Episode - Anxiety and Hyperthyroidism


Anxiety & Hyperthyroidism

Many people with hyperthyroidism experience anxiety.  Sometimes the anxiety is mild, but other times it can be quite extreme.  And while the elevated thyroid hormone levels associated with anxiety are a common cause, there can be other factors.

During this episode you’ll learn:

  • The relationship between inflammation and anxiety
  • Which nutrient deficiencies can play a role in anxiety
  • Some of the natural agents that can help to decrease anxiety
  • Action steps you can take

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Here is the transcript for this episode:

Welcome back to the Save My Thyroid podcast. This is Dr. Eric Osansky. In this episode, I will discuss how to overcome anxiety.

Probably to no surprise, we will start by discussing the importance of balancing thyroid hormone levels. In my patient base, I definitely see anxiety more commonly in hyperthyroidism. However, it can be a factor with hypothyroidism.

Talking about some of the studies I came across while doing research on anxiety, one study led me to the psychiatric manifestations of Graves’ Disease, including anxiety. While resolving the hyperthyroidism associated with this condition may help, the authors also mentioned that a substantial number of patients have anxiety even after successful treatment of hyperthyroidism and suggest there might be other factors involved. Of course, I will be discussing some of these other factors.

However, another study looked at the relationship between anxiety and thyroid function in patients with panic disorder and found that those with more severe panic attacks had a higher TSH. The severity of anxiety correlated negatively with T4 levels. In this case, it shows that hypothyroidism was more closely associated with anxiety.

Yet another study looked at the prevalence of anxiety and depressive symptoms among patients with hypothyroidism and showed that psychiatric comorbidity such as depressive disorder, anxiety disorder, and disturbances in memory and learning are common in patients with hypothyroidism. Either way, whether you have hyperthyroidism or hypothyroidism, it’s important to balance the thyroid hormone levels, even though as I mentioned in my practice I see it more commonly in patients with hyperthyroidism.

Let’s discuss other factors which can play a role in anxiety, starting with inflammation. Proinflammatory cytokines are associated with autoimmune conditions, including Graves’ Disease and Hashimoto’s. The research also shows they are present in generalized anxiety disorder, not just in autoimmune conditions. Some of the research suggests that proinflammatory cytokines can cause anxiety by modulating the metabolism of neurotransmitters, which include dopamine and serotonin.

Another study showed that inflammation can affect anxiety-related brain regions, including the amygdala, the insula, and anterior cingulate cortex. The problem is that a lot of things can cause inflammation. This includes eating inflammatory foods, chronic stress, certain infections, poor oral health (which can often go overlooked, unless you are going to a dentist. But if you go to a regular functional medicine practitioner for example, they might not take into account oral health.), environmental toxins, nutrient deficiencies, and more. Some detective work is usually needed to find the source of the inflammation, as it isn’t always obvious.

Besides inflammation, another factor that can play a role in anxiety is gut dysbiosis. This is an imbalance of your gut flora. You have both good bugs and bad bugs. Sometimes, it’s not just a matter of having too few good bugs or too many bad bugs. You may have too many good bugs. You can have a condition like SIBO (Small Intestinal Bacterial Overgrowth), where you have an overgrowth of good bacteria in the small intestine.

Also there’s candida. A lot of people think of candida as bad. Candida is a yeast. You might have a candida albicans overgrowth. It doesn’t mean you want to eliminate all of the candida, but you do want to do things to reduce the candida, to stop the overgrowth.

Let’s dive into the research of gut dysbiosis. In 2009, a journal article was written on the gut-brain access. Since then, there have been other articles discussing the connection between the influence of the gut microbiota on the brain as well as vice versa. The microbiota and the brain communicate with each other via various routes, including the immune system, tryptophan, the vagus nerve, and enteric nervous system. This includes but isn’t limited to the food we eat, stress, infections, and gut disrupting medications. These are all factors that can cause gut dysbiosis.

Antibiotics and proton pump inhibitors or acid blockers can cause gut dysbiosis. Certain chemicals like medications and glyphosate (the active ingredient in the herbicide Roundup) can also play a role in disrupting the gut.

In the case of infections, while addressing these can potentially resolve anxiety, it’s not always that simple. It’s the same thing with overgrowth of yeast or bacteria. Many times, addressing the infection or overgrowth can help to get rid of the person’s anxiety. Sometimes, you have to go beyond this.

Let’s say someone has H-pylori, or they have a parasite. If someone takes antibiotics for a gut infection, that might get rid of the infection, but keep in mind that the antibiotics will also harm the good bacteria in the gut. That could compromise the gut, and potentially cause inflammation.

There are many factors that can affect gut bacteria early in our lives and in adulthood. If someone wasn’t breastfed as a baby, which was the case with me, or if someone was born via C-section, that could also affect the gut bacteria. Of course, taking antibiotics early in life can be a factor, which also described me as well. Not only was I not breast-fed, but I had a lot of ear infections growing up, so I took a lot of antibiotics when I was younger.

I mentioned SIBO and candida overgrowth. These can potentially be a factor with anxiety. There is also a question of how this is related to inflammation, which causes anxiety, or decreased nutrient absorption. If someone has SIBO, maybe it’s not directly the SIBO. Maybe it’s SIBO causing inflammation. It also could be malabsorption due to the SIBO or any other type of gut infection. It might not be the infection per se, but it might be the consequence of decreased nutrient absorption which is causing problems with anxiety.

Also, with neurotransmitters, we need to keep in mind that not only do a lot of practitioners think of the brain when they think of neurotransmitters, but most of them are in the gut. If you have gut dysbiosis, that is going to not only potentially affect nutrient absorption but also the production of neurotransmitters, which can play a role in anxiety.

Let’s dive a little bit deeper into nutrient deficiencies, specifically some of the nutrients and the research, which have shown to play a role in anxiety. Thiamine, which is Vitamin B-1, has been used to treat people with anxiety.

Selenium. I commonly recommend selenium in my patients to help support the immune system, increase glutathione production. If someone has thyroid eye disease, the research shows that thyroid eye disease could benefit from selenium. It may not be the only factor, but it can play a role. A few intervention studies show that selenium can also improve mood and diminish anxiety.

Magnesium. Many listening to this understand the importance of magnesium, as it has many roles in the body. Since it has a calming effect, it shouldn’t be surprising that it can also play a role in helping some people with anxiety.

Vitamin D is just amazing. Some research shows that a Vitamin D deficiency can also play a role in anxiety. Vitamin D is more of a pro hormone than a vitamin, but you definitely don’t want to have a Vitamin D deficiency. This is easy to test for. Vitamin D also has anti-inflammatory effects. By correcting a Vitamin D deficiency, it can reduce inflammation. You also need to address any other potential causes of inflammation in the body.

Omega-3 fatty acids. Research shows that Omega-3 fatty acid supplementation can lower anxiety. Like Vitamin D, it might accomplish by reducing inflammation because that’s what Omega-3 fatty acids can do.

Folate and SAMe. There is methylenetetrahydrofolate reductase, also known as MTHFR. This is a key enzyme involved in the metabolism of folate. Some people have genetic variations of MTHFR. That includes myself. I have a homozygous C677T MTHFR polymorphism. I can’t say I experience anxiety personally, but having this polymorphism can play a role in anxiety in some people. Both folate and SAMe play a role in methylation. Methylation is a very complex topic, so I won’t go into detail here. I will say that it’s important for the production of neurotransmitters, which again can play a role in anxiety.

A polymorphism is a term for a genetic variation. I don’t like to use the term “genetic mutation.” A polymorphism is a common genetic variation. For some people with a MTHFR polymorphism, supplementing with methylated folate or SAMe or methylated B12 can help with anxiety. It’s also worth mentioning that sometimes taking methylated supplements can exacerbate a person’s anxiety. So you need to be cautious.

Let’s talk about herbs for anxiety. There are some people who are looking for a quick fix. Of course, the goal is to try to address the cause of the problem. I don’t believe in quick fixes. But in some cases, herbs can help while you’re addressing other imbalances, other underlying causes.

Kava. A few studies show that kava can help with generalized anxiety disorder.

Ashwagandha.  This is an adaptogenic herb. A few studies show that it can help to reduce stress and anxiety. Keep in mind ashwagandha is a member of the nightshade family. Although I have had many people over the years with Graves’ Disease and Hashimoto’s who have done well with ashwagandha, if someone is following a strict autoimmune paleo diet, you might want to be cautious about taking ashwagandha.

Rhodiola is another adaptogenic herb. A few studies show evidence that rhodiola can help with anxiety symptoms.

Then there is GABA. It is the primary inhibitory neurotransmitter known to counterbalance the action of the excitatory neurotransmitter glutamate. A few studies show that It can help with anxiety as well.

There is Valerian root. This herb is commonly used for the treatment of insomnia and anxiety, as it modulates the GABA-A receptors.

L-theanine. One study shows that chronic L-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance, and cognitive impairments in patients with major depressive disorder. However, a more recent study did not support the efficacy of L-theanine in the treatment of anxiety symptoms and generalized anxiety disorder. So there’s a little bit of conflict.I will say that I have given L-theanine to some of my patients, and I have seen some good results. I can’t say 100% of people; I can’t say this is true with any single natural agent. But I do find it to be helpful in many cases.

Lavender. A lot of people like to use essential oils. A few studies show that lavender oil can be an effective and well-tolerated alternative to benzodiazepines for reducing generalized anxiety.

Let’s go ahead and give a few action steps you can take if you are experiencing anxiety. Once again, you want to balance the thyroid hormone levels. If you have hyperthyroidism, you want to do things to lower the thyroid hormone levels. If you have hypothyroidism, you want to do things to increase the thyroid hormone levels. If you have hypothyroidism because you are taking antithyroid medication, of course, you want to check with the prescribing doctor about getting that decreased.

You need to do what is necessary to reduce inflammation. You want to not just take supplements, I did mention things like Vitamin D, Omega-3 fatty acids. And those might be the main cause. If someone has nutrient deficiencies, and that is the main cause of inflammation, that’s all you might need to do. But if someone has an infection, and maybe on top of that some nutrition deficiencies, and then all they do is correct the nutrient deficiencies but don’t address the infection, you want to try to make sure to find and remove the inflammatory triggers.

Improve the health of your gut microbiome. This is important for reducing inflammation. Also, when it comes to anxiety, you need ahealthy gut to produce neurotransmitters, which also play a role in anxiety. You need a healthy gut to digest and absorb nutrients. Having a healthy gut is very important.

Correcting nutrient deficiencies. Vitamin D is more of a pro hormone, but one of the more important and common deficiencies. I also mentioned selenium and L-theanine and Omega-3 fatty acids.

In some cases, you might want to consider taking herbs initially. To me, herbs aren’t a long-term solution. In most cases, it’s not going to address the cause of anxiety. Maybe in some cases. If stress is a big factor, ashwagandha could play a big role. You also want to do things to improve stress-handling skills. I think either way, you want to focus on the first four action steps I mentioned. In some cases, consider herbs initially.

That is all I want to discuss regarding anxiety. I hope you learned a lot. I look forward to seeing you in the next episode.