A Manhattan psychiatrist poses this question:
How much of what we are calling psychiatric pathology is in fact thyroid disorder?
I’m sitting on the edge of my seat as I prepare Dr. Kelly Brogan’s guest article for Hypothyroid Mom. Her question has my mind reeling. How many of my fellow Hypothyroid Mom followers are diagnosed with mental health illnesses? Could some or many of them be misdiagnosed? Could these symptoms be a red flag that somewhere deep in their body their soul is waving up in the air trying to alert the person, the doctor, someone, that their thyroid condition is undiagnosed or inadequately treated?
Written by Psychiatrist Kelly Brogan, MD
It’s not all in your head
Depression has become an epidemic in which psychiatrists are infamous for saying “oops” and quickly writing a prescription. We have bought into a disease-medication model, driven by the holy placebo-controlled trial. This is the language that doctors speak, and anything else is considered gibberish. We work with one-size-fits-all interventions and reduce patients to their indication, or diagnosis. We tell ourselves that the algorithm works when it is “evidence-based”. What does this mean when we see that the house of cards has been glued into its position?
Meta-analyses conducted by Kirsch, et al. have demonstrated the power of the placebo effect in randomized antidepressant treatment trials. Kirsch alleges that the placebo effect alone may account for up to 75% of the treatment effect of active medication exposure. Kirsch is one of many to expose the 40% of funding to the FDA that comes from pharmaceutical companies, and the fact that, despite registration of studies, data is still manipulated, cherry-picked, and redundantly submitted. He also supports a claim posited by Fournier, et al. that antidepressants only separate from placebo in the setting of severe depression. However, he observes that this effect is miniscule, at best.
This corruption of data and misattribution of benefit to pharmaceutical interventions is not just psychiatry’s problem. The problem is not just with the drug companies and the researchers, but with the whole system — the granting institutions, the research labs, the journals, the professional societies, and the many strands of this complex web.
What’s thyroid got to do with it?
So, what got me so into Functional Medicine? About 9 months after the birth of my first daughter, I was 7.5 months back to work at the hospital and in my private practice.
I was long back to my prepregnancy weight and loving motherhood, but I locked myself out of my office on several occasions, and had to, more than once, mail a cab driver a check because of a forgotten wallet (compassionate souls). One day, I stood at an ATM, at a total loss for what my PIN had ever been. I’d gone through an excessive amount of cocoa butter lotion that winter and remember trying to reassure myself about the tremendous and unrelenting hair loss.
On a routine physical, there it was, in black and white: Postpartum thyroiditis or Hashimoto’s with a TSH (Thyroid Stimulating Hormone) of 20 and antibodies in the thousands.
Having been robustly healthy my whole life, I was not about to sign up for lifelong treatment of a chronic disease. I went to a wonderful naturopath who reached out a hand and ushered me into the gentle, hopeful world of self-repair.
Four and a half years and one pregnancy later, I am prescription free with normal antibodies and optimal TSH…I’m allowed to brag because it required persistence and commitment to a new lifestyle, and I’ve never looked back.
Thyroid Disease as Psychiatric Pretender
Thyroid disease is one of the primary contributors to psychiatric diagnoses that has a physiologic explanation, which I call Psychiatric Pretender. Thyroid function is near and dear to my heart and is a big focus in my Manhattan psychiatric practice.
I will use postpartum thyroiditis, which I encounter in about 80% of my patients, as an example to illustrate how thyroid can really masquerade as a psychiatric condition. In the postpartum period what happens is the immune system undergoes a shift after the birth of the baby. There is a pattern of hyperthyroidism over a couple of months followed by hypothyroidism, low functioning of the thyroid. This pattern is exacted by the immune system, it’s attack on the gland. What happens in those early months after giving birth is the patient will typically feel like they’ve bounced back really easily, they’ve lost the baby weight, they have a ton of energy even though they are only sleeping 2 or 3 hours a night, but there might a dark edge where they are agitated or irritable and they have a racing heart and insomnia.
If you were to check their blood work then, you would find the presence of these antibodies. They have 3 different names, although usually there is a specific pattern where only 1 or 2 of them are present – Thyroid Peroxidase Antibodies, Thyroglobulin Antibodies, and Thyroid Stimulating Immunoglobulin (or Thyroid Stimulating Hormone Receptor Antibody). The TSH, which is typically the only thing that’s checked may actually be low or normal, but we have a harbinger of what’s to come which is over the course of a couple of months something that looks a lot like major depression or postpartum depression. It’s cloudy thinking, feeling slowed and lethargic, weight gain, sometimes constipation, excessive hair loss, dry skin, and depression punctuated with little pockets of tense anxiety that can actually manifest in the body as racing heart and a feeling of inner restlessness.
The reason I care so much about this is because if you didn’t look for the evidence of thyroid function specifically autoimmune thyroid function, then you would presume that these are manifestations of brain-based chemical imbalance. There are strategies for resolving autoimmune conditions from a functional medicine perspective that involve targeted nutrients things like selenium, zinc, probiotics. Often the most important aspect of the treatment is looking to the environment to find out what might be aggravating the situation or driving this autoimmunity. The big ticket items are usually food intolerances (things like gluten and dairy) and sometimes environmental endocrine disruptors like fluoride and plastics.
My Question to the Psychiatric World
I pose this question:
How much of what we are calling psychiatric pathology is in fact thyroid disorder?
It turns out this is a hard question to answer because of limitations in conventional diagnostics which typically consist of only one blood test called the TSH and in conventional treatment which typically only consists of replacement of synthetic thyroid hormone (T4). This paradigm neglects and dismisses the complex interplay between the brain, hormone levels, glands, receptive tissues, mitochondria, the immune system, and the pivotal role of the gut, diet, and environmental exposures.
The problem with this limited conventional paradigm is that patients are left suffering with chronic symptoms of fatigue, insomnia, brain fog, lethargy, depression, anxiety, and changes in metabolism. They are told that they are “fine”. They are referred to a psychiatrist or they are treated by a non-specialiast with psychiatric medication often for a lifetime in total neglect of the root cause of their symptoms. Perhaps the most important consideration when it comes to root causes is that of autoimmunity, which is when the immune system selectively targets in this case a gland for destruction.
I have a personal and professional vested interest in autoimmune thyroid dysfunction, whether it’s Graves’ disease, Hashimoto’s or postpartum thyroiditis. I’ve been following the literature that suggests that 20% of patients with depression have thyroid antibodies, that 52% of these patients have subclinical hypothyroidism (a type of hypothyroidism that would not be detected with conventional testing), that in pregnancy the presence of thyroid autoantibodies alone not only predicts adverse neonatal and obstetrical outcomes but also postpartum depression and even postpartum psychosis, and that an intervention as simple as 200 micrograms of selenium a day can improve those thyroid autoantibody levels, and that in what we are calling bipolar mania signs and symptoms of hyperthyroidism have been documented which calls into question the use of thyrotoxic medications such as lithium in these patients, and that over the years placebo-controlled randomized trials have demonstrated active thyroid hormone (T3) is an effective mood stabilizer.
But if we are going to think about the root cause of these symptoms we have to look at the whole person and we have to look at the web of influence, whether it’s macro or micro nutrient content of their diet, exposure to food antigens such as gluten, environmental exposure such as fluoride, metals, and endocrine-disrupting plastics, and even medications like oral contraceptives. It’s only when we use a whole body approach to psychiatry and look at the whole person and all of these influences and exposures do we have the opportunity for lasting resolution of symptoms.
About Kelly Brogan, MD
Dr. Kelly Brogan is a Manhattan-based holistic women’s health psychiatrist. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. She is board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine, and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms.
I have hypothyroidism now but started with a bad case of hyperthyroidism. I was prescribed numerous medications but was having a hard time finding any that worked. Finally received one that was helping and woke up one morning covered in a rash. Apparently I was allergic to it. That was over 30 years ago so I really couldn’t tell you the name of it. Long story short-I had radiation to combat the issue. I was not well. I’m 5’9 “ and I weighed 115 and losing daily. I was shaking, anxious, couldn’t sleep and had a strange craving for ice. The internet was nothing like it is today so I was limited on my ability to research it. Also- I had no thought process to work with so I was completely dependent on my doctor. Now I wish I had approached this more holistically. Thank you for the article, I learned a lot. I wouldn’t wish this on my worst enemy. It’s never thought of as serious when talking to anyone. Thyroid issues are so over-used by people. They’re over weight so it must be a thyroid problem or visa versa with weight loss. I wish everyone could feel as crazy as I do sometimes so they would realize it’s not a everyday common cold. I was wondering if it’s common to experience both hypo and hyper symptoms? I have and do. I don’t have a tendency to gain weight, I lose and I have had no real good results with the medications. I’m just okay.
Hi I have had Hypothyroidism, since December 2015, I have no idea why, what caused it! I went through menopause, I just turned 50, stopped my Period, I will be 62, in a few months, my meds I take is Levothyroxin it works great, if I don’t take it I get side effects, If I miss a few days.
Deanne, I’m happy you found the article helpful. Good to have you at Hypothyroid Mom.
they thought it was mental problem…till I had all the test proved thyroid ..how do I remove all that off my file as am treated with sycasim and disrespect. hissimoto
they thought it was mental problem…till I had all the test proved thyroid ..how do I remove all that off my file as am treated with sycasim and disrespect.
hello. I am desperate to find help. I am unable to tolerate ANY synthetic medications or Armour Thyroid. Had to stop them all. Results is thin, dry brittle hair. Numerous digestive issues. Sleep well what’s that? And I am chemically sensitive . Who, What, Where do I go? Doctors just throw up their hands. If you can’t take the pill, they are lost. Even functional medicine docs have not helped. And I am in pain. My scale NEVER moves no matter what I do I’ve done all I know on my own and this is is the source of my stress.
hello. I am desperate to find help. I am unable to tolerate ANY synthetic medications or Armour Thyroid. Had to stop them all. Results is thin, dry brittle hair. Numerous digestive issues. Sleep well what’s that? And I am chemically sensitive . Who, What, Where do I go? Doctors just throw up their hands. If you can’t take the pill, they are lost. Even functional medicine docs have not helped. And I am in pain. My scale NEVER moves no matter what I do
I have been diagnosed with a hot nodule . mt thyroid is ubderactive according to the symptoms i have. the endo doesn’t know what came first, the under active thyroid or nodule. he said he won’t treat either because it would make me sick. subsequent Dr’s have said my thyroid is fine and symptoms are not from my thyroid. any insight?
Hi Bobbie, Here in this article I include a mention of symptoms that may present with hot nodules: https://hypothyroidmom.com/when-hypothyroid-hyperthyroid-signs-present-together/
i was misdiagnosed as bi polar manic depression for 3 and a half years before someone finally said check her thyroid. it was soo awful and has effected my life still todzy.
I’m sorry you went through that, Tonja. I’m happy that you were told about the link to thyroid and that you got that checked. Many people have no idea. Also, be sure to get a copy of your labs and check that you’ve had all 6 thyroid lab tests outlined in this article here because often times TSH is the only test run but it does not give the full picture: https://hypothyroidmom.com/order-your-own-thyroid-labs-2/
Good to have you at Hypothyroid Mom.
Obviously I am not a woman, so none of the postpartum information applies to me. About 8 years ago, I was diagnosed with depression after having been on thyroid meds for some time. I was in the process of leaving an unfaithful wife, so the diagnosis seemed to fit. The psychiatrist’s we’re quick to prescribe antidepressants, which I quickly refused, and explained I am usually pretty happy, I am not depressed, and eventually stopped going to psychiatric appointments because I felt they were going nowhere and the conversations were exactly the same every time. Anyhow after a few years, I went back, just to be told a second time that I was depressed, and repeated the same process again. Only this time my new girlfriend recommended a naturopathic doctor, because I was have trouble staying active due to disabling pain and fatigue, and was begging my regular doctor to check me further, to no avail, because my blood work appeared to be fine. The naturopath ran the tests my regular doctor wouldn’t and determined that I have Hashimotos Disease and sent me down the right path to recovery. Now my days are good, there are no feeling of hopelessness, the pain and fatigue are gone, am I now enjoy a healthy, active lifestyle. My message to anyone struggling with any of the issues mentioned in this article, never give up, never stop striving to get better.
I was diagnosede with graves disease about 5 years ago .Also with congestive heart faulire and a heart effraction of 18%.Things looked very bleak.At the age of 39 the doctors said my heart was that of a 85 year old lady.My life changed that day.They believe my thyroid disease attacked my heart because I already had a enlarged heart.They are always bringing in student doctors at my app. they said im a good study for them.This is a new theory that the thyriod can attack the heart.I had iodine radiation…because surgerys was not a option.My numbers dropped to low now I have to take meds the rest of my days..Im ok with that.I dont seem to have alot of issues I see everyone eles have.I do have some mood swings..nothing new..Dry skin and weight gain is my biggest issue.Im happy to say heart function at last check was 57%.I still take 3 heart meds.I was just wondering anyone eles have chf due to graves?
I have been diagnosed of hypopyrathyroidsm Can u please help me. My doctor has prescribed alpha calcidol which I have been taking for more than a year now. But the symptoms have not improved that much. Please please I need ur help. I am confused
Hi,
I have had Hyperthyroidism since 2014, not long after giving birth and it was treated for two years with Carbamozole! Then, it came back Dec 2018, since it has levelled out however, my gp will only blood test my TSH and I could have sworn I used to have both my T3 and T4 tested. I questioned this and the gp said if you’re TSH levels are normal T3 test isn’t necessary! Wondered what others think about this? I am not hopefully seeing a consultant in June as I don’t feel well and feel this is wrong!
So, my lymph node on the right side of my neck where my jaw line and neck meet never goes down like the left side does. When I get sick with flu, strep, seasonal allergies (Oklahoma), etc., the right side is even bigger than usual as it fights off infection-
I go for an ultrasound next week- I’m not sure what that would even show, do you? I’ve gained 40 pounds in the last 6 months- I exercise regularly… although I finally stopped because my back pain started getting so unbearable –
…. I found out mt lower back has an old fracture.
My son will be 4 in June. I had severe- near suicidal depression.. treated for “depression”
Later gynecologist treated with birth control for hormone regulation.. I’m off of that for over a year.
Idk all that to say, I’m so confused
Wow Once again Thyroid Issues and Innocently Lost to a tangled Web of Psychiatric insanity as I can hardly believe this but I can because I’m aware of How this can happen because it did happen to Me but not anymore as I’m being treated with T3-T4 and not a host of Psychiatric Medicine so to all out there I can relate
This all really makes so much sense to me now I wish I could find a doctor like you in my area 22 years ago I had a half a pound baby girl do to toxemia. Soon after I was diagnosed what’s an anxiety disorder and put on meds. I have since gained about 50 something pounds and still on the same anxiety meds and now I’m on thyroid medicine as well.
Got my thyroid removed in 2000. No problem till 2018. In 2015 double pulmonary embolism followed by a severe depression with suicidal ideation due to domestic violence (left end 2015)
Having lost my first Mum at 3 years of age from suicide and having got problems of depression in my family (my two siblings), the doctors pretended that I was again in depression in 2018 when my mood was going down after having lost my job.
In nov 2017 the doctor changed my dose of thyroxine from 150 to 125.
I was again suicidal and in very very bad conditions. Taken to hospital several times and even one month again in psy ward in May 2018. In June the doctor stopped Praaosin that was prescribed by the psy at hospital since I got diziness. It helped a little bit but I got still some imbalance, some tremors and didn’t feel ok. Dr said you have to find the strength in yourself. I will, he said, asked a thyroid test….. it came back with a TSH of 14.4 ( from 5.9 in April, to 6.9 in May to 14.4 in July). I reckon it’s the moment they finally started to be scared. They increased my dose of thyroxine (EUtrosixg) from 150 every day to 150 /200 every other day. And …. do you know what …. I got the results today after having waited for 6 weeks (thyroxine has to pile in the system), from tsh 14.4 big hypothyroidism I have become just a bit hyper. (tsh 0.7), dr has asked to take 150 5 times a week and 200 twice a week. BUT the big solution is there … no imbalance anymore, no diziness anymore. I’m back to my ownself. I will have to have a tooth removed as well since I’ve got an infection and it could be as well the reason of the brainfog.
Conclusion : when dr and other psychiatrists say that you’ve got mental illness, PLEASE, PLEASE, PLEASE ASK FIRST A THYROID TEST AND GO TO YOUR DENTIST TO HAVE ALL YOUR TEETH CHECKED. It will avoid you the jail that is psychiatrist ward, avoid you the ongoing stress, could save even your job. I beg you to have these two tests not only for your own sake but for what it cost Medicare !!!!
I’m sorry to hear all you’ve been through Genevieve. Thank you for sharing your story. Our thyroid can wreak havoc on our brain but the mention of teeth reminds me of an article that I plan to post at Hypothyroid Mom in the coming months.
OMG
Thank U listening to U describing my
Granddaughter misdiagnosis. Always thought more was happening. I shall request this .
testing.ASAP
I wish I had all this info 23 years ago when I first became suicidal or at least 13 years ago when I was finally diagnosed with Graves Diseases
This is very interesting! I was actually diagnosed as having hypothyroidism by a psychiatrist! I went to see him for severe depression /anxiety and he was brilliant enough to get me tested for low thyroid, which my PCP never caught.