Thyroid and anxiety
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The Relationship Between Thyroid Function and Anxiety
Introduction to Thyroid and Anxiety Disorders
Thyroid dysfunction has long been associated with various psychiatric conditions, including anxiety disorders. The thyroid gland, through its hormones, plays a crucial role in regulating metabolism, mood, and cognitive function. This article synthesizes recent research findings on the connection between thyroid function and anxiety, highlighting the importance of thyroid health in managing anxiety disorders.
Comorbidity of Thyroid Disorders and Anxiety
Several studies have established a significant comorbidity between thyroid disorders and anxiety. Research indicates that individuals with anxiety disorders often exhibit subtle thyroid dysfunctions, such as blunted thyroid-stimulating hormone (TSH) responses to thyrotropin-releasing hormone (TRH) and an inverse relationship between self-reported anxiety levels and TSH1. Additionally, untreated hypothyroidism has been positively associated with anxiety, while untreated hyperthyroidism has been linked to major depressive disorder (MDD)2.
Thyroid Hormones and Anxiety Symptoms
Thyroid hormones, particularly triiodothyronine (T3) and thyroxine (T4), have been implicated in the modulation of anxiety symptoms. Studies on animal models have shown that hypothyroidism can induce mild anxiogenic effects, which can be reversed with T3 or T4 supplementation5. This suggests that maintaining optimal thyroid hormone levels is crucial for mitigating anxiety symptoms.
Thyroid Autoimmunity and Anxiety
Thyroid autoimmunity, characterized by the presence of antithyroid antibodies such as thyroid peroxidase antibodies (TPO-Abs), has also been linked to anxiety disorders. Epidemiological studies have found that individuals with thyroid autoimmunity are at a higher risk of developing anxiety and mood disorders6 8. However, some large population-based studies have not found a direct association between thyroid autoimmunity and anxiety, indicating that further research is needed to clarify this relationship4.
Physiological and Subjective Responses to Stress
Research comparing physiological and subjective responses to anxiety-inducing stressors in individuals with different thyroid statuses has yielded mixed results. While some studies did not detect significant group differences, they highlighted the potential risk for residual anxiety following treatment for hyperthyroidism3. This underscores the complexity of the relationship between thyroid function and anxiety, suggesting that thyroid health may influence the etiology or maintenance of anxiety disorders.
Impact of Thyroid Dysfunction on Quality of Life
Thyroid dysfunction can significantly impair quality of life (QoL) and exacerbate psychological symptoms. Studies have shown that both overt and subclinical thyroid dysfunctions are associated with worse QoL and higher levels of anxiety and depression. Treatment aimed at restoring euthyroidism has been found to improve QoL and reduce psychological symptoms, particularly in patients with overt thyroid dysfunction9.
Conclusion
The relationship between thyroid function and anxiety is multifaceted, involving hormonal, autoimmune, and physiological factors. While thyroid dysfunction is significantly associated with anxiety disorders, the exact mechanisms remain complex and warrant further investigation. Routine screening for thyroid disorders in patients with anxiety may be beneficial, and maintaining optimal thyroid health is crucial for managing anxiety symptoms effectively. Future research should focus on high-quality experimental and longitudinal studies to better understand the thyroid-brain interactions and their implications for anxiety disorders.
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Most relevant research papers on this topic
Hypothalamic–pituitary–thyroid (HPT) axis functioning in anxiety disorders. A systematic review
Thyroid disorders are significantly comorbid with anxiety disorders, and subtle thyroid dysfunction may be present.
Systematic Review
Rigorous Journal
Highly CitedDiagnosed thyroid disorders are associated with depression and anxiety
Untreated diagnosed hypothyroidism is associated with depression and anxiety, while untreated diagnosed hyperthyroidism is associated with depression.
Observational StudyHighly CitedThyroid hormones, psychophysiological reactivity, and anxiety
Posttreatment hyperthyroidism does not increase the risk of residual anxiety, but thyroid function may influence the etiology or maintenance of anxiety.
RCTThyroid autoimmunity, depression and anxiety; are there any connections? An epidemiological study of a large population.
Thyroid autoimmunity is a common disorder mainly affecting females, but no associations were found between antithyroid antibodies and depression or anxiety in a population-based study.
Observational StudyHighly CitedThyroid hormones regulate anxiety in the male mouse
Adult onset hypothyroidism in male mice leads to mild anxiety, but T3 or T4 supplementation can reverse this phenotype, suggesting that thyroid hormone levels may play a role in mood disorders.
Non-RCT
Animal StudyThe link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future
Thyroid autoimmunity may increase the risk of mood and anxiety disorders, suggesting a potential link between the two conditions in the community.
Observational StudyHighly CitedThyroid Function in Anxious and Depressed Patients
Thyroid hormone levels are lower in female patients with major depression, anxious depression, and anxiety disorder, and show a blunted TSH response in these patients.
Observational StudyAssociation of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis
Autoimmune thyroiditis is associated with an increased risk of developing depression and anxiety disorders, highlighting the need for early treatment and not just psychotherapeutic treatment.
Meta-AnalysisHighly CitedDepression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction.
Restoration of euthyroidism improves quality of life and psychological symptoms in patients with overt and subclinical thyroid dysfunction, except for subclinical hyperthyroidism.
Highly CitedDysregulated thyroid hormones correlate with anxiety and depression risk in patients with autoimmune disease
Dysregulated thyroid hormones, such as FT3, FT4, and TSH, are associated with increased anxiety and depression risk in patients with autoimmune disease.
Observational StudyRigorous Journal