It is well known that stress can have a major impact on our health, but perhaps what is less well known is just how much our stress can impact not only our risk of autoimmune disease but our thyroid function as well. In fact, many patients of mine have been able to point to a particularly stressful time in their life when their health started to go haywire - I know that was certainly the case in the development of my autoimmune thyroid disorder.
Interestingly, not only is stress a potential catalyst for the development of thyroid issues, but in my clinical experience, many thyroid patients have an impaired ability to deal with stress; that is, their body is not as well equipped to respond to and bounce back from life’s daily stresses. This is evident in the scientific literature, which suggests hypothyroidism is associated with reduced peripheral disposal of cortisol and blunting of cortisol feedback on the hypothalamic-pituitary-adrenal axis. What this really means is that stress management is an integral part of any holistic approach to managing a thyroid disorder, and certainly one that plays a big role in my prescriptions.
So How Does Stress Impact The Thyroid?
The scientific literature on the topic of stress and thyroid disease is abundant with examples showing the ways in which stress impacts thyroid function, and interestingly, many researchers have suggested the relationship may be bi-directional; that is, that stress disrupts the hypothalamus-pituitary-thyroid axis, and yet simultaneously, disturbed thyroid function alters our stress response. For example, in a 2012 study, TSH levels were found to significantly and positively correlate with cortisol levels, meaning those with higher TSH readings tended to have higher cortisol readings as well. As a side note, the authors also commented that a TSH >2.0 uIU/L may signal an abnormality in thyroid function, which is particularly interesting given many labs still use a reference range of 0.5-4.5 for TSH, despite the American Association of Clinical Endocrinologists (and a number of other influential bodies) recommending an upper limit of 3.0 mIU/L** (see note below).
Further, stress has been proposed as a potential catalyst for the development of thyroid autoimmunity in individuals genetically predisposed to thyroid disease. Stress has been particularly strongly associated with the onset of Graves’ disease, however there are some reports linking it to the beginnings of Hashimoto’s disease as well (and this is certainly something I have observed in clinical practice time and time again). Stress induces the production of glucocorticoids (such as cortisol), various neurotransmitters and inflammatory cytokines, which may all play a role in the onset and progression of autoimmune thyroid disease via modulation of immune activity and activation of inflammatory pathways. Interestingly, stress is also associated with increased intestinal permeability, which may be a risk factor for the development of various inflammatory disorders and autoimmune conditions, including those affecting the thyroid.
Lastly, high levels of stress may increase peripheral shunting of T4 into reverse T3; an inactive analogue of thyroid hormone. As I discussed in this blog on the topic, reverse T3 is a natural antagonist of our active thyroid hormone, T3, meaning raised rT3 can contribute to symptoms of hypothyroidism. This is yet another reason why managing stress is integral to ensuring your entire thyroid axis is working at its best.
How Stress Mimics Symptoms of Thyroid Dysfunction
Interestingly, for some patients, it can be difficult to distinguish between stress itself and symptoms of thyroid dysfunction. This might be because they often go hand-in-hand, but in other cases, it is because symptoms of stress can often mimic those of thyroid under- or over-function. For example, for some people, stress presents as a panicky feeling - they might feel hot, irritable, overwhelmed and they might even experience a racing heart, just like in cases of hyperthyroidism. They might also experience sleep disturbance, digestive issues and symptoms of blood sugar dysregulation, which can occur in both hyper- and hypothyroidism. On the other hand, for many people, stress results in symptoms such as fatigue, anxiety, headaches and mood swings, which can all be suggestive of an underactive thyroid. For this reason, when dealing with thyroid patients who have been under prolonged stress, comprehensive case-taking and blood tests can be helpful in distinguishing between signs of thyroid dysfunction and those of adrenal dysreguation, but ultimately, both will need to be managed to enable healing.
What Can You Do To Manage Stress and Support The Adrenals?
Stress is a normal and healthy part of life, however problems can arise when stress is prolonged or when an individual has a impaired ability to manage stress (often due to a chronic health condition). Unsurprisingly, some individuals are so used to dealing with stress they might not even notice the warning signs when things are becoming too much. That said, recent research has demonstrated the benefit of stress management in autoimmune hypothyroidism, in that not only did levels of anti-thyroglobulin antibody decrease, but overall quality of life and feelings of wellness improved as well.
In addition to removing sources of stress (which may or may not be feasible depending on the nature of the situation), I encourage all of my patients to make time for stress management techniques, such as reading, walking in nature, yoga, swimming and/or simply catching up with a good friend. These activities are so important for helping to clear the mind and enable a break from the day-to-day stresses of daily life. Further to this, I encourage my patients to ensure they are getting the absolute essentials right when it comes to their health - plenty of sleep, beautiful nutrition, adequate sunshine and moderate exercise. Sadly, these things can’t be bottled into a supplement, so prioritising them as part of your prescription for health is essential. Lastly, where indicated, I support my patients with nutritional supplementation or individualised herbal medicine, to help the body adapt and respond to stress. Certain nutrients such as vitamin C, magnesium and B-vitamins are essential for the healthy function of the adrenal glands and nervous system, and are often depleted in times of stress, so supplementation with the guidance of a qualified healthcare professional can often be beneficial. Lastly, individualised herbal medicine can be a lovely and gentle adjunct to treatment, whether it’s used to manage anxiety, improve sleep or support the body’s response to stress. Depending on the individual and situation, this might involve anxiolytic herbs like passionflower and magnolia, thymoleptic herbs such as oats and saffron, or adaptogenic herbs, such as withania, rehmannia and rhodiola. Ultimately, the lovely thing about herbal and nutritional medicine is that they can be tailored towards you and your individual requirements.
Yours in health,
**As a side note, a lower TSH (particularly those as low as 0.1-0.2) is not necessarily better. While suppression of TSH is certainly indicated in some states (in particular, in patients with a history of thyroid cancer), total suppression of TSH (such as with high doses of T4 or T3) is associated with thyroid atrophy, which further compromises thyroid function. Stay tuned for a future blog post on this topic, as it is certainly one worth exploring further.