their precise function is not yet understood.

The production and secretion of thyroxin are controlled by another hormone, thyrotropin, or TSH (thyroid stimulating hormone) which is synthesized by and released from the pituitary gland. TSH is secreted in a pulsatile manner with a circadian (daily rhythmic) pattern. As signals reach the pituitary that more thyroxin is needed throughout the body, the pituitary releases more TSH. When that TSH reaches the thyroid, the gland responds by stepping up its production and release of thyroxin. A negative feedback mechanism reduces TSH secretion as thyroxin levels rise.

Although a little thyroid hormone normally goes a long way, the body's needs are extensive. The thyroid is a vital link in the endocrine system. Even a small decline in the output of thyroid hormone, if sustained over an extended period of time, can have profound consequences for health and longevity. With no thyroid hormone, we would die within a short time.

Thyroid hormone helps regulate virtually every cell in the body, including those in the brain, heart, liver, kidney, skin and bone. Among its most important functions in our cells is to control the rate of metabolism, altering thermogenesis and oxygen consumption. If cellular metabolism drops too low, the result is widespread dysfunction that can manifest in a variety of ways, including depression; anxiety; cognition, learning, and/or memory impairment; loss of hair, hearing and muscle tone; weight gain; heart disease; hypoventilation; psychosis; and, in extreme cases, death.

Thyroid deficiency syndrome most often affects women over 40, but men and teenagers can also have reduced thyroid function, especially if it runs in the family. According to some estimates, as many as 15 to 20% of women over age 60 may have subclinical hypothyroidism (meaning they would benefit from thyroid supplementation even though most conventional doctors would insist, based on standard laboratory test results, that they had no thyroid pathology requiring treatment). Each year, 5 to 15% of these women develop symptoms, some of which may contribute to shortening their lives.

Some hypothyroidism, clinically diagnosed as thyroid deficiency syndrome, may be caused by a condition called Hashimoto's thyroiditis. This is an autoimmune disease in which the body's own immune defenses turn on the thyroid gland, causing an inflammatory process that eventually destroy it. Immunosenesence, immune decline with aging, is associated with increased autoimmune reactions. This progressive destructive process is a major reason why thyroid function commonly declines with age. (Nine out of ten cases of Hasimoto's syndrome occur in women.)

Hashimoto's thyroiditis is commonly seen in people who have other autoimmune disease, including insulin dependent diabetes mellitus, pernicious anemia, or myasthenia gravis. It may also occur with greater frequency in people who are left-handed or who have prematurely gray hair.

Hypothyroidism can also be caused by certain drug treatments (e.g., alpha-interferon, used to treat hepatitis C) or destruction of thyroid tissue by radioactive iodine treatment or surgery for conditions such as Grave's disease or thyroid cancer. It can also have a genetic origin, in which case it may manifest shortly after birth.

And, finally, there is simply the frequent slowdown in thyroid function that accompanies the general aging of the endocrine system. This is a problem often missed by conventional doctors.

Overt hypothyroidism is relatively simple to diagnose, if -and this is a big IF - you and or your doctor look for it. Hashimoto's thyroiditis may cause the gland to enlarge or swell, something an alert physician should be able to feel, even in its early stages. The diagnosis can then be confirmed by performing a series of blood tests, especially measures of TSH and antithyroid antibody. Elevated TSH is an indication that the thyroid is putting out insufficient thyroxine to maintain normal functioning; ergo hypothyroidism.

However, the diagnosis of age-related thyroid slowdown is more problematic, largely because primary care doctors are not generally trained to look for it. Or it may be because age-related functional decline of any sort is considered "normal," and thus not a medical problem. On this basis, doctors may dismiss signs of hypothyroidism, like fatigue, chiliness, muscle cramps, hair loss, dry skin, and constipation as "just" part of the aging process. As a result, the disease can probably does go undiagnosed in a large number of patients.


There is one simple thing almost anyone can do at home to uncover an underfunctional thyroid: take your own temperature. The "basal body temperature" test was developed by Broda O. Barnes, MD, a physician who, for decades, helped raise the consciousness of both physicians and others regarding the risks and prevalence of hypothyroidism and weak thyroid function. His book, Hypothyroidism: The Unsuspected Illness, first published in 1976, remains as the best clinical description of the syndrome.

Because thyroid hormone is so vital to cellular metabolism, reduced thyroid function often manifests as a drop in body temperature to below the normal level of 98.6F. Barnes recommended the following procedure.

- Shake down an oral glass thermometer before going to bed and leave it on the night table overnight. (Actually, it is better to shake just before using it.)

- Immediately upon awakening, and with as little movement as possible, place the thermometer firmly in your armpit next to the skin. (It is more accurate when placed on mucous membranes such as under the tongue or in the rectum.)

- Leave it there for 10 minutes.

- Record the readings on three consecutive days.

If the average temperature over the three days is less than 97.8F, then, according to Dr. Barnes, you may have hypothyroidism. Even if you have had a blood test and were told you did not have a low thyroid reading, you might go back and look at the results again. You may find that your blood levels of thyroid hormones are actually low normal. Many people who are within the so-called "normal" range but below the midpoint could benefit enormously from thyroid supplementation.


Proper thyroid function may require supplying the body with thyroid hormone or whole thyroid extract. In clinical use, it is common practice to use the TSH level as a gauge when titrating the proper dose of thyroid supplementation. As thyroid hormone levels rise in the body, TSH levels should fall (negative feedback loop). The amount of thyroid supplementation required to return TSH to the "normal" range is one of the major considerations in dealing with thyroid underfunction. As we have pointed out, because thyroid function changes with age, it is helpful to monitor TSH levels periodically to assure that the quantity of thyroid supplement being taken remains at appropriately youthful levels.

Another major controversy in the treatment of hypothyroidism concerns the use of natural glandular concentrates or extracts containing thyroid hormone (e.g., Armour Desiccated Thyroid Hormone, Nathroid, Westhroid, and other brands derived from the thyroid gland of the pig) vs. synthetic (laboratory-made) thyroid (e.g., Synthroid, Levothroid, levothyroxin, etc.). Not surprisingly, most conventional physicians prefer the synthetic product, which is widely promoted by pharmaceutical companies. (Synthroid is the third leading drug sold in the U.S.) Whether it is superior is open to serious question, however.

Armour Thyroid and other natural thyroid preparations contain natural thyroid hormone. Although these preparations have been criticized by some for being "impure" or "inconsistent" from dose to dose, it should be noted that Armour Thyroid and most natural thyroid preparations are made to standards approved by the United States Pharmacopeia (USP), which helps assure that its potency is accurately stated on the label.

They contain T4, T3, T2, and T1 and most closely resemble natural human thyroid hormone. At the proper dose, natural thyroid hormone works quite well and are preferred by nearly all "natural" or "alternative" physicians.

Synthetics, on the other hand, consist solely of T4. They depend on the body to convert the T4 to T3 and the other metabolites. This may be fine for some people, but, for those whose thyroid underfunction is caused not by a reduction in T4 production but by a defect in the conversion of T4 to T3, giving T4 may not help much.

A third option is likely to be the best of all for those who wish to help prevent age-related decline. This option is ThyroPlex, a new anti-aging glandlar formulation developed by Jonathan V. Wright, MD, one of the leading practitioners of alternative medicine in the US. ThyroPlex is a unique combination of glandular extracts, including those from glandular thyroid (1/4 grain), adrenal, hypothalamus, pituitary, and testicular (for males) or ovarian (females) tissue.

According to a classic study conducted in 1974 by Dr. James Isaacs, a pioneering cardiovascular surgeon from Baltimore, people who took ½ grain of thyroid along with vitamins and minerals over a period of 10 years showed significant improvement in cardiovascular function. Dr. Wright recommends ThyroPlex for people over age 40 who have no overt endocrine disease. He points out that, even if one is not experiencing symptoms, all endocrine glands are beginning to slow down at this stage of life. The most common comment from people taking ¼ grain of the natural thyroid component in ThyroPlex, according to Wright, is, "I just feel a little more energetic overall. My thinking seems a little clearer, and my bowel function is a little better."

Even if someone is already taking thyroid supplementation, most can still take ThyroPlex to get the benefits of the other glandular extracts, says Dr. Wright. "Unless you are in very brittle condition-and brittle means to an endocrinologist that the amount you take has to be exactly right on-you might consider the use of ThyroPlex, as part of your anti-aging program because, while it ads only ¼ grain of the actual thyroid glandular itself, it also nourishes the rest of the endocrine network."


(Thyroid Problems, Low Thyroid, Underactive Thyroid)

In this factsheet: The Facts on Hypothyroidism
Causes of Hypothyroidism
Symptoms and Complications of Hypothyroidism
Diagnosing Hypothyroidism
Treating and Preventing Hypothyroidism
The Facts on Hypothyroidism

The thyroid is a gland located in the neck below the Adam's apple. It helps control the body's metabolic rate by producing the hormones thyroxine (T4) and triiodothyroxine (T3). A metabolic rate is the rate of chemical processes occurring within the body that are necessary to maintain life.

Hypothyroidism is the most common of the thyroid disorders. It occurs when the thyroid gland becomes underactive and does not produce enough thyroid hormones. The metabolic rate falls and normal bodily functions slow down.

Hypothyroidism occurs in 1.5% to 2% of women and in 0.2% of men, and it is more common with increasing age. Up to 10% of women over the age of 65 show some signs of hypothyroidism.

Although less common, hypothyroidism does occur among the young. Neonatal hypothyroidism, called cretinism, is associated with mental retardation, jaundice (yellowing of skin), poor feeding, breathing difficulties, and growth problems. Childhood (juvenile) hypothyroidism is characterized by delayed growth and problems with mental development; however, with prompt treatment, problems can be minimized.

Causes of Hypothyroidism

Primary hypothyroidism occurs when there is a problem with the thyroid. The most common cause of adult hypothyroidism is Hashimoto's thyroiditis. It's caused by an autoimmune reaction where the body produces antibodies that attack and gradually destroy the thyroid gland.

Women are eight times more likely than men to develop Hashimoto's thyroiditis, especially as they age. It can also run in families or be associated with syndromes of genetic abnormalities such as Turner's syndrome, Klinefelter's syndrome, and Down syndrome.

Hypothyroidism can also be caused by treatments for hyperthyroidism. To treat hyperthyroidism, the thyroid gland may be rendered inactive with medications or radioactive iodine treatment, or it may be surgically removed. The result may be a lack of thyroid hormones, causing hypothyroidism.

The thyroid gland requires iodine to function properly. A chronic lack of iodine means that less thyroid hormone can be produced and this causes the thyroid to enlarge. Since salt manufacturers now add iodine to salt, this form of hypothyroidism is extremely rare in North America. However, it is still the major cause of hypothyroidism in underdeveloped countries, where iodine is often lacking in the diet.

Some rare inherited disorders cause enzyme abnormalities in the thyroid gland that don't allow it to make the hormones. Secondary hypothyroidism (when there is a problem with the pituitary or hypothalamus, not the thyroid) may occur if the pituitary gland in the brain isn't working properly, and not producing a hormone (called thyroid-stimulating hormone (TSH)) needed to stimulate the thyroid gland. These disorders are quite rare and not a major cause of hypothyroidism.

Some medications can cause a person to develop hypothyroidism by interfering with the production of the thyroid hormone. These include amiodarone (a heart medication), lithium (a bipolar disorder medication), and interferon alpha (a cancer medication).

Symptoms and Complications of Hypothyroidism

Because the hormones T4 and T3 are lacking, the body's metabolic rate and organ functions slow down. Symptoms aren't always obvious, and hypothyroidism may sometimes be mistaken for other diseases.

People with hypothyroidism often experience:

coarse and dry hair
cold intolerance
confusion or forgetfulness (often mistaken for dementia in seniors)
dry, scaly skin
fatigue, or feeling sluggish
hair loss
increased menstrual flow (women)
muscle cramps
slower heart rate
weight gain

It is important to note that these symptoms are less likely to occur in seniors. Seniors may experience symptoms of confusion, anorexia, weight loss, falling, and decreased mobility.

If hypothyroidism isn't treated, the symptoms will progress and, rarely, a severe form of hypothyroidism called myxedema will develop. With myxedema, the body temperature drops, anemia occurs, and there is a risk of congestive heart failure. Myxedema coma occurs in some people with severe hypothyroidism who are exposed to some kind of stress, such as an infection, severe cold, trauma, or the use of sedatives. Symptoms include loss of consciousness, seizures, slowed breathing, and lack of blood flowing to the brain.

Diagnosing Hypothyroidism

If your doctor suspects hypothyroidism, tests can be performed to check how well the thyroid gland is functioning. Levels of T4 in the blood are measured, along with thyroid-stimulating hormone (TSH) that is produced by the pituitary gland. High levels of TSH suggest that the thyroid is underactive and that the pituitary is overcompensating by making excess hormones to stimulate the thyroid gland.

With secondary hypothyroidism, the pituitary gland isn't functioning properly and both T4 and TSH levels in the blood are low.

Thyroid scans, using radioactive iodine or technetium, allow doctors to see the thyroid gland and identify areas that are less active.

Treating and Preventing Hypothyroidism

Treating hypothyroidism requires replacing hormones with synthetic or natural thyroid hormones. The easiest and most effective thyroid hormone replacement involves a synthetic form of T4 that is taken orally (by mouth). The tablets are available in a variety of strengths, and doses are adjusted for each individual until the correct hormone levels in the blood are reached and there is a satisfactory control of symptoms.

So-called "natural" thyroid supplements, which usually contain ground-up thyroid glands from animals, are rarely used now. This is because they can cause allergic reactions and do not provide a consistent dose of T4.

Large doses of T4 can have serious side effects. Small doses are therefore given and slowly increased until levels of T4 and TSH in the blood are back to normal.

People with mild hypothyroidism might feel fine and not require treatment, while others will be bothered by symptoms and require treatment. Hypothyroidism tends to get worse over time and even mild cases should be regularly monitored. Individuals taking small amounts of thyroid hormones may need to have their doses increased with time. Beyond a certain age, seniors sometimes need lower doses of T4.

If a dysfunctional pituitary gland is the cause of hypothyroidism, it will need to be treated. The pituitary controls many other glands in the body as well, and several medications may be needed.

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