Thyroid Disease as a Psychiatric Pretender

by Dr. Kelly Brogan MD August 8, 2013

thyroidBy Dr. Kelly Brogan MD, Holistic Psychiatrist

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 Hashimito’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. Here’s a bit of what I’ve learned:

Thyroid Disease as a Psychiatric Pretender

  • So Much More Than Synthroid: The thyroid is responsible for producing T4, T3, T1, and T2 and cells are responsible for converting the storage form of hormone, T4, into its active form, T3. This is a process dependent on optimal cortisol and nutrient availability such as iron, iodine, zinc, selenium, B vitamins, C, and D.
  • It’s The Immune System:  Dummy autoimmune thyroid conditions such as postpartum thyroiditis are not fundamentally thyroid problems — they are manifestations of a dysfunctional immune system; one that is misrecognizing the body’s tissues as foreign. Many doctors don’t even screen for antibodies because their presence doesn’t change the intervention, which is typically a lifetime of varying dosages of synthetic T4.
  • Are You Really A Mental Patient? Thyroid imbalance can cause anxiety, depression, cloudiness, weight gain, poor concentration in addition to cold and exercise intolerance, dry skin, and hair loss. You’re wearing socks to bed, pooping once a week, and penciling in your eyebrows. In postpartum thyroiditis, this presentation is typically preceded by a period of hyperthyroidism where women can feel over-energized, suffer from insomnia, diarrhea, anxiety, and precipitous weight-loss — these are the women who “bounce back” quickly after the baby only to be peeling themselves off the ground 9 months later.
  • Whole Body Ills: Low thyroid function impacts the ability of cells to use energy (hence low body temp), metabolize cholesterol, and to properly use B vitamins for an important cellular process called methylation.  Thyroid dysfunction can cause or be the result of other bodily imbalances.
  • Pregnancy/Postpartum: Reportedly, 10% of women develop postpartum thyroiditis. In my practice, it’s about 85% of my patients who come in with postpartum complaints. A number of interesting studies like this, this, and this have implicated autoantibodies in the development of postpartum mental illness. Psychiatry has a well-established precedent for the use of active thyroid hormone, or T3, for the treatment of depression, so we have bidirectional reasons to consider appropriate screening in this population.

Healing The Body

Heal the gut! Elimination of food allergens, but always gluten. The premise of Functional and Naturopathic Medicine is healing the gut first.

The seat of >70% of our immune system and our most vulnerable interface with our environment, the gut is a powerful site of communication about what is “ok” and what needs to be attacked. Fascinating research by Fasano et al has helped to elucidate just how wheat/gluten grains can promote intestinal permeability or “leaky gut” allowing peptides through this precious barrier where they go on to stimulate the brain and immune system. A concept referred to as “molecular mimicry” underlies the direct relationship between these peptides and immune response agents that end up attacking tissues that share amino acid sequences with the offending intruder (i.e. bagel).

This is not about celiac disease (it’s usually about “non-celiac gluten enteropathy”) although the link between celiac and autoimmune thyroiditis has paved the way for our understanding. An elimination provocation diet is the best way to determine what foods your body hates, but I focus on processed dairy and gluten for the purpose of initiating gut healing. Believe me, raised on homecooked Italian food, and addicted to dairy, kissing lasagna good-bye was not easy.

Suffice it to say that the more you learn about processed dairy and gluten-containing foods, the less tasty they become.

Endocrine disruptors

Another primary theory behind epidemic rates of autoimmune dysfunction in our population is the prevalence of environmental pollutants, pesticides, and household chemicals that are “endocrine disruptors”. What gives them that name is the fact that they stimulate our immune systems and act as hormones in our systems.

Some lock into hormone ports like pesticides do with estrogen receptors and others, like fluoride, interfere with production of hormones. My post here is a good starting point for cleaning up the house with a focus on filtering water, air, eliminating pesticides, and plastics.

Adrenal Repair

When trying to resurrect thyroid function, you can’t ignore the adrenals. Adrenals are little glands that sit over your kidneys and make a variety of hormones that help you respond to every day demands including cortisol, dhea, aldosterone, norepinephrine, and epinephrine. There are stages of response to stress, acute and then chronic, that describe exaggerated and then diminishing returns on adrenal hormone functioning. To respond to thyroid hormone well, the pattern of cortisol over the course of the day must be optimized.

This requires stress management, low sugar diet, and sometimes, B5, B6, and vitamin C. Adaptogenic herbs like Rhodiola can also be helpful in balancing the body’s response to stress.

Check the right labs and body temp In my practice, I test for TSH, freeT3, free T4, reverse T3, total T3, and thyroglobulin antibody, thyroid peroxidase antibody, and thyroid receptor antibody to get a more complete picture of thyroid functioning.

I also listen to the patient above and beyond the labs. There are known limitations of these lab parameters.

Checking body temps 3 times a day and looking for a temp below 98 can also be an indicator of hypofunction.

Helping the body correct with supplements and prescription hormones. Supporting the immune system’s correction and thyroid hormone production is truly an exercise in holistic medicine. That said, zinc is essential to the conversion of T4 to T3. Zinc at 30mg with 2mg of copper is a typical dose. Selenium is critical to antioxidant enzymes and immune reactivity. 200 mcg/day is a typical dose. Iodine, while somewhat controversial in high dose applications (>3mg daily), is essential for the production of thyroid hormone, and when used with selenium, can play an instrumental role in recovery. Other agents for immune system balance include Beta glucan, a friendly yeast, saccharomyces boulardii, curcumin, N-acetylcysteine are other more personalized considerations. Some patients opt for hormone replacement in the form of compounded T4/T3 or a prescription called Nature Throid or Armour, and others are interested in protocols like this which flush out reverse T3 and stimulate proper glandular functioning.

Some pioneering work has also been done with immune modulation through a low dose prescription of naltrexone.

Perhaps one of the most important reasons to correct thyroid dysfunction and associated autoimmunity is the heightened risk of developing other autoimmune disorders. We live in a very “stimulating” world and it is difficult to predict whose system is going to rebel against it. Once you address diagnoses like these from the ground up, your entire body, hormones, gut, neurochemicals, and immune system are primed for optimal performance — taking control of your health for future vitality.

About The Author

As an undergraduate at M.I.T., Dr. Kelly Brogan studied Cognitive Neuroscience and worked with Harvard undergraduates to create a public forum for the discussion of alternative medicine, directing conferences for the Hippocratic Society.

She attended Cornell Medical School where she was awarded the Rudin Scholarship for Psychiatric Oncology and began her work in Reproductive Psychiatry, which she went on to train in during her residency at NYU/Bellevue.

A strong interest in the interface of medicine and psychiatry led her to pursue a fellowship in Consultation Liaison/Psychosomatic Medicine at NYU/Bellevue/VA Hospital.  Since that time, she remains on faculty and has focused her efforts on her private practice where she cares for women across the life cycle including pregnancy and postpartum.

A passion for holistic living, environmental medicine, and nutrition are the bedrock of her functional medicine practice. She has published in the field of Psycho-Oncology, Women’s Health, Perinatal Mental Health, Alternative Medicine, and Infectious Disease.  She is Board Certified in Psychiatry, Psychosomatic Medicine, as well as Board Certified in Integrative and Holistic Medicine.

You can learn more about her at www.kellybroganmd.com, and connect with her on FacebookTwitterand through her monthly newsletter

 

Comments (52)

  1. By eliminating the causes of productivity loss, absenteeism, and worker accidents, mental health services increase a company’s efficiency, productive capacity, and quality of goods and services.

    Reply
  2. Pingback: When Thyroid Disease Masks as a Mental Health Disorder | Healthy Holistic LivingHealthy Holistic Living

  3. Keep the sun from damaging your hair with products that have actually sunscreen in them, continual sun exposure could undo all the excellence you have actually done for your hair, shielding the hair will keep its colour and help it look much better much longer!

    Reply
  4. The more I read about thyroid problems, the more I feel this is what is wrong. The mood swings. The cloudy thinking. The tired. I lost 30 pounds out of no where. I am always cold. I am even wearing a jacket now in my own house. I have sleep problems and chronic infections. I feel like a mental patient but nothing seems to be wrong with me.

    Reply
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  8. Can anyone suggest a good Dr in the Syracuse N.Y. area?
    My TSH is 4.634 T4 is 1.15 T3 is 3.3
    I am not taking anything for my thyroid at this time but I am experiencing symptoms.

    Reply
  9. Hello, thank you for your info it is eyeopening….i like to know what company is high quality for rhodiola please.?

    Thank you.

    Reply
  10. I finally got my grocery store to stock coconut-oil, at your suggestion, I hadn’t had the chance to use it yet, but the other day, I was fixing my dogs food and with her kibble I always put a little bit of steamed chicken pieces in with the kibble, but when I steam the chicken it always sticks to the plastic, so I remembered I had the c.oil and put a little 1/2 teaspoon and swapped the bottom of the steam bowl, placed it in the steamer with the chicken, when it was done approximately 20 min. I took it out and the smell was incredible with the juices from the chicken,and that coconut oil, I took one taste of it, Hate to admit it but Gidget got the kibble, I ate the chicken..Its great stuff, thank you Dr.Kelly

    Reply
  11. so happy i stumbled upon this website! What would be a good diet for hypothyroidism? I am currently taking 275mcg of levothyroxine, which is a very high dose. I do not have luck losing weight no matter what i try.

    Reply
  12. High-dose iodine supplementation is useful for displacing accumulated fluoride, bromine and chlorine. My adrenals seem to be healing. I’ve gained several pounds of muscle so I’m thinking that my elevated cortisol level has come down a bit. The book “The Iodine Crisis” is a good starting point. Women need considerably more iodine than men, notably due to breast tissue being a large consumer of the element. Iodine deficiency is a big driver of breast cancer. Between fluorosis and Mountain Dew (bromine) I managed to cause problems. And mercury, read Andrew Cutler for how to deal with that. If you already have serious thyroid problems you’ll need to be careful with iodine, and even if you don’t you need to know what to supplement with it.

    Reply
  13. Great article! There is only once aspect that I am not comfortable implementing. When a person has Hashimoto’s it is advisable to NOT take extra iodine because it can actually worsen symptoms of hypothyroidism. According to Dr. Kharrazian it’s like throwing fuel on the fire. Undiagnosed Hashimoto’s is very common in thyroid patients. Iodine can actually be part of the problem. What are your thoughts on that?

    Reply
  14. Pingback: Confessions of a Renegade Psychiatrist | The Daily Sheeple

  15. Pingback: Study: Autism 4 times likelier when mother’s thyroid weakened – 12NewsNow.Com | Thyroid Center

  16. Pingback: Confessions of a Renegade Psychiatrist

  17. Beautifully written article Dr. Brogan! Too many people are sick and suffering with thyroid dysfunction today caused by nutritional and environmental factors. I use a Bioenergetic Medicine system in my practice and always find moderate to high levels of endocrine disruptors (chlorine, fluorine, bromine, pesticides, perfumes, various heavy metals, etc.) trapped within the thyroid gland. There is no question that the frontal lobes of the brain (seat of emotions) are directly affected by hormone imbalances and how much better people feel when the underlying root causes are treated. Amazing how everything in the body is interconnected. Loved your personal story and how Functional Medicine healed your body. The world certainly needs more Holistic Psychiatrists. Blessings!
    Dr. John Foley\’s last post: The Reason Why You Can’t Lose Weight

    Reply
  18. Hi Kelly,

    Thanks for the great post.

    My naturopath/accupucturist put me on the almost exactly same protocol + vitamin C, A LOT of FCLO and a lot of food (fermented foods, fat and liver especially).

    I know that it is not easy to say but could you please share what is the average time for recoverythat you’ve observed?

    Also, my right eyebrow is thinning, actually I have a little “hole” in it, does this restore with time in your experience?

    Also, the right side of my body and face is behaving funny (a lot more stiff for the body, and the right half of my face is kind of sagging and looking a lot older than the left one). Have you seen such a manifestation and does it resolve with the thyroid function going back to normal in your experience. Thanks!

    Reply
  19. I crashed and burned when I stopped nursing my seventh child at 4 yrs. old. Went to the neurologist, endocrinologist, ENT dr., natural doctors, etc. They told me I need to take hormones, muscle relaxers, anti-depression meds, and more. I found a great guy at the health food store and got on vitamins. Then I went to the chiropractor and got adjustments every week day for 2 weeks, then every other day, then less and less. Stress and sadness play a huge roll in our lives. Also pinched nerves do also. Thank you for sharing….it is so true!

    Reply
  20. Pingback: Self-repair ‹ BeachFit Moms

  21. I should also say my temp always at 96 and i had long suspected thyroid. Long ago before kids i had it checked out by a conventional doc and they said my levels were in the normal range. Could the treatment for the pyrrole be treating any underlying thyroid disorder too?

    Reply
  22. I had pretty much the same symptoms following all my pregnancies with my 3rd time round the worst. I did lots of research and found it is usually a zinc/ copper imbalance and started taking zinc and biotin. Saw an ND and she diagnosed me with pyrrole disorder (the body makes pyrroles, a by product of blood. Some people make too many. Certain nutrients like b6 and zinc bind themselves to pyrroles which you normally excrete. So then you are continually deficient in said vit/minerals. So i was placed on a supplement that has megadoses of b6, zinc, chromium, manganese, molybdenum, biotin, boron taurine and a little magnesium. It has helped but the thing that helped the most was going gluten free which i had an aha moment and did on my own. I still have to take supplements though. Usually you cut back until you find your maintenance dose. But whenever i cut back i start to lose hair again.

    Could the pyrrole disorder and thyroid be related? Or one mistaken for the other?

    Reply
  23. Pingback: Factors that Affect Thyroid Function | boldcorsicanflame's Blog

  24. I have been trying to read this article as this is a subject I am extremely interested in. I have yet to get past the word Synthroid as the commercial bar comes on and when I click it off, it throws me down to the comment section. Not sure how to get past it, Very frustrating.!!!

    Reply
  25. It is interesting how important the thyroid is to memory. I have Hashimoto’s. I found out just before going through a round of IVF (successful, btw). That was over 10 years ago. I guess it had progressively gotten worse, in such a slow fashion that I thought it was normal to forget the plot of a movie right after watching it. I had also lock my car a couple of times with the car running.

    One thing most doctors don’t seem to pay attention to, as Dr. Brogan points out, is the fact that the thyroid makes more than T4. I am so glad to have found an endocrinologist, Dr. Zaidi, who does understand, and has the patience to work with me, as a partner. His belief is the root of it all is stress, but nutritional deficiencies play a major role. Thank you for the great posting!

    Reply
  26. Excellent article I shared with the FTPO – For Thyroid Patients Only Facebook page. I personally think it’s a great article. Now we need more doctors who treat their patients this way, ALOT more! It was encouraging to see a doctor publically advocating LDN. If only this article were in the Wall Street Journal this week instead of the horrible piece that they published. Looking forward to more great articles like this one. Keep up the good work!

    Reply
  27. Hi~ your article was very interesting. I was diagnosed with Hyperthyroid when I was 6 months pregnant and found a lump on my neck ( turned out to be thyroid goiter). Tested many times and no graves disease, I am 27 years old. This was almost 3 years ago and I have tried Homeopathy for 1 1/2 years with no luck of improving or shrinking goiter. Now I have turned to Chinese Medicine and have been on this new medication for @ 2 months. Any suggestions or recommendations?

    Reply
    • Iodine deficiency is the #1 cause of goiter. My mom grew up on Wisconsin (part of the goiter belt). Every Friday the kids lined up in school to receive their iodine pill. Now days they think the minicule amt in salt is enough. BS! Check out dr David brownstein and his book “Iodine, why we need it and can’t live without it.” On my blog I write about environmental factors that block iodine absorption. http://Www.body-geek.com
      All the best, sherry

      Reply
  28. I am convinced that a huge percentage of the population has undiagnosed Thyroid issues. I am including myself. I am so grateful for medical professionals who are getting the information out to all of us who are desperate for facts that we can use to help ourselves and others. Thank you and keep it coming! God bless from West Texas!

    Reply
  29. Pingback: Tarczyca – zaburzenia i leczenie | Czarodziejska Kraina

  30. Hello all and thank you for the wonderful feedback. Michele – it is the feeling on the part of most holistic/functional med providers that patients often feel vastly improved on dessicated compounds like Nature Throid. In the setting of thyroidectomy, this would be my recommendation so that you are replacing not just T4, but T1, T2, T3, calcitonin, iodine, etc. I’m of the general opinion that cutting gluten does something for just about everyone ; )

    Warmly,
    KB

    Reply
    • Thank you for the great information. Would you happen to know of a doctor in the Columbus, Ohio area who would be on the same page as yourself? I wish I could find a doctor like you!! Also, I have been on Synthroid since after my first pregnancy (approx 2.5 yrs) due to.Hashimotos. Does Synthroid damage the thyroid’s ability to ever recover if there was a chance for recovery? I keep hearing “once on thyroid meds, always on thyroid meds”. Thank you!!

      Reply
  31. Wow, this is could be my personal medical history!! I have had my thyroid tested and told its functioning normally, but always doubted it. Insomnia, anxiety, weight gain, clouded thinking, depression, hair loss? That’s me. I have been eating a mostly traditional diet for several years. It has helped but I still seem to teeter on the edge.

    What are some natural sources for the minerals in this article?
    Is it advisable to self treat with Rhodiola?

    Reply
  32. Great article, I do have a question though.

    Is there anything you can do once the thyroid is removed? I had a full thyroidectomy and central neck dissection due to cancer. I take synthroid daily and now liothyronine nightly because I just don’t have normal energy levels. I have gained 30 lbs since the surgery. I have IBS since my twenties and although meds help keep me from running to the potty every two minutes, when it flares up it is worse. Would cutting gluten really do anything for me at this point?

    Thanks for any response.

    Reply
    • Michele – my thyroid was removed in2004. The quick weight, fatigue, etc all the hypo symptoms can be devistating. Lucky for me I discovered stop the thyroid madness though it did not help deal with issues minus thyroid. But it led me to the yahoo groups where I found thyroidless. What a wonderful support and knowledge! It is even more important for us to test FT3 levels as TSH is meaningless without a thyroid. At first Armour was great but they reformulated it in 2009 and doesn’t work well for thyroidless people. I get my Erfa thyroid from Canada – excellent! You will learn so much when you join – but create and join with a yahoo email acct so you can view archives. All the best!

      Reply
  33. Thank you for a wonderful and timely article. I am waiting on some blood work to figure out what’s going on. From what I have read I believe I have postpartum thyroiditis or hypothyroidism. My baby is 4 months old. I have 80-90% of the symptoms I can find listed.

    My question: Can all the things you suggested be done while breastfeeding? I would love to go to a naturopath, but I am a stay at home mother of 3 children and it’s just not in the budget so I need to figure this out myself as much as possible. Should I go on synthroid in the meantime or no? I have eliminated dairy and wheat, reduced fruit to 2 servings/day max and 1 T honey max,so far. We eat very traditionally as well.

    Reply
    • I lost the weight after 5 hour labour, baby girl born at 37 weeks, 7.6lbs, yoga, walks, and a WAPF diet. My diet was implemented at 5 months preg and am still refining it( found raw milk last week, bone broths and organ meats hard to prepare regularly)

      My girl is 6 weeks old and I am healthier looking and slimmer than I’ve ever been before.

      I have the same question as the one above. Plus, how do you implement naltrexone? I am assuming after pregnancy. Does the GAPS diet have to be implemented before naltrexone? And what else can you tell us?

      Reply
  34. Thanks for a great article. I wish Dr. Brogan lived in Minnesota. I tried to find a natural doctor to help me switch to Armour or another natural thyroid medicine last year. I went to an integrative health clinic. It was the first time I had a full thyroid panel done. I was so excited to finally feel better. I learned for the first time that I had Hashimoto’s. Beyond that the doctor said my labs looked good and to continue on my current dose of levothyroxine. But what about the Hashimoto’s? When I asked about Armour she said I could switch if I wanted and gave me a prescription for an “equivalent” dose and sent me on my way.

    I slept a total of 4 hours over the next 3 nights and was so full of anxiety that I couldn’t function. Of course this was over a weekend. When I called her she said to stop taking it and go back to the Levothyroxine. She said that my labs showed I was converting the T4 to T3 quite well and it would be best. I asked her if there was anything else I could do considering that I had hashimoto’s and was not just hypothyroid? She said my antibodies were pretty low, which was probably due to my gluten free sugar free diet and just to continue that. I was so disappointed!!

    OK enough whining. If I keep learning more from great articles like this, there is always hope. Thanks again Dr. Brogan.

    Reply
    • Karen, you have to transition from Levo to Armour, and you have to ramp up the dose slowly after ensuring that levels of other things are optimal (cortisol, iron, for example). Stopthethyroidmadness.com is THE authority on all things thyroid and has all information about switching meds.

      Reply
      • Thanks JMR. I did ask the doctor to test my cortisol levels and she had me do a 24 hour saliva test. The results came back all within normal range. I later read that using lorazepam can effect the results. I had been taking this for about 9 years for sleep. I did ask the Dr. about any meds effecting the results when she gave it to me and she said no.

        I did read the book Stop the Thyroid Madness. It was all new information and I felt ovewhelmed by it all, but hopefully over time I can sort it all out. It doesn’t help that I feel such brain fog most of the time. Iron is on my list for my next thyroid check.

        Reply
  35. Can low thyroid be reversed if I’ve been taking Synthroid and now Armour for around twenty years? I took 90mg but recently had some extreme stress in my life and I now take 120mg.

    Reply
  36. Pingback: Thyroid Disease as a Psychiatric Pretender | sondasmcschatter

    • Hi Courtney! I live in Charlotte and am currently working with a Holistic Doctor regarding my thyroid. She is fantastic and incredibly knowledgeable! She has an office at Abundant Health Family Chiropratic – (704)759-9020. Her name is Dr. Traci Giles. Her prices are also very reasonable.

      Reply
  37. I think your patients are very fortunate to have a physician with such knowledge. I had a multitude of disabling thyroid symptoms, with TPO Ab and TgAb in the thousands and TSI Ab in the mid-hundreds, a thyroid you could see from across the room was swollen and ultrasounds showing several large nodules on my thyroid. Diagnosis from multiple conventional doctors: healthy thyroid. Why? TSH is always well in range. Always.

    I don’t use conventional doctors anymore and I’m doing much, much better. I don’t eat gluten, but have never noticed any improvement (except for less constipation) from eliminating it. Antibodies remain in the thousands. I’ve been on T3 only for years (repeated trials of Armour lead to immediate return of symptoms with high RT3). Apparently I don’t convert T4 to T3 and all my lifestyle changes haven’t fixed that. I still have hope, but my thyroid is pretty much destroyed by now.

    Reply
  38. Outstanding article! One would think all the “rocket scientists” our there (aka allopathic physicians) would figure it out too.

    I went through an experience of hyperthyroidsim as you described last summer. After working with an excellent holistic doctor on a protocol similar to yours one year later I am hale & hearty at 53 yo. The single best thing I did was go gluten free. Results were almost immediate. It has now been 11 months and I feel fantastic.

    In hindsight, growing up Italian with bread and pasta being staples I believe the gluten has long been an issue and explains many things. Again, great article!

    Reply

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