The 20-something woman explained to the nurse writing in her chart that she was experiencing a range of symptoms -- she felt anxious all the time, her heart was racing, her hands shook, she had chronic diarrhea, she couldn't sleep, her periods had all but stopped, and she'd recently even had her first panic attack. She sat in the examining room on the table, at the office of her old-school doctor, and as she was waiting, he came in to the room quietly, and then clapped his hands loudly, right behind her ears. Startled, she nearly jumped off the table!
“Yep,” said the doctor, chuckling. “Looks like an overactive thyroid to me. Every one of you practically go airborne!”
He had reviewed her chart and latest symptoms, and suspected correctly that she had an overactive thyroid.
While his diagnostic method is not one Holtorf Medical Group doctors would use, we still consider this patient luckier than some, because many women who complain about anxiety, panic attacks, nervousness, palpitations, and insomnia end up with misdiagnoses, including:
- generalized anxiety disorder (GAD)
- panic disorder
- bipolar disease
- sleep disorder
Then, they are given a long list of medications — benzodiazepenes, antidepressants, beta blockers — everything from Valium, to Atenolol, to Xanax, to Ambien. Since lack of appetite, and/or rapid weight loss can also occur with an overactive thyroid, some women are even misdiagnosed as having anorexia or bulimia, and put on antidepressants, and/or sent to eating disorder clinics for treatment. And because these side-effect laden drugs are not addressing the underlying problems, they are often ineffective at dealing with the main symptoms.
And all along, there is a lack of recognition that these symptoms can be associated with an undiagnosed or improperly treated thyroid disorder.
Hyperthyroidism – an overactive thyroid – can cause revved up symptoms like high heart rate, high blood pressure, palpitations, anxiety, insomnia, tremors, diarrhea, lack of menstrual periods, loss of appetite, and weight loss. The most common cause of hyperthyroidism is the autoimmune condition known as Graves’ disease, where the immune system causes the thyroid to produce antibodies that stimulate the thyroid to produce too much hormone.
In some cases, multinodular goiter — an enlarged thyroid with nodules — can also cause the thyroid to release excessive amounts of thyroid hormone.
Surprisingly, the opposite problem — the underactive thyroid condition known as hypothyroidism — can also cause anxiety and seemingly hyperthyroid symptoms in a subset of thyroid patients. Some patients with Hashimoto’s disease – the autoimmune disease that causes the slow destruction of the thyroid gland by antibodies — also go through temporary periods of hyperthyroidism as their gland slowly becomes less functional. Hyperthyroidism can also be a transient phase for women who develop thyroid problems after childbirth (postpartum thyroiditis).
Bypassing the crude “clapping behind your head” method, there are a number of professional ways that a competent physician can determine whether anxiety and related symptoms are potentially thyroid-related. Your basic evaluation should at least include the following:
- A family and personal medical history
- A clinical exam, including palpating the thyroid, feeling for lumps and enlargement
- A check of your reflexes (hyper-reflexiveness can be a hyperthyroid symptom)
- A Thyroid Stimulating Hormone (TSH) blood test
- Free T4 and Free T3 blood tests
- Thyroid antibody tests, including Thyroid Peroxidase (TPO) and Thyroid Stimulating Immunoglobulins (TSI)
In some cases, an ultrasound, CT scan or x-ray (thyroid uptake scan) may be important to get a visual of the gland and any nodules, and to evaluate how the thyroid is functioning.
While not all anxiety is due to a thyroid imbalance, it’s clear that there are many people — women in particular — who are suffering from anxiety and related symptoms, and whose symptoms might be resolved if they had proper thyroid diagnosis, evaluation, and treatment.
Before you agree to take anti-anxiety, antidepressant or sleep medications, consider asking for a comprehensive and knowledgeable evaluation to rule out — or rule in — the possibility that a thyroid condition may be the unknown cause of your symptoms.