What is Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder where the immune system attacks the thyroid gland. This causes inflammation and damage to the thyroid tissue, leading to hypothyroidism or underactive thyroid.
Some of the most common symptoms of Hashimoto’s include fatigue, weight gain, sensitivity to cold, muscle weakness, dry skin, hair loss, and depression. Anxiety and panic attacks can also occur in some patients with Hashimoto’s.
What causes anxiety in Hashimoto’s?
There are a few reasons why Hashimoto’s thyroiditis can trigger anxiety:
Thyroid hormone imbalance
One of the main jobs of the thyroid gland is to produce thyroid hormones T3 and T4. When the gland is damaged by the autoimmune attack in Hashimoto’s, it can no longer produce enough of these hormones. This creates an imbalance, with lower thyroid hormone levels leading to hypothyroidism.
Thyroid hormones regulate many body functions, including mood, emotions, and brain functioning. When thyroid hormone levels are low, it can disrupt normal neurological activity and brain chemicals like serotonin and dopamine. This can trigger or exacerbate underlying anxiety.
Inflammation
Chronic inflammation of the thyroid gland and autoimmune activity in Hashimoto’s may also affect the brain and nervous system. Research shows that inflammation activates the same pathways in the brain that are associated with anxiety and mood disorders.
Genetic susceptibility
Some people may have an underlying genetic predisposition to anxiety that gets triggered by the thyroid imbalance and inflammation in Hashimoto’s disease. There are shared genetic links between autoimmune thyroid disorders and psychiatric conditions like anxiety and depression.
Medical treatment options for anxiety with Hashimoto’s
There are several medical treatment approaches that can help manage anxiety associated with Hashimoto’s thyroiditis:
Levothyroxine
Restoring normal thyroid hormone levels is crucial for controlling anxiety symptoms. Levothyroxine is a synthetic version of the T4 hormone that is used to treat hypothyroidism.
Taking levothyroxine daily helps replenish thyroid hormone levels and reverse the effects of the thyroid deficiency. As thyroid levels normalize, anxiety symptoms typically improve. Doses of levothyroxine are tailored to the individual based on weight, age, and thyroid lab tests.
Anti-anxiety medications
Prescription anti-anxiety drugs like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines are sometimes used on a short-term basis to quickly relieve anxiety symptoms in Hashimoto’s patients.
Examples include citalopram, escitalopram, paroxetine, fluoxetine, venlafaxine, clonazepam, and lorazepam. These medications alter brain chemistry to boost neurotransmitters like serotonin and GABA that regulate mood.
Therapy
Cognitive behavioral therapy (CBT) is an evidence-based form of counseling that helps patients change negative thought patterns and behavior that contribute to anxiety. CBT can teach coping skills, relaxation techniques, and new ways of thinking to reduce anxiety triggers.
Lifestyle changes and natural remedies
Along with medical treatment, making certain lifestyle changes and trying natural remedies may also help soothe anxiety associated with Hashimoto’s:
Exercise
Regular exercise like cardio, yoga, tai chi, or strength training has anti-anxiety effects. Exercise boosts feel-good endorphins and neurotransmitters in the brain while reducing immune system inflammation. Aim for 30-60 mins of exercise most days.
Relaxation techniques
Practices like deep breathing, progressive muscle relaxation, meditation, visualization, massage therapy help activate the body’s relaxation response. This reduces blood pressure, heart rate, and anxious thinking patterns.
Quit smoking
Smoking worsens thyroid inflammation and anxiety symptoms. Quitting can improve anxiety, mood, and thyroid function.
Healthy diet
Eat a nutritious whole foods diet rich in fruits, vegetables, lean proteins, nuts, seeds, and omega-3s from fish. Avoid inflammatory foods like processed foods, refined carbs, and sugars which may exacerbate anxiety and thyroid problems.
| Anti-Inflammatory Foods | Inflammatory Foods |
|---|---|
| Salmon | Fried foods |
| Broccoli | Sugary drinks |
| Blueberries | Baked goods |
| Walnuts | Red meat |
| Chia seeds | Alcohol |
Stress management
Chronic stress fuels anxiety symptoms. Use stress-busting methods like sufficient sleep, social connection, laughter therapy, music, boundaries, and time management. Consider joining a support group.
Herbal supplements
Herbs like ashwagandha, magnesium, omega-3s, chamomile, lemon balm, and green tea have anti-anxiety benefits. Discuss using supplements with your doctor.
Limit caffeine
High intake of caffeinated coffee, tea, soda, and energy drinks spikes cortisol levels, worsening anxiety. Limit to 1-2 caffeinated drinks per day.
When to seek professional help
See your doctor promptly if anxiety symptoms are severe or interfering with your daily activities. Suddenly stopping anti-anxiety medications can also cause issues, so never quit them abruptly. Speak to your doctor about safely tapering medication dosages.
Get emergency care right away if anxiety reaches the point of causing suicidal thoughts, self-harm, or psychosis.
Outlook for anxiety with Hashimoto’s
The good news is that for the vast majority of people with Hashimoto’s thyroiditis, regulating thyroid hormone levels with medication helps stabilize mood and greatly improves symptoms of anxiety or panic attacks. It may take some trial and error to find the optimal dose of thyroid medication. Ongoing monitoring of thyroid lab work helps ensure adequate control of hormone levels.
Combining thyroid medication with anti-anxiety strategies, counseling, a nutritious diet, stress reduction, exercise, and other lifestyle adjustments provides optimal management of anxiety associated with Hashimoto’s. With proper treatment, many patients find they can successfully manage anxiety flares when they occur and go on to live full, normal lives.
In rare cases where anxiety remains extremely severe, progressive treatment with an endocrinologist, psychiatrist, and therapist may be needed to completely resolve symptoms.
The bottom line
– Hashimoto’s thyroiditis is an autoimmune condition causing underactive thyroid and anxiety symptoms in some patients.
– Replacing thyroid hormone levels using levothyroxine medication is the first step in controlling anxiety.
– Additional anti-anxiety medications, cognitive behavioral therapy, lifestyle changes like exercise, relaxation techniques, diet, and stress reduction can also help manage anxiety.
– With proper treatment, most people with Hashimoto’s can achieve relief from anxiety flares and related symptoms.