Thyroid Disease as a Psychiatric Pretender
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.
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.
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 whole 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.
Kelly Brogan MD holds an undergraduate degree from M.I.T., where she studied Cognitive Neuroscience. She graduated from Cornell Medical School and began her work in Reproductive Psychiatry. 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. She is Board Certified in Psychiatry, Psychosomatic Medicine, as well as Board Certified in Integrative and Holistic Medicine.