by Kelly Brogan MD team
ThyroidChange Guest Writer
Updated 12/30/2020
- Why the symptoms of a thyroid disorder, including depression and flat mood, are often missed.
- The connection between thyroid disease and mental or psychiatric conditions.
- Why standard thyroid testing misses many cases of thyroid disease.
- The relationship between thyroid disease and adrenal dysfunction.
- Factors influencing cortisol output.
- Recommended thyroid blood tests that you need.
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Do you have one or more of the following symptoms?
- Unexplained weight gain or loss
- Swelling, puffiness
- Low energy, depression
- Racing heart, anxiety
- Lethargy, sleeplessness
- Digestive disturbances, constipation or loose stools
- Brain fog, forgetfulness
- Aching muscles, cramps
- Hair loss, thinning
- Dry skin, brittle nails
If so, you could be among the nearly 200 million people worldwide (the majority of whom are women) who have some type of thyroid problem [1].
If you also suffer from symptoms of depression, did you know that a "normal", in reference range thyroid test can be masking a critical link between these two conditions? It could possibly be the source of your depression
The Thyroid Gland: A Quiet Regulator
From the production of hormones to regulating metabolism, the thyroid helps maintain healthy weight, overall immunity, and even regulates mood and memory functions. When one or more of these systems is disturbed, we must explore a possible connection to thyroid to avoid treating the symptoms while neglecting a root cause.
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone. Characterized by feelings of anxiety, a racing heart, bouts of insomnia, diarrhea, and weight loss, this is more rare than underactive thyroid, and has the potential to trigger heart and bone problems.
An underperforming thyroid, or hypothyroidism, is a condition in which the thyroid gland doesn’t produce enough thyroid hormone. Despite being incredibly common, hypothyroidism is one of the most under-diagnosed conditions in America.
At least 20 percent of all women have an under responsive thyroid – yet only half of those women get diagnosed.
And the other half? For reasons I will explain, too many of these patients are given a clean bill of physical health, and a prescription for an antidepressant.
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Are You Really a Mental Patient?
I’m not alone in these observations. Scientists like Dr. Mark S. Gold, a world-renowned addiction expert, have long known about the relationship between a dysfunctional thyroid and symptoms of depression [2]. Through ongoing research, this correlation continues to be validated [3].
So, why the staggering number of missed diagnoses?
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Missing the Diagnostic Mark
Complaints of low energy, flat mood, poor sleep, and appetite disturbance, are too easily hung on the nail of “depression”, for which an easy fix is applied – a prescription for antidepressant medication.
The standard medical test for thyroid, called TSH, measures thyroid stimulating hormone levels. Even when doctors perform this test, their interpretation of the clinical picture is limited by their biases.
I speak from experience when I say that most physicians are simply not trained to diagnose thyroid imbalance properly.
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Where Standard Thyroid Testing Goes Wrong
1. Over-reliance of the TSH Test
2. Forgetting to Test Thyroid Antibodies
3. Over-reliance of Levothyroxine
The gold-standard T4-only thyroid treatment, Synthroid, is the most-prescribed drug on the market today [4]. Based on proper interpretation of optimal thyroid hormone labs of T3 and T4, combination T3/T4-containing medications (liothyronine + levothyroxine) might be needed for many patients.
However, with inadequate analysis of optimal Free T3 and Free T4 levels, patients are prescribed treatment that fails them.
4. Relying on Broad Reference Ranges
Current medical standards allow for a normal result within the vast range of 0.5 to 5.0. However, variations in laboratory testing as well as deviations by age, pregnancy, and other health factors, have allowed many patients at the fringes (and well beyond) to go undiagnosed [5].
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The Thyroid’s Relationship with Adrenals
When signaled by the brain, adrenals produce the stress hormone cortisol, which is intrinsically tied to thyroid functionality. This is key to why stress has a direct impact on thyroid and mood.
Whether through overactive cortisol production (a state of chronic fight or flight), or the brain essentially shutting down cortisol secretion, patients who suspect thyroid dysfunction must test cortisol output throughout the day to see the big picture. When properly tested, thyroid patients often show abnormal adrenal output.
The next question to ask is “Why?”
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Adrenal Stress Factors
1. Birth control pills
2. Gluten
3. Fluoride
4. Endocrine Disrupters
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The Thyroid is a Canary in the Coal Mine
The thyroid is a canary in the coal mine. In our fast-paced, nutrient-depleted world that’s filled with toxic substances, your thyroid gland may be the first to come under siege. While you may not feel the attack in your thyroid per se, you’ll feel it in your mood and cognition.
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What Are The Best Thyroid Tests?
For starters, insist on testing (or order your own) beyond the standard TSH. The following breaks down my own testing protocol:
1. Full Thyroid Panel
Ask your doctor to run this panel, or you can order them here:
Test for TSH, T4, free T3 (FT3), reverse T3 (RT3) and the antibodies listed below.
2. Hashimoto's and Graves' Disease
For Hashimoto’s thyroiditis, order thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).
If you suspect hyperthyroid symptoms, screen for Graves' disease by ordering TPOab, TRAb, TSI, and TBII. Again, ask your doctor to run this panel, or you can order them here.
3. Cortisol Levels
For help interpreting the results of these tests, I recommend connecting with an experienced functional medicine doctor or naturopath who has experience working with thyroid patients. SteadyMD also has great integrative doctor options who specialize in thyroid health.
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Safeguard Your Thyroid to Improve Your Mood!
This protocol includes the comprehensive testing I have outlined here, which goes far beyond the standard employed by traditional doctors.
But these tests are just the beginning. The next steps are a series of diet and lifestyle adaptations that will begin to bring these critical systems back into balance.
Supporting a healthy thyroid is an exercise in holistic medicine. It starts with supporting the immune system so it doesn’t attack the body’s own tissues and manifest as symptoms of depression – and autoimmune disease.
The healing journey continues with the awareness of what’s really going on in your body, and deepens as you become empowered by choices that support your vitality –mind, body and soul.
To learn more, check out A Mind of Your Own. For hands-on support with these lifestyle changes, explore the Vital Mind Reset.
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References
1 http://www.thyroid.ca/thyroid_disease.php
2 https://www.researchgate.net/publication/16572953_Hypothyroidism–or_is_it_depression
3 https://www.hindawi.com/journals/jtr/2012/590648/abs/
4 http://www.webmd.com/drug-medication/news/20150508/most-prescribed-top-selling-drugs
5 https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/1756-6614-8-S1-A17
6.https://medicalxpress.com/news/2015-02-fluoridation-england-linked-higher-underactive.html#nRlv
© Kelly Brogan MD. This work is reproduced and distributed with the permission of Kelly Brogan MD. For more articles, sign up for the newsletter at www.kellybroganmd.com
Updated 12/30/2020
If you need qualified guidance in your healing journey to strong mental health, seek out the help of a licensed counselor. BetterHelp has licensed counselors with experience in helping patients with the life changes of a chronic medical condition.
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Kelly Brogan, MD is a holistic women’s health psychiatrist, author of the NY Times Bestselling book, A Mind of Your Own, the children’s book A Time For Rain, and co-editor of the textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from M.I.T. in Systems Neuroscience.
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