Hypothyroid and Mental Health

Thyroid hormones influence every cell in the body and impact all major neurotransmitters like Dopamine, Serotonin and GABA. Knowing this, it's important to properly evaluate thyroid parameters when depression or other mood dysregulation is present. Currently, 20 million people suffer from low thyroid, and many more are affected, but undiagnosed. On the other hand, depression affects 17.3 million American adults. (R)

Hypothyroid Symptoms

Basically, every system is affected and metabolism slows from low thyroid hormone activity. Common symptoms include the following:

Fatigue

Intolerance to cold weather

Dry skin,

Constipation

Depression

Brain fog

Body pain,

Weight gain

Slow movements and thoughts

Muscle aches

Muscle cramping

Thin hair

Hashimoto's Hypothyroid

In most cases, hypothyroid is actually an autoimmune disease called Hashimoto's and not simply ordinary hypothyroidism. This is important since the care plan will change toward an immune attack on thyroid tissue instead of primary gland dysfunction and just merely giving thyroid hormones. Environmental triggers become more important to recognize as does dietary factors, leaky gut, infections, stress levels, and supplementation in the case of Hashimoto's. It's also known that many people with one autoimmune disease can have others.

Thyroid-Brain Connection

Thyroid hormones have been shown to support myelination, spurring of dendrites and play a role in synaptic plasticity. They're also important in neurotransmission productivity and function. In depression, it's important to check thyroid health and in low thyroid patients, it's important to evaluate brain health as well. Four to nearly forty percent of patients with affective disorders have sub-clinical hypothyroidism. In regard to psychological symptoms, hypothyroid patients frequently demonstrate features of depression, cognitive dysfunction, apathy, and psychomotor slowing. (R) And, according to the American Association of Clinical Endocrinologists, “The diagnosis of subclinical or clinical hypothyroidism must be considered in every patient with depression.

Hypothyroid Management

Patients with low thyroid are often mismanaged and only placed on thyroid medication, when in actuality, they need an autoimmune protocol. In other words, only one element of the story is being addressed during management. Dietary changes including a gluten free and dairy free diet have been researched to be helpful primarily because these proteins cross-react with thyroid tissue and cause damage. (R) This is good, but I like to take it one step further and suggest an Autoimmune Paleo Diet (AIP) for patients with Hashimoto's. This eliminates grains, nightshades, and emphasizes a low lectin diet, which is important for people with auto-immunity. (R) Patients will focus on animal protein, fish, vegetables with select fruit.

Supplement wise, Selenium has the most research and seems to lower TSH, help with converting T4-T3 and lowers antibodies. (R) It's also been shown to shrink goiters in thyroid patients. Inositol is another key nutrient and although a sugar, it seems to have similar findings to selenium with regard to lowering TSH and helping conversion. (R) I also feel Flavonoids such as Quercetin and Luteolin are important in lowering Th17 cells and the inflammatory cascade within thyroid tissue. (R) Other anti-inflammatory compounds that may be helpful are Turmeric, Resveratrol, Glutathione, and Black Cumin Seed, which are all key antioxidants. Again, the goal is to slow the tissue destruction so the thyroid gland can become healthy once again. Other factors are decreasing stress, where breath work becomes important and psychotherapy, processing trauma, staying away from iodine, and making sure that patients are getting enough balance in their life. The topic of stress and auto-immunity may be another topic for a different day, but certainly interesting. Addressing mold, histamine intolerance, methylation and making sure that sleep is addressed.

The blog by Trivita Health Center is written by Dr. Aaron Newman who sees patients in Oregon, Washington, North Dakota and Arizona by telepsychiatry. He focuses on holistic, psychiatric care and works with children, adolescent and adults doing medication management, psychotherapy and nutritional psychiatry including dietary support and supplementation.