- How Stress Affects Thyroid Problems
- Understanding Thyroid Storm and Stress
- How to Manage Stress With Thyroid Problems
- How Does Stress Affect Hypothyroidism?
- Signs You May Have Hypothyroidism
- The Effect of Stress on Your Thyroid
- Adrenal Glands and Hypothyroidism
- How Stress Can Be Extremely Dangerous
- Thyroid deficiency and mental health
How Stress Affects Thyroid Problems
Stress seems to be a factor that’s linked to the complications of many health conditions, including thyroid problems. But that link is often difficult to define and even harder to prove.
While there’s no proof of a relationship between stress and most thyroid problems, says Mario Skugor, MD, an endocrinologist with the Cleveland Clinic, his experience is that many patients will talk about thyroid-related symptoms and mention stressful events occurring around the same time.
“Most endocrinologists have this nagging feeling that there is a connection between stress and thyroid conditions, but whenever the theory is tested, it’s never held true,” . He notes that there have been several studies done on stress and thyroid problems, but a clear connection has yet to be discovered.
Understanding Thyroid Storm and Stress
A thyroid problem proven to often be brought on by physical stress is a condition called thyroid storm, also known as thyrotoxic storm and hyperthyroid storm — a potentially life-threatening situation that occurs in some people with untreated hyperthyroidism and Graves’ disease.
Most often, thyroid storm is triggered by a physically stressful event, such as an infection, heart attack, childbirth, diabetes, or even hyperthyroid treatments like surgery and radioactive iodine therapy.
Thyroid storm is a very rare but serious condition that needs immediate medical attention. Symptoms include:
- High fever
- Excessive sweating
- Rapid, irregular heartbeat
- Anxiety and nervousness
- Shaking or tremors
- Vomiting and nausea
- Delirium or confusion (impaired mental state
RELATED: The United States of Stress
It’s thought that physical or mental stress can lead to thyroid storm because stress causes high levels of certain hormones to be released into the bloodstream. People with hyperthyroidism seem to be particularly sensitive to these hormones — adrenal hormones like dopamine, epinephrine (adrenaline), and norepinephrine, for instance — which can have the effect of putting all body systems into high gear.
Combine those hormones with the high levels of thyroid hormone present in someone with undiagnosed or untreated Graves’ disease, and you have a flood of substances that can cause overactivity in nearly all body systems.
Thyroid storm must be treated immediately and aggressively, usually requiring admittance to an intensive care unit. If it’s left untreated, heart failure, difficulty breathing, or coma may result.
How to Manage Stress With Thyroid Problems
Although thyroid storm is typically associated with a specific physical stress, managing your emotional stress can decrease the levels of some of the hormones related to this condition. Try these stress-reducing tips to manage your thyroid-related symptoms:
- Write in a journal or talk to someone about what’s bothering you.
- Don’t take on more than you can handle.
- Learn time-management skills.
- Keep as positive an attitude as possible.
- Understand and accept there are things you can’t control.
- Exercise and stick to a healthy diet with little sugar, caffeine, and alcohol.
- Get enough sleep.
- Allow relaxation time every day — treat yourself to a hot bath or shower, a cup of coffee, or time alone to read or listen to music.
If you have been diagnosed with hyperthyroidism, it’s important to know about thyroid storm. Following your doctor’s treatment recommendations for hyperthyroidism and being alert to the symptoms of thyroid storm, especially after a trauma like surgery or an infection, is the best way to prevent thyroid storm. Keeping your mind and body strong through regular exercise, a healthy diet, and plenty of moments to relax will also help you to keep everyday stress in check.
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by Dr. Will Cole
Your thyroid hormones influence the function of every single cell of your body: How your hair grows, what mood you are in, how well your immune system works, what your energy levels are, how efficiently you digest your food, how hot your metabolism runs, and how much of a sex drive you have, all hinge on the delicate balance of your thyroid hormones. This is why you can have such a diverse array of symptoms when your thyroid isn’t working correctly since there are many underlying reasons for thyroid problems such as with autoimmune thyroid problems like Hashimoto’s or Graves disease (when your immune system attacks your thyroid gland), or with low T3 syndrome, when your body isn’t converting inactive T4 hormone to the active, usable T3 form.
Fortunately, the thyroid responds well to lifestyle changes, so nip these 14 causes of thyroid dysfunction in the bud and feel better fast. Eliminating these troublemakers will have a positive cascading effect on your health:
Stress can mess with you in all kinds of ways, and one of the biggest is impairing thyroid function. Your main stress hormone, cortisol, can block conversion of T4 to the active T3, and can also increase the unusable reverse T3 (rT3), further confusing the delicate balance of thyroid hormones that are so essential for good health. Many of my patients discover that their thyroid problems started after a stressful time in their lives. Research validates this stress-thyroid-connection – two studies found that autoimmune thyroid patients had a higher rate of stressful life events before their diagnosis when compared to control groups.
What to do: Be consistent with stress-busting practices like mindfulness meditation and yoga. These activate your body’s parasympathetic nervous system, which will make you feel more zen, while also boosting healthy thyroid function.
2. Low vitamin A
Low vitamin A can spell trouble for your thyroid because this fat-soluble vitamin has been shown to boost T3 levels and normalize TSH.
What to do: True vitamin A, called retinol, is only found in animal products like fish, shellfish, fermented cod liver oil, liver, and butterfat from grass-fed cows. Plant carotenes, a precursor to vitamin A, are found in sweet potatoes and carrots, but the conversion rate to the usable retinol is very weak. In fact, research suggests that just 3 percent of beta-carotene gets converted in a healthy adult. So eat up those animal fats!
3. Low selenium
Selenium is essential to convert T4 to T3 in your liver. Selenium also protects against autoimmune thyroid problems.
What to do: Eat a variety of nuts and seeds, especially Brazil nuts, as well as oysters, another good source of selenium.
4. Viral infections
Low-grade reactivations of viruses such as Epstein-Barr virus (EBV) have been linked to autoimmune thyroid problems such as Hashimoto’s.
What to do: Treat the root cause with a natural antiviral supporter such as astragalus, olive leaf, larrea tridentata, bee propolis, Melissa officinalis, L-lysine, zinc, and vitamin C.
5. Too much iodine
I see patients all the time who are taking iodine to treat their thyroid naturally, but are actually triggering an autoimmune thyroid storm because they are taking too much. While iodine is needed for thyroid hormone production, several studies have found that increased iodine intake is associated with flareups of Hashimoto’s disease. This goes to show that even with natural medicines, what supports the health of one person can aggravate the health of another. It also suggests that iodine may be preventive, but not a cure when disease is already in process.
What to do: You still need iodine to make healthy thyroid hormones, but I suggest getting it in from food medicines. Sea vegetables like dulse, nori, kombu, and arame are all rich in iodine. Getting your iodine levels tested is a good idea to know where your starting point is.
6. Low iron
Iron is needed for the production of thyroid peroxidase, the enzyme used to make your thyroid hormones.
What to do: If you have low iron, the most important thing to discover first is the underlying problem that’s causing the iron deficiency. Healing your gut is essential for healthy nutrient absorption, especially iron. Once the gut is healed, iron-rich foods like grass-fed beef, liver, and spinach can be effective – as can cooking with cast-iron cookware.
7. Low copper
Healthy copper levels were found to increase total T4 and T3 levels.
What to do: The best way to get bioavailable copper is by eating grass-fed liver and oysters. Sesame seeds are a good plant source as well.
8. Hormone imbalances
Your hormones are all connected, and the ripple effect from dysfunction in one endocrine gland outputting any hormone can negatively affect your thyroid. Low estrogen, insulin resistance, and low testosterone were all found to inhibit thyroid function.
What to do: Depending on your individual hormone problems, solutions will vary. Take a look at my hormone guide to find out what may be best for you.
9. Artificial sweeteners
Sweeteners like saccharine (Sweet’ N Low), sucralose (Splenda), or aspartame (Equal and NutraSweet) are in many sugar-free, diet, or zero-calorie drinks and foods. One small-scale study showed a reversal of Hashimoto’s just by eliminating these unhealthy sweeteners. Why are they bad for you? Researchers are pointing to their negative impact on our microbiome.
What to do: Avoid artificial sweeteners like the plague. Opt for raw honey or pure maple syrup in moderation, if you must add sweetener.
Toxins such as pesticides, plastics, antibacterial products, and heavy metals are just some of the culprits behind dysfunctional thyroid activity. They are also suspected triggers for autoimmune disease and flare-ups.
What to do: Make your life a detox. You are organic, so your food and beauty and cleaning products should be too. Make the switch to cleaner foods and products and green-up your environment stat.
Being in chronic pain ahs been shown to suppress deiodinase, the liver enzyme that converts 80 percent of your T4 into your active T3.
What to do: There is no simple answer for this. No one chooses to be in chronic pain, but there are many therapies that may help. I have seen some success with liposomal turmeric, which has great bioavailability compared to the standard version of this anti-inflammatory natural product.
12. Microbiome problems
Gut problems like leaky gut syndrome, candida overgrowth, and SIBO are all associated with autoimmune thyroid problems. In fact, 20 percent of your T4 is converted to T3 in the gut, and an imbalanced, unhealthy microbiome can inhibit this process.
What to do: Healing your gut takes time. The first step to start the gut-healing journey is an elimination diet, to discover the foods that are triggering symptoms and negatively impacting your microbiome. Check out my video class for a step-by-step guide for how to do this.
A proverbial expletive in the health world, this protein – found in wheat, rye, oats, barley, and spelt – is an issue for many people with thyroid problems. The inflammatory effects of gluten were shown to last up to six months after you eat it, each and every time. Even worse, mainstream doctors typically don’t run comprehensive labs to see if this is a real trigger for individual patients. Instead, they typically do one test and if it is negative, they don’t look any further, when in reality there are multiple aspects of gluten your body could be reacting to.
What to do: When cooking and baking, opt for the gluten and grain-free flour options such as coconut, almond, cassava, or hazelnut flour. We live in a time when products using these grain-free options are more common than ever (Starbucks even has coconut-flour treats!) Otherwise, simply avoid all foods and rinks made with gluten-containing grains like wheat, barley, rye, and spelt.
Obviously, smoking isn’t healthy for anyone, but in people genetically susceptible to thyroid issues, it can be downright disastrous. Multiple studies have looked at the effects of smoking on people with autoimmune thyroid disorders, and one study observed an increase in autoimmune hypothyroidism in women, while another study showed an increase in Graves disease in smokers.
What to do: This one is a no-brainer: stop smoking! But in addition, studies have shown that a decrease in thyroid function could be reversed by taking n-acetylcysteine (NAC), and by increasing the super-antioxidant glutathione.
If you want to learn more about your own health case please check out our free health evaluation. We offer in person as well as phone and webcam consultations for people across the country and around the world.
The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.
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April 21, 2000 — Feeling tired or forgetful? Is your skin and hair drier than normal? Are you retaining water, gaining weight, constipated, or hoarse? These are just a few of the symptoms of a disease called hypothyroidism, which occurs when the thyroid — a bow tie-shaped gland in the front of the neck — does not produce enough thyroid hormones.
Low levels of thyroid hormones can cause many problems because the hormones affect nearly every part of the body, such as breaking down fat, regulating menstrual periods, and controlling body temperature.
But you may have low levels of thyroid hormone and not even know it. A recent study in the Archives of Internal Medicine found that nearly 10% of reportedly healthy people whose thyroid function was tested during statewide health fairs in Colorado had low thyroid levels.
“The symptoms of mild hypothyroidism are nonspecific, change gradually, and are easy for a person to write off as the effects of stress or overwork,” says study author Gay J. Canaris, MD, MSPH. Canaris is assistant professor of internal medicine at the University of Nebraska Medical Center in Omaha.
The study’s results suggest that people are not screened frequently enough for hypothyroidism, and researchers recommend that doctors screen more people for the disease and better educate them about its symptoms.
Other symptoms of hypothyroidism include the following: fatigue, lethargy, mood swings, depression, decreased appetite, cold intolerance, slow wound healing, menstrual irregularities, and joint pain.
The basic test to screen for thyroid disease measures the level of thyroid-stimulating hormone (TSH) in the blood. This hormone is extremely sensitive to the body’s need for thyroid hormone. When the thyroid is making too little hormone, TSH levels shoot up to try to spur it into action. Therefore, a high TSH level is a sign that all is not well with the thyroid gland.
Thomas C. Rosenthal, MD, says his experience as a family physician has shown him that hypothyroidism can be difficult to recognize.
” I used TSH as part of my routine screening panel, I was surprised to find that many patients had unsuspected hypothyroidism,” he says. “These were typically patients who might present with depression … aches and pains, or concerned about their memory problems.” Rosenthal is professor and chair of the department of family medicine at the State University of New York at Buffalo.
How Does Stress Affect Hypothyroidism?
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Stress is a part of your daily life; whether you’re trying to get to work on time or a family member calls with a personal crisis, it’s inevitable. But it’s not always such a bad thing. You need a little bit of stress so your body and mind react correctly when you’re in a life-threatening situation, like a near-miss incident while driving.
The problem is when stress gets so out of control that it affects your health. If you had an underlying thyroid condition, stress could cause it to turn into a full-blown health problem, like hypothyroidism. Anyone can get hypothyroidism, although it’s more common in women older than 50, and you’re more likely to have mildly underactive glands instead of full-blown hypothyroidism.
Signs You May Have Hypothyroidism
Hypothyroidism (also called an underactive thyroid) is a condition in which the thyroid gland doesn’t produce enough hormones. You might have symptoms that include weight gain, fatigue, depression, cold hands and feet, achy muscles, headaches, decreased libido, weakness, water retention, menstrual irregularities, dry skin, coarse hair or hair loss, constipation, or possibly feeling cold.
The Effect of Stress on Your Thyroid
When you’re under constant or chronic stress, your body produces the stress hormone cortisol. But if there’s too much cortisol surging through your body, it can wreak havoc on your thyroid. Too much cortisol makes your thyroid gland work harder to produce enough thyroid hormone. This process can tax the thyroid gland and lead to imbalances of the thyroid hormone in your body.
If you just finished a huge work project only to find yourself sick the following weekend, you probably know that being under stress for long periods of time can compromise your immune system. Researchers have found evidence that links cells in the immune system to the regulation of thyroid hormone activity during normal physiological conditions and when the immune system is stressed and fighting off infection.
So when your body is fighting off an illness, the immune system jumps in to help regulate activity of the thyroid hormone. This may also hinder the immune system from using all of its resources to fight off the infection itself. If your immune system gets thrown out of whack frequently, you’re more likely to be prone to autoimmune diseases.
Adrenal Glands and Hypothyroidism
The adrenal glands are responsible for secreting the stress-response regulating hormones cortisol, epinephrine, and norepinephrine. While these glands affect nearly every response in the body, when the adrenals are weak, they can cause hypothyroidism symptoms like those mentioned above. Some research has found inflammatory cytokines, which are released into the body during a stress response, can reduce levels of thyroid-stimulating hormone (TSH). When you have a thyroid illness or imbalance, you’re more likely to have inflammation in the body, which can lead to other diseases and health problems.
How Stress Can Be Extremely Dangerous
Rarely, people with an underactive thyroid develop myxedema coma. Myxedema is more likely to occur in people who’ve had the thyroid gland removed, either surgically or by radioactive thyroid ablation. Severe, ongoing stress, infections, and surgery can trigger myxedema coma. Symptoms to watch out for include a severe drop in body temperature, difficulty breathing, slow heart rate, constipation, seizures, and weight gain due to fluid buildup in the body.
If you have hypothyroidism, talk with your doctor for suggestions on how minimizing stress, vigorous exercise, and relaxation techniques can help you. Also ask about dietary recommendations and possible medication adjustments to help you manage stress and your thyroid imbalance.
Most people know that stress can negatively affect one’s health. But most people with a thyroid condition don’t realize that chronic stress can actual lead to the development of a thyroid condition. So if you have a thyroid disorder, managing your stress is essential if you’re hoping to restore your health through natural thyroid treatment methods.
But how can stress lead to a thyroid condition? Well, first of all it’s important to understand that our bodies weren’t designed to handle chronic stress. The adrenal glands were designed to handle acute stress situations without much of a problem. But in today’s world most people are overwhelmed with stressful situations, as they have stressful jobs, stressful relationships, financial issues, and many issues that lead to chronic stress.
Since the adrenal glands weren’t designed to handle chronic stress situations, what happens is that for a person who deals with a lot of stress AND does a poor job of managing it, over a period of months and years their adrenal glands will weaken, which can eventually lead to adrenal fatigue. But even before these glands reach this point, this can create other problems, including dysfunction of the thyroid gland.
How Stressed Out Adrenal Glands Can Cause A Thyroid Disorder
The way that stressed out adrenals can cause thyroid malfunction is the following: when the adrenal glands are stressed out, it puts the body in a state of catabolism, which means that the body is breaking down. Because of this, the body will slow down the thyroid gland as a protective mechanism. The reason behind this is because the thyroid gland controls the metabolism of the body, and so the body slows it down in order to slow down the catabolic process. This is why many times the thyroid gland won’t respond to treatment until you address the adrenal glands.
If the adrenal glands are not addressed, this can affect other bodily systems. For example, someone with weak adrenal glands who has a thyroid disorder can develop a compromised immune system. This eventually can lead to an autoimmune thyroid disorder, such as Graves’ Disease or Hashimoto’s Thyroiditis.
Why The Adrenal Glands Must Be Addressed
In other articles and blog posts I have mentioned how the malfunctioning thyroid gland is usually not the actual cause of the disorder. So for someone who has a thyroid condition that is caused by stressed out adrenal glands, treating the thyroid gland itself won’t do anything else other than manage the symptoms. And what we frequently see is most endocrinologists and other medical doctors basically trying to manage the person’s symptoms for the rest of their lives, rather than address the actual cause of the thyroid condition.
On the other hand, a competent natural endocrine doctor will evaluate each individual and attempt to find out the cause of the thyroid condition. In some cases the function of the thyroid gland can’t be completely restored through natural thyroid treatment methods. On the other hand, in many cases the person can have their health restored back to normal. But as I’ve mentioned numerous times in other articles and posts, taking nutritional supplements alone will not solve the problem. And this is especially true for the person who does a poor job of managing the stress in their life.
How To Restore The Health Of The Adrenal Glands
In order to restore the health of the adrenal glands, and ultimately restore the function of the thyroid gland back to its normal state, one obviously needs to address the cause of what’s stressing out the adrenals. With regards to stress, it of course is impossible to eliminate all of the stress from your life. On the other hand, there are two things you can do when it comes to dealing with chronic stress that will lead to better health:
1. Minimize the number of stressful situations. Once again, you won’t be able to eliminate all of the stress in your life, but in many cases it is possible to reduce some of the stressful situations you are dealing with. Write down all of the different things in your life that you consider stressful, and try to figure out how you can make some changes to make things less stressful.
2. Learn how to better cope with the stress in your life. While it might be difficult to eliminate some of the stressful situations in your life, you do need to learn how to do a good job of managing stress. Of course there are many different ways to manage stress, as one can exercise or yoga, get a relaxation massage every now and then, have a counseling session, eat a healthier diet, get more sleep each night, etc. These obviously are just a handful of basic examples, but I think you get the picture.
In summary, chronic stress can cause a lot of different problems, and if not managed it can ultimately lead to a thyroid condition. Of course this doesn’t mean that all thyroid conditions are caused by stress, but there’s no question that stress is the culprit in many thyroid disorders. And for those who have a thyroid disorder caused by stress, doing a better job of managing the stress in their life is essential if they want to use natural thyroid treatment methods to restore their health. But even for those who choose conventional medical treatments, it still will benefit your overall health to become an expert in stress management.
Other Articles You Might Like To Read:
What Leads To The Development Of An Autoimmune Thyroid Condition?
7 Things You Can Do To Obtain Better Quality Sleep
5 Herbs To Help Overcome Your Thyroid Condition
How The People You Interact With Can Affect Your Thyroid Health
Thyroid deficiency and mental health
Published: May, 2007
At least 13 million Americans suffer from thyroid disorders, and in more than 80% of cases, the problem is an underactive thyroid gland — hypothyroidism. The condition is more common in women, and the rate rises with age, reaching 20% in women over 65. The interest for mental health is that thyroid deficiency may be associated with cognitive and emotional disturbances, and thyroid hormones may be useful in the treatment of depression.
Sitting at the base of the neck, the thyroid gland produces hormones that regulate basal metabolic rate, the speed at which our bodies burn food for energy. The thyroid gets its directions from the hypothalamus, at the base of the brain, by way of the pituitary gland. On a signal from the hypothalamus, the pituitary sends thyroid-stimulating hormone (TSH) into the bloodstream. It travels to the thyroid gland and causes the release of thyroxine (T4), which is partly converted into triiodothyronine (T3). Through a feedback mechanism, the hypothalamus determines when levels of T4 and T3 are low and alerts the pituitary to supply more TSH.
In a person with hypothyroidism, the thyroid gland does not fully respond to TSH, so levels of T3 and T4 remain low while TSH accumulates in the blood. The most common cause is an autoimmune disease, Hashimoto’s thyroiditis, but the symptoms can also result from an infection, from cancer, or from treatment of an overactive thyroid (hyperthyroidism) with surgery, radiation, or medications.
Clinical hypothyroidism is identified by an abnormally high level of TSH and abnormally low levels of thyroid hormones. It is treated with a synthetic form of thyroxine, taken in a pill. Subclinical thyroid deficiency, which has few or no symptoms, is defined as abnormally high TSH with normal thyroid hormone levels. Experts disagree on whether and when it requires treatment.
The symptoms of hypothyroidism are variable and sometimes hard to pin down. They may include fatigue, sluggishness, cold intolerance, weight gain, constipation, muscle or joint pain, thin and brittle hair or fingernails, reduced sexual drive, high blood pressure, high cholesterol, and a slow heart rate. Patients may also have problems with concentration and memory.
Some of these symptoms also occur in depression or other psychiatric disorders, and there may be links between hypothyroidism and depression, although the evidence is conflicting and doubtful.
Researchers at the University of Iowa found that among nearly 7,000 healthy young adults, men with TSH and T4 levels suggesting subclinical hypothyroidism were more likely to be depressed. In a Dutch study, depressed patients who were not taking antidepressants had higher blood levels of TSH than controls matched for age and sex. German researchers comparing psychiatric patients with and without thyroid conditions found a correlation between subclinical thyroid deficiency and mild depression. Thyroid abnormalities were not associated with any other psychiatric symptoms in this study. Another German study found an association between mood deterioration and clinical hypothyroidism. In a study of adolescent girls who had recently been sexually abused, lower levels of T4 were associated with post-traumatic stress disorder and depressive symptoms.
In an Italian study, 36 women with mild hypothyroidism performed poorly on neuropsychological tests and psychological rating scales. After six months of standard treatment with thyroxine, their mood and verbal fluency improved. Belgian researchers compared controls with patients before and after removal of the thyroid gland for cancer. After the operation, patients were more anxious and depressed than controls and had more problems with attention and executive function. Dutch researchers found that high levels of TSH were correlated with memory deficits in people in their 50s and 60s, but the difference vanished when depressive symptoms were taken into account.
But findings have been inconsistent, especially in studies with larger numbers of participants. In one such survey, Canadian researchers found that the only psychiatric disorder associated with thyroid disease was social anxiety disorder (social phobia). In a study of more than 300 people over age 60 who came to internal medicine and psychiatry clinics, some of them for depression and others for symptoms suggesting abnormal thyroid activity, researchers found a high rate of depression among those with subclinical hypothyroidism but not those with clinical hypothyroidism. A large Norwegian survey found no relationship between TSH levels and anxiety or depression.
So the influence of thyroid deficiency on mental health remains uncertain. Findings may conflict because studies have selected patients and evaluated depressive symptoms and thyroid function by different standards.
There’s better evidence that thyroid medication may be helpful for depressed patients, even those with normal thyroid function. German researchers found that high doses of thyroxine improved the symptoms of 17 depressed patients who had not responded to antidepressant drugs. Half of them recovered, and only one failed to improve. These results have been replicated with T3.
More than a hundred Israeli patients with major depression were divided into two groups and given either an antidepressant alone or an antidepressant and thyroxine. The combination was nearly three times more likely to produce a response within six weeks.
Canadian researchers found that added thyroxine helped patients with major depression who did not respond to selective serotonin reuptake inhibitors.
Researchers at Massachusetts General Hospital in Boston administered either thyroxine or the mood stabilizer lithium to 142 patients whose depression had not improved despite earlier treatment. About 25% of those taking thyroxine improved, compared with 16% of those taking lithium.
Examining all the findings so far, an expert panel has concluded that there is not enough evidence to associate TSH levels with psychiatric symptoms or to recommend thyroxine treatment for depressed patients. But there may be just enough evidence to explore these possibilities further — and to recommend tests of thyroid function in seriously depressed patients.
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