Hypothyroidism is a condition that can leave you feeling sluggish and contribute to weight gain and mood changes, so it’s not a surprise that it can be tied to depression. But hypothyroidism symptoms can also include anxiety. In fact, a review published in June 2018 in JAMA Psychiatry found people with hypothyroidism are more than twice as likely as people without the condition to develop anxiety disorders and that 29.8 percent of all anxiety disorders are associated with autoimmune thyroid disease.
Hypothyroidism occurs when the cells in the thyroid gland can't make enough thyroid hormone, which is necessary to keep the body energized and running properly, according to the American Thyroid Association (ATA). Hypothyroidism and anxiety can be tricky to untangle because their symptoms can initially be quite similar. “When a patient comes to me with symptoms like irritability, constant worry, and muscle tension, in addition to treating them for anxiety, I have them get a thyroid test to check their levels for hyper- and hypothyroidism,” says Diane Solomon, PhD, a psychiatric nurse practitioner in Portland, Oregon. “This is especially true if it’s a woman in her late thirties or early forties.” That’s because women this age are in a period called perimenopause, the 5 to 10 years before menopause sets in. Some women may experience a shift in hormones, which can affect their thyroid.
But hypothyroidism can affect women — and men — for many reasons, according to the ATA. These can range from having autoimmune diseases such as Hashimoto's thyroiditis, to taking certain medications like lithium, to having too much or too little iodine in the body.
Anxiety is a normal reaction to a stressful situation, according to the American Psychiatric Association. It helps you to stay alert during an important short-term event, such as doing a job interview or keeping your toddler from running into the street. But when anxiety crops up too often and becomes a habit, it can become problematic. “Most people with anxiety aren’t even aware they have it, because it’s how they are used to operating,” Dr. Solomon says. Anxiety disorders can include generalized anxiety, panic disorder, social anxiety, and specific phobias, such as fear of flying. “If anxiety keeps you from doing everyday activities, that can point to an anxiety disorder,” says Solomon.
Anxiety is very common with hypothyroidism, and it can exist alongside depression or on its own, Solomon says. A study of 100 people with hypothyroidism published in the July-August 2016 issue of the Indian Journal of Endocrinology and Metabolism found that 63 percent showed some degree of anxiety.
Why are people with hypothyroidism more likely to develop anxiety? "One theory is that simply having a physical problem like hypothyroidism can increase anxiety," says Cheryl R. Rosenfeld, DO, a spokesperson for the American Association of Clinical Endocrinologists (AACE), partner at North Jersey Endocrine Consultants, and adjunct clinical associate professor of medicine at the Touro College of Osteopathic Medicine in New York City. "Symptoms of hypothyroidism include poor concentration, decreased memory, and difficulty performing daily activities — all of which can be anxiety-producing."
Not getting proper treatment for hypothyroidism can contribute to anxiety, as well. Levothyroxine is a common treatment for hypothyroidism, but if your dose is too high, it can directly lead to anxiety and cause symptoms like rapid heartbeat and shakiness, which can make anxiety worse, says Rosenfeld. And if hypothyroidism is not treated, symptoms like dry skin, sensitivity to cold, hoarse voice, and mood swings will persist. Over time, untreated hypothyroidism can cause heart issues like a weak pulse or heart failure, which may provoke further anxiety.
Anxiety can also make it harder to stick to your hypothyroidism treatment if it causes you to forget to take medications or causes problems going to the doctor or sticking to a healthy lifestyle.
Interestingly, even in women who are treated for hypothyroidism, anxiety may still occur. A study published in December 2019 in the International Journal of Environmental Research and Public Health found that despite being treated with levothyroxine and reaching normal thyroid function again, women who were diagnosed with hypothyroid had a 13 percent higher prevalence of anxiety than women without hypothyroidism.
If you’ve been diagnosed with hypothyroidism, anxiety symptoms to monitor yourself for include:
“It is often hard to separate anxiety or panic attacks from the symptoms of thyroid disease and treatment itself,” Rosenfeld notes.
The good news is that both hypothyroidism and anxiety are highly treatable. According to Solomon, proven ways to manage anxiety include:
Solomon is especially fond of teaching her clients mindfulness as a way to counter anxious thoughts. “Watch your thoughts; just observe them. Then ask, ‘Is this thought true? Is it overly negative?’” she suggests. “Then ask yourself, ‘Can I replace this thought with something more positive?’”
In some cases, treating hypothyroidism alleviates anxiety completely — although this is mostly when anxiety symptoms came on suddenly as a result of too-low thyroid levels, Solomon says. But it many cases, hypothyroidism and anxiety need to be treated concurrently, though treating one will help ease the other.
If you have both hypothyroidism and anxiety, be sure to work with your doctor to monitor both conditions. “Initiation of treatment and adjustment of thyroid hormone dose should be guided by both laboratory testing and symptoms, ideally by a supportive and understanding healthcare provider,” says Rosenfeld. “People with anxiety or panic disorder may require more frequent thyroid laboratory (blood) testing, as it is difficult to distinguish between thyroid dysfunction and mental health concerns,” she adds.
And because your mind is just as important as your body, work with your doctor to treat anxiety as well, whether it’s by working with a therapist, practicing lifestyle habits like mindfulness and yoga, or a combination of approaches.