People with thyroid disorders often have emotional or mental health symptoms as well as physical symptoms. This is especially the case for people with hyperthyroidism (an over-active thyroid), hypothyroidism (an under-active thyroid), thyroid related eye disease, or thyroid cancer.
What kind of emotional problems might I experience?
Whatever your type of thyroid disorder, it can make you feel more emotional than you felt before and you may find that your mood changes, sometimes rapidly and unpredictably. Common emotional problems are:
- Anxiety - a feeling of nervousness, with butterflies, heart racing, trembling, irritability, sleep difficulties
- Depression - low mood and difficulty enjoying things, tearfulness, loss of appetite and disturbed sleep
- Either over-activity or under-activity
- Mood swings - snappiness or short-temper which people often call 'moodiness'
- Sleeping difficulties
What about mental health problems?
Mental health, or cognitive, problems that can occur, most often with thyroid under-activity, include:
- Difficulties with concentration
- Short-term memory lapses
- Lack of interest and mental alertness
These symptoms can cause older people to worry about permanent memory failure (dementia) but in fact they are rarely as severe as seen in dementia.
What causes the psychological symptoms?
The cause is sometimes abnormal thyroid hormone levels. Hyperthyroidism can cause anxiety, irritability and mood swings, while hypothyroidism can cause mental slowing and memory problems as well as depression.
Patients sometimes report they have gained weight or that they find it difficult to lose weight during treatment which may contribute to feelings of low self-esteem and mood.
Rapid changes in thyroid hormone levels, in particular, can unsettle your emotions. Rapid and effective control of the hyperthyroidism is essential to stabilise the mood, and it is important to make sure that the thyroid remains stable.
Sometimes psychological symptoms are a side-effect of the treatment. Steroids for example can aggravate depression. Beta blockers prescribed to slow down your heart rate and to reduce anxiety if you are hyperthyroid can make some people feel tired, depressed, and mentally less alert.
A thyroid disorder can also cause changes in appearance - for example, changes due to thyroid eye disease, weight gain or loss, or loss of hair - which can damage your self-esteem. People may ask awkward questions or stare, which can be distressing.
It is sometimes suggested that stressful life events can cause or aggravate a thyroid disorder. If you are already experiencing stress in other areas of life, this can of course contribute to your psychological symptoms if you have a thyroid disorder, and they may be more pronounced or take longer to settle.
Learning that you have thyroid cancer is a stressful event and you may feel bewilderment and loss of control. It is not unusual to have an emotional reaction before, during, or after treatment. Do talk to your doctor to check your thyroid medication is properly balanced. Finding a support group or talking with a British Thyroid Foundation volunteer can help you through this period.
Forgetting to take your medication can also be a factor. Some people lose motivation when it comes to daily tablet-taking or attending clinics. Taking tablets irregularly can upset your hormone balance and aggravate the psychological symptoms.
Often other factors can be the main cause of the problem, so it is always important to look at all things that may be affecting you
What about treatment?
Fortunately, in the great majority of cases, psychological symptoms improve as the thyroid disorder is brought under control by treatment, if the thyroid is the cause of the problem. But this improvement may not be as rapid as you hope, and it is common for people to feel emotionally and mentally out of sorts for some time even after their blood tests return to normal. There are lots of people who can help. Rather than bottling up your fears you can:
- talk to your doctor
- ask to see a specialist with experience in dealing with thyroid disorders
- confide in a family member or close friend who may be able to help you through this difficult time, or
- talk to others who have been through a similar experience - the British Thyroid Foundation has a network of telephone support volunteers who can help
Don’t feel awkward or embarrassed about talking to your doctor about the psychological symptoms associated with your thyroid disorder. They are an important part of your illness, not just a side-issue or a sign of weakness. Ask as many questions as you need to in order to understand what is happening to you.
These symptoms can also have an impact on your family and friends so it is important to give them the opportunity to understand what is happening. The symptoms can affect your work so it is important that your employer understands the problem. Likewise, for school-age children these symptoms can have an impact on schoolwork, so it is important that their teachers are informed and can make allowances, especially at exam time.
Physical symptoms such as hair loss, thyroid eye disease, weight gain or loss, can affect the way you feel. Your doctor can refer you to a specialist who can help.
Even though the cause may be physical, anxiety or depression sometimes require treatment in their own right. Non-drug treatments such as relaxation or short-term psychotherapy can help. If your problem is more persistent you may be prescribed a drug such as an antidepressant. These are not addictive.
If your symptoms are especially severe, or if they continue even after a fair trial of thyroid treatment, then you should ask your doctor to refer you to a psychiatrist or a clinical psychologist - one with expertise in psychological problems associated with physical illness.
Will I recover?
The outlook for all types of most thyroid disorders is good, and even if the psychological symptoms take a long time to settle initially, people usually make a full recovery and lead normal lives once thyroid disease is treated. When symptoms do not settle, this is normally because the problems have an alternative explanation and further treatment and evaluation will be needed to manage this situation.
Some important points….
- Your emotional and mental health problems should improve as your thyroid condition stabilises, and the long-term prospect is good
- Confiding in a family member or close friend or talking to someone (for example, through a support group) who has been through this experience can help you through this difficult time
- Don’t bottle it up - your doctor can help you, or you can ask to be referred to a specialist
It is well recognised that thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted.
If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you. You may also contact the British Thyroid Foundation for further information and support, or if you have any comments about the information contained in this leaflet.
The British Thyroid Foundation
The British Thyroid Foundation is a registered charity: England and Wales No 1006391, Scotland SC046037
The British Thyroid Association - medical professionals encouraging the highest standards in patient care and research
The British Association of Endocrine and Thyroid Surgeons - the representative body of British surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal)
First issued: 2008
Revised: 2011, 2015
Our literature is reviewed every two years and revised if necessary.
© 2015 BRITISH THYROID FOUNDATION