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Could your depression be linked to your thyroid?

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Thyroid imbalances can mess with your mood. Here’s what you need to know — and how to get a correct diagnosis.
Written by Jessica Migala
Updated on September 28, 2021

For such a small gland, your thyroid has a big job. It makes hormones that control how your body uses energy. These hormones affect your breathing, body temperature, heart rate, digestion and cognition. And the more hormones this mighty gland releases, the faster those systems function.

So what happens when something is amiss with your thyroid? Well, your entire body can feel “off,” says Linda Lester, MD. She’s an endocrinologist at Oregon Health & Science University in Portland. Drastic and seemingly unrelated changes can happen to your weight, energy and mood. And, yes, it can even lead to symptoms of depression.

About 20 million Americans have some form of thyroid disease, according to the American Thyroid Association. And what’s worse: Up to 60% of people with a thyroid condition may not know it.

If you’ve been diagnosed with depression, here’s what you need to know about the role your thyroid may play. (And if your conditions require medication, Optum Perks can help you save. Download our app today.)

Types of thyroid imbalances

Your thyroid is a butterfly-shaped gland at the base of your neck. It produces and releases hormones at a steady rate to keep your body humming along as it should. But certain conditions can cause hormone imbalances, says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Two common thyroid problems are hypothyroidism and hyperthyroidism.

  • Hypothyroidism happens when your thyroid doesn’t make enough of the hormones your body needs. When the gland is underactive, some of your body systems can slow down. Common symptoms are fatigue, weight gain, dry skin or dry hair, and a slower heart rate. It’s typically treated with replacement thyroid hormones that you take as a pill, such as levothyroxine (and, less commonly, liothyronine).
  • Hyperthyroidism is when your body overproduces thyroid hormones. When you have an overactive thyroid, some body systems can speed up. Some common symptoms can be trouble sleeping, weight loss, mood swings and an irregular heartbeat. Treatments include beta-blockers (to relieve symptoms fast) or antithyroid medicines such as methimazole. These help your thyroid pump out less hormones.

Both conditions are more likely to happen to women and those who are over the age of 60. Other risk factors include a family history of thyroid disease or certain health conditions such as type 1 diabetes.

The thyroid and depression connection

Experts aren’t exactly sure why, but thyroid issues can bring about symptoms of depression. In fact, a 2021 study published in Clinical Endocrinology found that people with hyperthyroidism at the start of the study were more likely to develop depression 4 years later than those with normal thyroid hormone levels.

“Depression is more commonly seen with hypothyroidism but can also be seen with hyperthyroidism, along with anxiety and agitation,” says Dr. Lester. And that’s especially true in older adults. For example, younger people with an overactive thyroid may show signs of anxiety. This includes restlessness and chronic worry. But older adults may appear more apathetic.

What that looks like to an outside person, says Dr. Lester, is someone who sits quietly and doesn’t engage much in conversation, has slowed body movements or doesn’t move much. Or they sit with an inexpressive facial expression, something she says is often dubbed a “masked face” or “flat effect.”

So do depression and thyroid conditions always go hand in hand? Certainly not. In fact, it’s thought that most people with depression have normal thyroid function, a review published in the Journal of Thyroid Research found.

Depression can be caused by many different factors, says the National Institute of Mental Health. A family history of depression, trauma, stress and a wide range of health conditions or medications can all play a role. We answer your top questions about treating depression here.

Why a correct thyroid diagnosis matters (and how to get one)

Trouble sleeping, feeling low energy, changes in weight. Yep, these are some of the symptoms that depression and thyroid disorders can share. And that can make it hard for your doctor — and you — to tell the difference. But it is important to have an accurate diagnosis.

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People age 60 and older are sometimes misdiagnosed with depression when they really have an overactive thyroid, says the NIDDK.

“Over time, untreated hypo- or hyperthyroidism can cause poor health outcomes,” says Dr. Lester. Untreated hypothyroidism can lead to obesity, high cholesterol (which in turn can lead to heart disease and heart failure) and goiters (an enlarged thyroid that causes a visible lump in the neck).

Hyperthyroidism complications include blood clots, stroke and heart failure. If your overactive thyroid is due to the autoimmune condition Graves’ disease, you may also be at risk for Graves’ eye disease. With this condition, the eyes bulge outward and can cause eye pain and vision loss. Faster bone turnover in hyperthyroidism can also weaken bones and increase the risk of osteoporosis, says a review in the Journal of Clinical Medicine.

“Patients do not feel well and may be concerned that they have other medical conditions. Diagnosing and treating their thyroid disease can bring peace of mind and prevent unneeded testing for other diseases,” says Dr. Lester.

If you’re experiencing symptoms of depression, ask your doctor for a screening to rule out thyroid dysfunction, says Dr. Lester. She often recommends that older adults and people who are at risk for thyroid disorders be screened each year.

To screen for thyroid conditions, your doctor will do a blood test. They’ll typically measure your levels of TSH (thyroid stimulating hormone). TSH regulates the balance of other thyroid hormones in your bloodstream, says the Cleveland Clinic.

It’s kind of like a seesaw: If your TSH is low, that means the levels of your other thyroid hormones are high. And this can be a sign of hyperthyroidism. And if your TSH is high, that’s a sign of hypothyroidism. In either case, if your TSH is outside of the normal range, your doctor may do other imaging or blood tests to confirm.

A thyroid disorder is only 1 possible cause of depression symptoms. So if you’re feeling off — mentally or physically — talk to your doctor. There are many ways to manage depression and get back to living your life to the fullest.

And if you need help for depression (or anxiety), you can always speak to a therapist or medication prescriber virtually through the Optum Store.

Additional sources
Hypothyroidism overview: National Institute of Diabetes and Digestive and Kidney Diseases
Hyperthyroidism overview: National Institute of Diabetes and Digestive and Kidney Diseases
Thyroid levels and risk of developing depression: Clinical Endocrinology (2021). “Thyroid-stimulating hormone levels and incident depression: Results from the ELSA-Brasil study”
Review of research on thyroid function and depression: Journal of Thyroid Research (2012). “The Link between Thyroid Function and Depression”
Depression overview: National Institute of Mental Health
How thyroid conditions can impact bone health: Journal of Clinical Medicine (2020). “Thyroid Hormone Diseases and Osteoporosis”
How thyroid conditions are diagnosed: Cleveland Clinic
About 20 million Americans have some form of thyroid disease: American Thyroid Association