What's Up with Thyroid Problems and Anxiety?

In the past few years, numerous friends have mentioned that they're facing thyroid issues. Invariably, it seems like my sensitive, thoughtful friends are dealing with everything from hypothyroidism to thyroid dysfunction to thyroid cancer. It's made me want to look at the relationship of the thyroid and endocrine system to the nervous system.

Remember high school biology?

•  The fast-moving sympathetic nervous system sends signals to the adrenal glands, which, along with the thyroid are part of the endocrine system. 
• This sympathetic nervous system manages "flight or fight" responses, affecting those of us with anxiety.
• The adrenals release hormones like pregnenolone, adrenaline, estrogen, progesterone, testosterone, DHEA and cortisol into the bloodsteam. These are for key hormones anxiety sufferers.
• The slower moving parasympathetic nervous system is responsible for the body's "rest and digest" functions.
• The thyroid is strongly influenced by the parasympathetic nervous system. 

Though we understand the above as facts, stress's effect on the everyday functioning of the glands is a cause of much confusion and discussion. Let's trace how that played out in my own journey.

Cortisol, the frenemy that's here to stay.

Cortisol is a strong theme in my writings on anxiety. It's a big part of the hormone wave I've been learning to face in my own life. I first learned about cortisol in the months leading up to my Generalized Anxiety Disorder diagnosis by my neurologist. I was seeing a family nurse practitioner at One Medial Group here in San Francisco. After hearing my list of physical symptoms including nausea, headaches, light-headedness, and bloating, she suggested we test my adrenals and cortisol rhythm over the course of a 24-hour period. I spit into a small test tube over and over at pre-defined times. A few weeks later she received the results of my test. This is what they looked like:

This is where we get into debate territory. It starts with how to interpret the results of a test like this. Naturopaths would point to my low levels of cortisol in the morning (when it's supposed to be high) and high cortisol at night (when it's supposed to be waning down) and say that I was showing signs of adrenal "fatigue." Many endocrinologists would say that there is no such thing as adrenal fatigue. "Your adrenals either work or they don't," they say. Julie Deardorff, Chicago Tribune reporter writes about the controversy, saying:

Adrenal fatigue proponents say the condition can affect anyone but is often triggered by a serious illness or injury, allergies, poor nutrition or intense social, emotional or physical pressure. Perfectionists and those who feel trapped or helpless, don't get enough rest or have a stressful job are especially vulnerable, they say. 

My FNP looked at my cortisol patterns and summarized that something was off in the way that my adrenals were functioning. She drew a Venn diagram I still look at from time to time.

She said, "We need to look at all of these different factors when trying to figure out what's happening with you. We started with adrenals, and now we need to do a thyroid test. Eventually we will do a hormone test over the course of a month to see what's happening there as well."

So I had my blood taken that day and got my thyroid hormones levels tested. Later that month, I spat into a test tube again, this time to get a read on my hormone levels.

I had investigated every circle in the Venn diagram above but neurotransmitters. I went to see my neurologist, and that's when I was diagnosed with Generalized Anxiety Disorder. I began taking the SSRI Lexapro and in the following year, along with important lifestyle changes, I saw my symptoms improve. For me, the neurotransmitter section of the diagram was the one I needed to address to see improvement.

Hey, aren't we here to talk about the thyroid?

Yes. If every person has their own factors affecting their own Venn diagram, and each of the circles can affect each other, how is the thyroid affected by stress, anxiety, and mental illness?

I don't know.

But I am seeing the pattern of thyroid issues in the stressed-out people around me. That, along with this diagram and the testing framework I used a few ago, has me seeking answers to that question. Do you have thoughts about it?

If you're a doctor who has treated patients for co-morbid thyroid and adrenal issues, I would love to hear from you. If you are a patient who has sought answers for your own thyroid issues, I want to hear from you.

Together we can tackle this sea of confusion by sharing findings, learning from each other, and connecting the dots.

Please share a comment below!