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Objectives
~ Identify the connection between thyroid hormones and mental and cognitive health
~ Explore the relationship between thyroid hormones and gonadal hormones and mental and cognitive health
~ Identify interventions to assist people with thyroid and mood disorders.
Thyroid Hormones
~ T4 is Thyroxine an excitatory hormone and the main thyroid hormone
~ T4 is converted to T3 (triiodothyronine)
~ T3 tests are useful for diagnosing HYPERthyroidism, but not as useful for detecting HYPOthyroidism
~ Thyroid Stimulating Hormone (TSH) tests detect whether the thyroid is being triggered to release T4. Normal or low TSH and low T4 indicate hypothyroidism
~ “T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. Patients can be severely hypothyroid with a high TSH and low FT4, but have a normal T3.”
Stress and Thyroid
~ Acute stress has been shown to causes transient activation of the HPT axis, whereas prolonged stress is associated with decreased activity
~ Significantly lower TSH and T3 levels have been found in populations reporting stress-related mental health problems
~ Low-T3 syndrome is a condition characterized by a reduced peripheral conversion of T4 to T3 in the presence of normal thyroid hormone secretion. It occurs in a variety of nonthyroidal illness (NTI) including autoimmune disorders and is defined as nonthyroidal illness syndrome (NTIS).
Thyroid Hormones and Mental Health
~ About 30%-50% of patients experience inadequate response to antidepressant therapy
~ Irritability, anxiety, mood swings, sleeplessness, restlessness, sensitive, easily angered are all symptoms associated with hyperthyroidism (“manic veneer”)
~ Hypothyroidism is associated with a depression, fatigue; attention/concentration, memory, perceptual function, language and executive functioning difficulties; weight gain, and reduced libido and reproductive challenges
Thyroid Hormones and Mental Health
~ Thyroid autoimmunity refers to the detection of thyroid autoantibodies in combination with normal thyroid function
~ At least 2–3% of women have some form of thyroid dysfunction during pregnancy
~ 3–13% of people (men and women)have thyroid autoimmune disease despite euthyroidism
~ Increased prevalence of circulating thyroid autoantibodies can be seen in depression, PPD (men get it too) and anxiety.
Thyroid and Gonadal Hormones
~ Both hypothyroid and hyperthyroid women have been reported to have a greater prevalence of menstrual disturbances compared with euthyroid women
~ Total T4 and T3 are positively correlated with estrogen, progesterone and testosterone levels
~ Environmental toxins, smoking, obesity, stress, aging and alcohol consumption all impact levels of gonadal hormones which in turn impact the HPT Axis
~ Low gonadal hormones contribute to depression, sleep disturbances, Alzheimer's disease, schizophrenia and dementia
~ High gonadal and thyroid hormones may contribute to symptoms of anxiety and irritability
Thyroid Hormones and Cognition
~ Symptoms of thyroid dysfunction experienced in the elderly are often misinterpreted as signs of the aging process, such as fatigue and neurological disorders
~ The prevalence of hyperthyroidism in individuals older than 60 years ranges from 1% to 15%
~ Higher TH concentrations are associated with increased frailty and decreased functional capacity in old patients
~ Subclinical hypothyroidism was associated with reduced risk of dementia, whereas overt hyperthyroidism, particularly very elevated FT4, was associated with increased risk of dementia (cortisol triggers TSH and FT4 and inhibits conversion to T3)
Thyroid Hormones and Inflammation
~ Hyperthyroidism and hypothyroidism have been shown to be associated with oxidative stress and inflammation
~ Hypothyroidism is associated with obesity and/or chronic stress which are associated with increased estrogen and secretion of proinflammatory hormones and cytokines
Neurotransmitter Recap
~ Serotonin- Positively correlated to T3
~ Norepinephrine – Positively correlated to T3
~ Cortisol inhibits t4 to t3
~ Acetylcholine positively correlated to thyroid levels
~ Glutamate positively correlated to thyroid levels
~ GABA inhibits TSH
Neurotransmitter Recap
~ Endocannabinoids
~ (and cannabinoids) inhibit TRH release (reducing thyroid hormone levels) through effects in the hypothalamus and pituitary gland
~ Thyroid hormone status also modulates ECS. Hypothyroid reduces the effectiveness of CB receptor agonists
~ Dopamine is positively correlated with T3 levels (Parkinsons/RLS vs schizophrenia)
~ Regularly have thyroid levels evaluated in people on antipsychotic medications
Thyrostress
~ Thyro-stress is defined as an emotional state, characterized by extreme apprehension, discomfort or dejection, caused by the challenges and demand of living with thyroid disorders such as hypothyroidism
~ What are these challenges?
~ Physical
~ Affective
~ Cognitive
~ Occupational
~ Relational
Interventions
~ Proper functioning of the thyroid gland iodine, requires a number of elements, including idodine, selenium, iron, zinc, copper, and calcium
~ Recent studies revealed the emerging role of excess uptake of lipids in the development of hypothyroidism.
~ Monitoring of patients on lithium which can contribute to hypothyroid
~ Effective treatment of thyroid abnormalities may also reverse cognitive issues
~ Addressing trauma and chronic stress to reduce cortisol and help regulate the HPA-Axis
Interventions
~ Sobriety to address dysfunction of the hypothalamic-pituitary-thyroid axis in alcohol dependence
~ Adequate, quality sleep and circadian rhythm regulation since thyroid function, is known to be influenced by the sleep/awake status and circadian rhythm
~ Sleep studies may be necessary for people with apnea
Summary
~ Thyroid hormones can be altered by physical or emotional stress
~ Thyroid hormones via the HPT axis are intertwined with the HPA-Axis –dysfunction in one produces dysfunction in the other
~ Many cognitive, affective and behavioral symptoms commonly seen in behavioral health settings may have some underpinnings in thyroid dysfunction
~ Mental health clinicians can educate patients about the far-reaching impact of thyroid hormones; help them address cognitive and emotional stress and trauma and address sleep and circadian rhythms.