Anxiety And Hyperthyroidism: Is There A Link?

Some anxiety during everyday life is normal. Anxiety is defined by the American Psychological Association¹ (APA) as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Simple, everyday anxiety becomes an anxiety disorder when people, according to the APA, have “recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat.”

When seeing a doctor about different medical conditions, whether it’s diabetes, high blood pressure, or hyperthyroidism, many doctors recommend reducing stress.

Although often used interchangeably, stress and anxiety are two different things. Stress tends to be situational, while feelings of anxiety are almost always present in individuals with anxiety disorder.

It is true that anxiety and hyperthyroidism commonly occur together, but does that mean hyperthyroidism is caused by anxiety?

Currently, research does not support the claim that hyperthyroidism is caused by anxiety or stress,² but both can definitely worsen symptoms of hyperthyroidism.³ At the same time, some people with hyperthyroidism may also experience heightened anxiety.

What is hyperthyroidism?

Hyperthyroidism is a condition characterized by an overactive thyroid gland that produces too much thyroid hormone. Thyroid hormone works together with the hypothalamus and the pituitary gland, both of which are housed in the brain.

The concentration of thyroid hormone in the body helps these two glands control various functions around the body. When there is too much thyroid hormone due to an overactive thyroid, the body kicks some functions into overdrive, prompting several unpleasant symptoms.

Common symptoms of hyperthyroidism include:

• Heart palpitations, increased heart rate

• Sensitive to heat, feeling hot a lot of the time

• Tremors

• Excessive sweating

• Increased number of bowel movements

• Difficulty sleeping

• Hyperactivity and anxiety

• Brittle fingernails and hair

In the beginning stages of hyperthyroidism, you may not show clear symptoms that indicate your thyroid hormones are out of balance.

However, if you do experience symptoms, treatment for hyperthyroidism, like antithyroid medication, radioiodine, or surgery (thyroidectomy), can help relieve them and allow you to manage the condition.

Risk factors of hyperthyroidism

Hyperthyroidism affects approximately 1% of the US population.⁴ The most common risk factors for developing hyperthyroidism include:

• Being a female

• Being 60 years old or above

• Being pregnant within the last year

• Having an autoimmune condition (multiple sclerosis, type 1 diabetes, etc.)

• Having a family history of thyroid problems

People outside of these categories can still develop hyperthyroidism, but the above groups are significantly more likely than the average population to receive a hyperthyroidism diagnosis.

If you fall into any of the above categories or have concerns about developing hyperthyroidism, speak with your doctor and get regular physical examinations.

Can anxiety cause hyperthyroidism?

There is currently not enough evidence to show that anxiety can directly cause hyperthyroidism. Anxiety and hyperthyroidism are often found together, and anxiety is actually a common symptom of hyperthyroidism.

This is likely because hyperthyroidism can send stress hormones into overdrive, which prompts an increased heart rate, tremors, and hyperactivity, all of which are also symptoms of anxiety. For this reason, it’s incredibly easy to confuse anxiety disorders and hyperthyroidism without the right diagnostic tests.

Physicians need to check thyroid-stimulating hormone (TSH) levels and, if TSH is low, measure thyroid hormone levels and thyroid antibodies. They will perform an iodine uptake scan if a person has anxiety issues and other relevant symptoms.

While we cannot accurately state that anxiety causes hyperthyroidism, anxiety and other mood changes are common symptoms of hyperthyroidism. Extreme physical stress, like a heart attack, can lead to a thyroid storm in a person with undiagnosed or untreated hyperthyroidism.

What is a thyroid storm?

A thyroid storm is a serious medical condition that can occur in people who have untreated hyperthyroidism. It is brought on by physical stress, such as infections or surgeries in people with untreated Grave’s disease or hyperthyroidism.

Although research is not yet clear on the exact cause of thyroid storms, one common hypothesis is that a rapid increase of thyroid hormone⁵ sends the central nervous system into overdrive.

A spike of thyroid hormone can tip the body over the edge and cause severe symptoms, such as:

• High fevers

• Profuse sweating

• Respiratory distress

• Poor feeding and weight loss

• Seizures

• Vomiting

• Rapid heart rate

• Delirium and confusion

• Diarrhea

Thyroid storms require immediate medical intervention, as they can be life-threatening. Call 911 or get to an emergency room if you or someone around you is experiencing a combination of the above symptoms.

If you have already been diagnosed with hyperthyroidism, you should take your medications as prescribed to prevent thyroid storms and other unpleasant side effects.

When to see a doctor

You should make an appointment to speak with your doctor if your thyroid gland appears to be swollen, your heart beats rapidly while at rest, or if you have lost weight unexpectedly while maintaining the same amount of oral intake.

If you are concerned about your thyroid health, you can always bring it to your doctor's attention at your annual physical. They will ask you several questions about your health history, and they may order labs to check for TSH and T4 and thyroid antibodies if TSH is abnormal.

If the blood test confirms hyperthyroidism, they will perform a radioactive ion uptake test and thyroid scan to confirm the cause of the hyperthyroidism. Your doctor will then work with you to create a treatment plan that works for you.

Managing hyperthyroidism and anxiety

Managing both hyperthyroidism and anxiety at the same time is not an easy feat, but several treatment options can reduce the severity of both conditions.

If you have hyperthyroidism and are suffering from anxiety-like symptoms, anxiety and other mood changes related to hyperthyroidism should also improve with the right treatment program.

Hyperthyroidism

Your doctor may prescribe antithyroid medications for hyperthyroidism, which help stop the thyroid from producing new thyroid hormones. Most people will likely need to be on antithyroid medication for 12 to 18 months,⁶ but relapse is possible.

Another hyperthyroidism treatment is radioactive iodine, which is taken as a tablet. This medication gets absorbed by the thyroid and causes the gland to shrink so that it produces less thyroid hormone.

If the idea of taking something radioactive scares you, it’s important to understand that the radioactive iodine gets expelled by the body after a few weeks of treatment.

Additionally, beta-blockers may be prescribed to help with hyperthyroidism symptoms. They work by blocking the effects of adrenaline, which can help them slow your heart rate to a more normal level. Beta-blockers may also reduce anxiety and tremors that people with hyperthyroidism can experience.

Those who don’t respond to treatment, or have a goiter causing obstructive symptoms, may have to undergo a thyroidectomy or removal of some or most of the thyroid gland.

People who have their entire thyroid removed will need thyroid hormone therapy medications for life, while those who only have a partial thyroidectomy may not need thyroid hormone therapy.

Besides the above treatments, a proper diet⁷ and light exercise can help reduce some of the symptoms of hyperthyroidism.

Anxiety

Whether your anxiety is caused by hyperthyroidism or if you had it long before your thyroid hormones were thrown out of whack, there are numerous ways you can work to curb feelings of anxiety.

Like hyperthyroidism itself, anxiety symptoms can also be improved with a balanced diet,⁸ the right amount of exercise, and a feeling of connection with others.

Breathing exercises⁹ have been shown to help with anxiety symptoms, especially during an anxiety attack. Other people find grounding techniques helpful, as they help keep you in the present instead of letting your mind drift and worry about the future.

The 5-4-3-2-1 grounding exercise below is particularly popular. If you feel an anxiety attack coming, think of the following:

• 5 things you can see

• 4 things you can touch

• 3 things you can hear

• 2 things you can smell

• 1 thing you can taste

Seeking professional help with anxiety from a therapist or counselor can also help you feel better, as they can help you talk through your anxious thoughts and develop solutions to help you overcome them.

Many people also find success with SSRI medications, which are prescribed for both depression and anxiety.

Your doctor will likely wait to see if the hyperthyroidism treatments curb your anxiety before prescribing you an SSRI, but these medications are unlikely to produce drug interactions with your hyperthyroidism medications. 

The lowdown

Although anxiety cannot directly cause hyperthyroidism, hyperthyroidism can actually cause anxiety. Both conditions are highly associated with one another. It’s common for those suffering from untreated hyperthyroidism to also have symptoms of anxiety, although there are plenty of people with anxiety disorders who don’t have hyperthyroidism.

Whether you have anxiety, hyperthyroidism, or both, it’s best to seek professional help to get you back to feeling like yourself again.