Hypothyroidism, also known as underactive thyroid, is a disorder that occurs when the thyroid gland does not produce enough thyroid hormones. Thyroid hormones help regulate metabolism, heart rate, body temperature, and mood. When thyroid hormone levels are low, it can cause a variety of symptoms, including anxiety.
Anxiety and hypothyroidism
Anxiety is a common symptom of hypothyroidism. Studies estimate that up to 40% of people with hypothyroidism also experience anxiety. The relationship between hypothyroidism and anxiety is complex and not yet fully understood. However, there are several reasons why low thyroid levels may contribute to anxiety symptoms:
- Thyroid hormones help regulate levels of serotonin, dopamine, and norepinephrine in the brain – chemicals that influence mood and emotions
- Hypothyroidism causes fatigue and brain fog which can increase stress and anxiety
- Hypothyroidism can cause sleep disturbances, which may worsen anxiety
- The metabolic changes of hypothyroidism can mimic anxiety symptoms like heart palpitations and shakiness
Treating the underlying thyroid hormone deficiency may help alleviate anxiety in hypothyroid patients. However, the anxiety may still persist even after thyroid hormone levels are balanced.
Common anxiety symptoms
The anxiety experienced with hypothyroidism can manifest in a variety of ways. Here are some of the most common anxiety symptoms reported in hypothyroid patients:
Excessive worrying
People with hypothyroid-related anxiety often struggle with excessive and persistent worrying. Their anxiety is often focused on health, family, relationships, work, or finances. The worrying feels difficult to control and may interfere with daily functioning.
Feeling keyed up or on edge
Individuals with hypothyroidism may feel constantly wired, tense, or on edge. They may feel like something bad is about to happen. This sensation of being keyed up can occur even without an identifiable cause.
Restlessness
Hypothyroid patients with anxiety often feel restless, fidgety, and unable to relax. They may pace, tap their fingers, shake their legs, or shift positions frequently. Sitting still can feel impossible.
Fatigue
Fatigue from hypothyroidism can get compounded by anxiety. The mental strain of constant worry can be exhausting and lead to severe tiredness, low energy, and feeling drained.
Impaired concentration
Anxiety can make it hard to focus or concentrate. People with hypothyroidism may struggle with forgetfulness, mental fog, and distracted thinking when anxious. Staying focused on tasks can feel difficult.
Irritability
The combination of anxiety and hypothyroidism can cause increased irritability. People may feel on edge, tense, and short-tempered. Small annoyances may provoke anger and frustration.
Sleep disturbances
Stress and anxiety can disrupt sleep. People with hypothyroidism may have trouble falling asleep, staying asleep, or feel unrested after a full night’s sleep. Insomnia or poor sleep can worsen anxiety.
Panic attacks
Some individuals with hypothyroidism experience panic attacks related to their anxiety. Panic attacks involve sudden, intense physical and emotional symptoms like shortness of breath, racing heart, dizziness, terror, and feeling a loss of control.
Physical symptoms
In addition to the psychological symptoms, the anxiety experienced with hypothyroidism can also cause various physical symptoms, including:
- Headaches
- Nausea
- Dizziness
- Shakiness
- Sweating
- Muscle tension
- Rapid heart rate
- Shortness of breath
- Fatigue
- Insomnia
- Upset stomach
These physical symptoms are often the direct result of the anxiety. The mental strain and stress taxes the body. However, some physical symptoms like rapid heart rate and sweating may also be partially caused by the thyroid dysfunction.
When to see a doctor
If you are experiencing anxiety symptoms along with other signs of hypothyroidism like unexplained weight gain, depression, or fatigue, see your doctor for evaluation. A simple blood test can determine if you have a thyroid hormone deficiency. If so, thyroid hormone replacement medication may help resolve both the hypothyroidism and associated anxiety.
It’s also a good idea to talk to your doctor if:
- Your anxiety symptoms are severe or disabling
- Your anxiety is getting worse or not improving with hypothyroid treatment
- Your anxiety is accompanied by panic attacks
- You have suicidal thoughts related to the anxiety
Your doctor can help determine if you may need additional treatment for an anxiety disorder, such as therapy and anti-anxiety medications, beyond just thyroid medication.
Treatments for hypothyroid related anxiety
To treat anxiety caused by hypothyroidism, your doctor will likely recommend:
Thyroid hormone replacement medication
Medications like levothyroxine help restore adequate thyroid hormone levels. This may help alleviate anxiety along with other hypothyroid symptoms. It can take several weeks or months to feel the full effects.
Anxiety medication
If anxiety persists after the hypothyroidism is treated, anti-anxiety medications may be helpful. Some common options include antidepressants like Zoloft, antianxiety drugs like buspirone, and benzodiazepines like Xanax.
Therapy
Seeing a therapist can help you manage anxiety through techniques like cognitive behavioral therapy (CBT) and mindfulness. Joining a support group may also help you cope.
Relaxation techniques
Relaxation exercises like deep breathing, meditation, yoga, and tai chi may help lower anxiety levels. Massage and other stress reduction techniques can also help.
Exercise
Regular aerobic exercise like walking, swimming, or cycling can help burn off stress and anxious energy. However, overdoing it can backfire by causing exhaustion.
Getting enough sleep
Aim for 7-9 hours of quality sleep per night. Maintain good sleep habits to ensure you are well-rested and able to cope with anxiety symptoms.
When to seek emergency help
If your anxiety is severe and you are experiencing:
- Thoughts of harming yourself
- Hallucinations
- Heart palpitations
- Trouble breathing
- Chest pain
Seek immediate emergency care, call 911, or go to the nearest emergency room. These can be signs of a medical emergency, like a thyroid storm or heart attack, requiring urgent treatment.
Living with hypothyroid anxiety
Here are some tips for coping with anxiety from hypothyroidism:
- Get regular lab testing to keep thyroid hormone levels optimized
- Follow up regularly with your doctor and report any anxiety symptoms
- Take anxiety medication as prescribed if needed
- Seek counseling or join a support group
- Reduce stress and build relaxation into your daily routine
- Engage in soothing activities like reading, crafting, or spending time in nature
- Avoid alcohol and limit caffeine, as these can worsen anxiety
- Connect socially and share your experience with trusted loved ones
- Focus on getting adequate sleep and rest
- Eat a balanced, nutritious diet to help manage symptoms
- Be patient, as controlling anxiety can take time even after thyroid levels normalize
Outcome and prognosis
With proper treatment, many people with hypothyroidism are able to manage anxiety symptoms successfully. Adequate thyroid hormone replacement is key, but anxiety medication, therapy, lifestyle changes, and self-care strategies often play an important role as well.
Patience and persistence are important, as it can sometimes take months for anxiety to improve even after thyroid function is restored. Ongoing communication with your healthcare providers is key to developing an effective treatment plan.
While anxiety may always be a challenge for those with hypothyroidism, the right multi-faceted treatment approach can help keep anxiety well-managed and improve quality of life.
