Stress, Thyroid, Hormones, and Mood

Foreign. People come to BetterHelp every day looking for a counselor. BetterHelp makes it easy for you to move your practice online and focus on what you love most, helping others. Better Help's easy to use platform, takes care of referrals and billing and provides a secured platform to communicate with your clients. Join more than 18,000 therapists at better Help helping to improve people's mental health and lives. I'd like to welcome everybody today's presentation on stress, thyroid hormones and mood. I AM your host, Dr. Donnelly Snipes. In this presentation, we're going to identify the connection between thyroid hormones and mental and cognitive health. We'll explore the relationship between thyroid hormones and your gonadal hormones. Those things are going to rear their ugly head again. And mental and cognitive health. And we'll identify interventions to assist people with thyroid and mood disorders. Now, before we get too far into it, we talked, oh gosh. A couple of weeks ago about the HPG axis, the hypothalamic pituitary gonadal axis. We've talked a lot about the HPA axis, the hypothalamic pituitary adrenal axis. Today we're going to be talking about the HPT axis, the hypothalamic pituitary thyroid axis. Now, all of these, all three of these are their own axes, but they all intersect. So it's important to recognize that when one goes wonky, it's going to affect the function functioning of the other two. So let's just start at the beginning. T4 is thyroxin and that is a stimulatory hormone, an excitatory hormone and your main thyroid hormone. When your HPA axis, for example, is triggered, your pituitary tells the thyroid through thyroid stimulating hormone to release thyroxin. Then thyroxin is converted to T3. T3 tests is what a lot of people get when they go to the, when they go to the doctor, especially a GP, not so much an endocrinologist, but T3 tests are very useful for diagnosing hyperthyroidism. So overactive thyroid, but is not nearly as useful for detecting hypothermia, hypothyroidism. A lot of people, when they go to their gp, they think they've got hypothyroid, they want a thyroid test and the doctor will run a T3 test and they're like, well, it's, it's fine. So what we need to help them understand, and if they go to an endocrinologist, then it's a non issue that there are different tests that are more effective for assessing hyper both thyroid the thyroid stimulating hormone test or the TSH test detects whether the thyroid is being even triggered to release the T4. So is the pituitary doing what it needs to do to release the TSH into the system? Is enough TSH even being released in order to trigger the thyroid? So that's where we want to look for the first breakdown in the system. Normal or low TSH and low T4 indicate hypothyroidism. So they want, you want to look and see, you know at of the, look at those T4 levels as well as the TSH levels and you need to look at them in tandem. According to the American Thyroid Association, T3 testing is rarely helpful in the hypothyroid patient since it is the last test to become abnormal. Patients can be severely hypothyroid with a high TSH and a low T4 but still have a normal T3 levels. So you know, if you want to work through all the gyrations of the math and how that works, more power to you. But you know from the experts the T3 test that is the one that's typically run to test thyroid is the very last one that's going to show anything thing amiss and we're going to understand why that's a problem in a minute. Acute stress has been shown to cause transient activation of the HPT axis, the thyroid axis. Whereas prolonged stress is associated with decreased activity. Just like the HPA axis, when it is under chronic stress it the body becomes more resistant to the glucocorticoids and the, the HPA axis has less impact on the body, the body becomes resistant to it. Same sort of thing. As for the HPT axis, the thyroid hormone receptors start becoming resistant. Significantly lower TSH and T3 levels have been found in populations reporting stress related mental health problems. And this study actually looked at ER nurses. So I thought it was kind of a unique population to look at. But in people who were reporting stress related mental health problems, including burnout, the majority of them had significantly lower TSH and T3 levels. Now remember the pituitary and the HPA axis or the HP part of the HPT axis sends out the signal through TSH to have the thyroid release T4 and convert it to T3. Well if the hypothyroid and pituitary aren't functioning well because they've already started to shut down because of chronic stress, then there it's not going to release enough tsh. Potentially another thing that we're going to talk about in a few slides somewhere is that cortisol actually inhibits the breakdown or conversion of T4 to T3. So high levels of cortisol are going to alter thyroid hormones. Low T3 syndrome is a condition characterized by a reduced peripheral conversion of T4 to T3, just like we were talking about in the presence of normal thyroid hormone secretion. So in some people, they may have normal TSH, normal T4 levels, but that T4 is just not getting broken down into T3. And they've associated that in part with high levels of cortisol and other non thyroidal illnesses, including autoimmune disorders. People with autoimmune disorders are much more likely to also have thyroid disorders, and they could be thyroid disorders that are autoimmune or thyroid disorders that are not autoimmune in nature. If you are working with a client who has some autoimmune issue, and it's important that we really familiarize ourselves with the common types of autoimmune disease. Diabetes. Both type 1 and type 2 are now being thought to have autoimmune components to them. Eczema, rheumatoid arthritis, fibromyalgia, Crohn's disease. You know, there's a long list of unfortunately very common autoimmune issues. When people have those, they are at higher risk of low T3 syndrome and or thyroid dysfunction, which can have significant impacts on their mood. About 30 to 50% of people experience inadequate response to antidepressant therapy. Just let that sit in for a second. And we've experienced this. If you've been seeing clients for any period of time, you know that there are a lot of people who start taking antidepressants and they're like that. I don't really feel any different or worse yet, I feel tired all the time. It was bad enough I felt flat, now I feel flat and tired. We need to recognize, and, you know, this is one of my soapboxes that it's important to understand. Number one, which of the neurotransmitters are contributing to the depressive symptoms? Is it low norepinephrine, is it low serotonin, low dopamine? All of the above, Some combination. And what is causing that imbalance? You know, just upping, increasing the duration that the neurotransmitter sits in the synapse? Well, that's all well and good, but if the body is reacting to something else in order to try to maintain homeostasis, eventually it's going to become tolerant Adjust to that antidepressant. So we really want to look at what is the underlying issue that is causing the neurochemical imbalance. One of those things can be hypothyroid or hyperthyroid or, or imbalances in gonadal hormones. You know, there's a lot of physiological things, as well as chronic stress and trauma that can contribute to dysfunction. Irritability, anxiety, mood swings, sleeplessness, restlessness, sensitive sensitivity, and being easily angered are all symptoms associated with hyperthyroidism. Now I learned a new term when I was putting this course together. They call it manic veneer. When people are severely hyperthyroid, it may look manic or hypomanic in nature. As such, they're starting to wonder whether there are a lot of people or some a portion of people who are diagnosed with bipolar disorder, especially people who tend to have prominent hypo, manic or manic symptoms. They're starting to wonder whether those people are having thyroid issues or if the thyroid issues are contributing to their symptoms. Hypothyroidism is associated with depression, fatigue, problems with attention, concentration, memory, perceptual function, language and executive functioning difficulties, weight gain, reduced libido, and reproductive challenges. So hyperthyroidism is associated to, to a certain extent with reproductive challenges as well. If you're working with people who are trying to get pregnant, you know, and they have a thyroid dysfunction, that can be an extremely stressful time for them because the thyroid, you know, they're a part of their own body, may be preventing them or hindering their ability to get pregnant, and that can be infuriating. So we do want to be sensitive to all of the potential consequences of thyroid disruption. Thyroid autoimmunity refers to the detection of thyroid autoantibodies in combination with, with normal thyroid function. So some people can have completely normal thyroid function and they also have thyroid autoantibodies that are detectable in the bloodstream. They can also be have hypo or hyperthyroid and thyroid auto antibodies in their bloodstream. At least 2 to 3% of women have some form of thyroid dysfunction during pregnancy. Important note, sometimes it self corrects, sometimes it doesn't. But it is important to recognize that this can be a clinical issue and it can contribute to mood and cognitive symptoms during and pregnancy and in the postpartum period. 3 to 13% of people, men and women, have thyroid autoimmune disease despite having a normal thyroid function. Kind of let that sink in for a second. Look around your room, look around the cafeteria when you're at lunch. Today. And, you know, on the high end, you know, one in 10 of those people may have a, a thyroid autoimmune issue. The increased prevalence of circulating thyroid auto antibodies has been demonstrated to be much higher, to be correlated with depression, postpartum depression in men and women, and anxiety. It's important to recognize that after, you know, after a child is brought into the house, when an infant is brought into the house, there are hormonal changes that are triggered not only by lack of sleep, but also by having this new life that you're responsible for. And there are significant alterations in men's testosterone levels in that postpartum period and as well as, you know, alterations in the birth mother's hormones. So, you know, postpartum depression is a really interesting thing, but we'll get into that in another class. So let's talk about the gonadal hormones. I mentioned earlier that thyroid difficulty can impact libido. We also know that gonadal hormones, if you were in the class on the hypothalamic pituitary gonadal axis, you know that gonadal hormones significantly impact the availability of serotonin, norepinephrine and dopamine. All of those are, you know, mood related chemicals. Both hypothyroid and hyperthyroid women have been reported to have greater prevalence of menstrual disturbances compared with women who have a normal thyroid functioning. And this is something that we want to pay attention to if we are working with a client who is experiencing premenstrual dysphoric disorder, is experiencing polycystic ovarian syndrome, endometriosis, anything that indicates that the normal menstrual cycle is not functioning as it should, it is important to consider that there may be thyroid involvement as contributing to that. Now, going back, we also know that stress, you know, that HPA axis stress will also impact gonadal hormone levels. Stress will impact thyroid hormone levels. Stress is just kind of a bugger. Total T4 and T3 are positively correlated with estrogen, progesterone and testosterone levels. So when people's thyroid hormones are at a neutral level, we'll call it neutral, then their gonadal hormones are often at a neutral level. When their thyroid hormones are too high, when they've got hyperthyroid, a lot of times you will see that their gonadal hormones are also in excess. They are estrogen dominant, they've got too much progesterone, they've got excessive testosterone. Likewise, when they are hypothyroid, you tend to see lower levels of estrogen progesterone and testosterone. We know that people with that estrogen, when it is high, excessively high levels of estrogen can contribute to anxiety. Excessively low levels of estrogen, as seen in menopause, for example, can contribute to depression. Testosterone is the same way. When it's too high, it can contribute to agitation and aggression. When it's too low, we start seeing a lot of symptoms of depression and apathy. We have to remember that, you know, as those go up and down, so do thyroid hormones and vice versa. Environmental toxins, smoking, obesity, stress, trauma, aging and alcohol consumption, among other things, all impact levels of conatal hormones, which in turn impact the HPT axis. So for example, certain environmental toxins, BPAs, may make estrogen a lot more dominant in somebody's system. Well, if estrogen becomes more dominant, then that follows that likely the thyroid hormones are going to potentially increase. We may see some symptoms of anxiety, agitation, and hyperthyroid alcohol consumption is another one of those that, well, all of these have the ability to alter hormone levels. The importance of that in our clinical practice is when we're doing our biopsychosocial assessment to note these things, educate the individuals about the impact of these different things, environmental toxins, smoking, obesity, you know, yada, yada, on their gonadal hormones, on their thyroid hormones and how it could be contributing to their mood symptoms, and then encourage them to go to the doctor. You know, preferably all clients should go to the doctor and get, you know, a full blood work panel early in treatment to identify any physiological causes or underpinnings of their symptoms. It doesn't mean there's not also cognitive stuff going on. There probably is, but we also want to make sure that the factory is healthy and able to function as well as possible. Low gonadal hormones contribute to depression, sleep disturbances, Alzheimer's disease, schizophrenia and dementia. Now those were things Alzheimer's and, and schizophrenia I was not aware of, but until I did this presentation. But the research is, has shown that it is important because our gonadal hormones, estrogen, testosterone, are neuroprotective. They protect against the excitotoxicity of glutamate. They protect the brain against the toxic environment of stress. When we don't have enough of those gonadal hormones in our system, then the brain doesn't have that protective measure, that neuroprotective thing in there. When thyroid levels are low, gonadal hormones levels will be low, which means neuroprotective substances are also going to be low. High gonadal and thyroid Hormones may contribute to symptoms of anxiety and irritability. We kind of talked about that already. Symptoms of thyroid dysfunction experienced in the elderly are often misinterpreted as signs of aging process, such as fatigue and neurological disorders. You know, the assumption is the person is foggy headed or slowing just because they are aging. The person is tired all the time just because they are aging. It's really important to not normalize some of these behaviors if they are impeding the person's quality of life. You know, if they've suddenly started becoming slower, it's important to have that checked. Hypothy well, thyroid issues, period, whether it's autoimmune, thyroid disease, hypo or hyperthyroid, all of these things can occur at any point in time. There is a significant portion of the youth population that actually has thyroid symptoms or thyroid dysfunction. So if we're working with youth who seem to be sluggish, who seem to be not developing as quickly as they should now generally the doctor will pick up on that one. If they seem to have excessive symptoms of depression and anxiety that may have a, some underpinnings in their physiology, you know, it's always helpful, you know, just screen it out. No harm, no foul. The present prevalence of hyperthyroidism in individuals over 60 years old ranges from 1 to 15%. Now this part I found really, really interesting because we think of hypothyroid, we think of slowing, we think of difficulty completing sentences, slower thinking, slower movement, depressive symptoms, and you tend to think of those things as being predecessors to dementia. But you would be wrong. You would be very wrong. In actuality, they found that people with lower levels of thyroid hormones that are still within the normal range or very mild hypothyroid tend to actually have longer lives than people who have hyperthyroid. Higher thyroid hormone concentrations are associated with increased frailty and decreased functional capacity. In patients over 65 years old, subclinical hypothyroidism was associated with reduced risk of dementia, whereas hyperthyroid thyroidism, particularly elevated T4 was associated with increased risk of dementia. So when we have high T4 levels then, and people with hyperthyroid, it tends to for some reason increase problems in the people who are in, in people who are older. And the only analogy that I could really come up with is, is, you know, when you are, when you have hyperthyroid, think of it like running a car really, really hard. You know, you are just, you're flooring it every time you're driving it. You, you know, jump off the line, you screech to a stop, you are driving it really hard so that that car is probably going to wear down sooner. You're, you're putting a lot more stress on it. People with hyperthyroid, because their system is running faster and harder, so to speak, may be more at risk for, you know, frailty and decreased functional capacity. Hyperthyroidism and hypothyroidism have been shown to be associated with oxidative stress and inflammation. Now the, the way they cause it is different, but the take home, you know, the thing that you really care about is that thyroid dysfunction is associated with increased oxidative stress, which we know contributes to the development of a variety of diseases, including cancer and inflammation. Now we also know that depression is associated with increased inflammation. So as inflammation goes up in the body, the risk of depression also goes up. People with hyperthyroid or, well, either one, people with thyroid dysfunction, and that systemic inflammation as a result are at greater risk of depression. And those with depression often have systemic inflammation. Treating the thyroid issue, if there is one, can help reduce that systemic inflammation, which can be, be complementary to their treatment. You know, a lot of times for people just fixing their thyroid hormone levels isn't, doesn't do everything, but it is, it's an adjunct, it helps. It's kind of like, we'll go back to the car analogy. It's like having the oil, you know, good oil put in as well as good. You know, I shouldn't use a car analogy because I don't know much about them, but having all of the fluids changed and the tires rotated and everything, having that full tuneup done is a lot more effective at making sure that your car keeps running and doing what it needs to do than to just occasionally change one thing or the other. You know, if you go in and you change everything, then you're starting out with you on, on a more even keel because we know that everything is new. Hypothyroidism is associated with obesity. Well, when your thyroid is low, it means your base metabolism is lower. It means you. Typically people who are hypothyroid feel depressed, they're apathetic, they have low energy, so they don't move as much. So hypothyroidism is associated with the development of obesity and chronic stress, which are associated with increased estrogen. When our obesity, when our lipid levels go up, when our fat percentage goes up, our estrogen levels go up. And this is true for men and women. Estrogen increases with fatness now, not weight in general. If you're one of those big, you know, 300 pounds bodybuilders that you know is 6% body fat or something. You know, that's different. What we're looking at is body fat percentage. As that goes up, estrogen goes up. When estrogen goes up, there's an increase in secretion of pro inflammatory hormones and cytokines which again increases inflammation. And it is quite a cycle that, that we need to take a look at and we'll talk about that at, in just a minute. Serotonin. Let's take a look at how thyroid hormones interact with our neurotransmitters though because you're, most of us are familiar with the big five serotonin. That's the one that we typically think of for depression. But serotonin is also involved, remember in appetite. Appetite, pain regulation, energy levels, heart rate, blood pressure, gastric motility. You know, I think serotonin is involved in just about every bodily function there is. Serotonin is positively correlated to T3. So as your T3 goes up, serotonin goes up. If your T3 gets too high, serotonin may get too high and then you have symptoms of anxiety. We know high levels of anxiety are associated with or high levels of serotonin are associated with anxiety. We know high levels of thyroid hormones are associated with hypomanic anxiety like symptoms. Norepinephrine is another excitatory neurochemical. It also is your main, one of your main focus neurochemicals. It helps you, you know, maintain your focus and your concentration during the day. It is also positively correlated to T3. So when people are hypothyroid, when they have really low levels of T3, they may have foggy headedness, difficulty concentrating, low attention. When they have high levels of T3 they may be like laser focused. Remember again that cortisol inhibits the conversion of T4, 2, T3. So when people are stressed then their body may have enough TSH to trigger the release of T4 which is all wonderful but that cortisol may be may prevent the body from converting the T4 to T3. So the person has that T3 syndrome that we were talking about. So we do want to really understand the nefarious effects of cortisol acetylcholine. We talked about that a few days ago. Is one another one of your excitatory neurochemicals. It as well as glutamate, which is your main excitatory neurochemical, are positively correlated with thyroid levels. Now we did talk a couple weeks ago with about glutamate. When glutamate levels, when your excitatory neurochemical levels get too high, you can think of excitatory in terms of heat, if you will. So when you're in excitatory neurochemicals get too high in the brain, it becomes too hot, it becomes excitotoxic is what they call it. And you start losing dendrites and axons and, you know, nerve cells start to start to dissipate. So it's important to remember that, yes, we need a certain amount in order to be energized, in order to be excited, focused, all of those things. We need to have neutral levels of these, of these chemicals in our body. When they're too low, we have depressive symptoms. When they're too high, we have anxiety and neurotoxic symptoms. When we have that neurotoxicity and we start losing brain cells, and literally, then it also contr. Is also another reason that contributes to the development of cognitive issues later on. The longer that persists, the more mass people lose in their brain, the more difficulty with certain cognitive functions they have later on. Now, GABA is an interesting one. Gaba, remember, is our relaxation hormone or neurotransmitter. I'm sorry, it is a. Our body's natural volume. So it would make sense, and it does. Our body really makes sense when you think about it logically. GABA inhibits thyroid hormones. Gaba doesn't want TSH to be secreted and T4, which is to, to be secreted. Remember, thyroxin is a stimulant. It's an excitatory hormone. So GABA tells the body, no, we don't want to be excited right now. We want to relax. So GABA actually inhibits thyroid stimulating hormone, which inhibits the release of T4 and T3. So it's interesting to take a look at and think about what might be going on that is contributing to this person's mood issues right now. If their GABA levels are too high for some reason, and we can see that in opioid overdoses, for example, then they may not have the level of secretion of thyroid hormone that that's necessary. So we do want to be curious sometimes. You know, Remember I said 30 to 50% of people don't respond to antidepressants thoroughly or as well as hoped or whatever, whatever the phrase was. But if you throw a ssri, for example, at a person and they start taking it, you know, SSRIs are designed to keep the serotonin it's not designed to produce any more serotonin. So they're not increasing serotonin levels. It's designed to keep the serotonin in the synapse for longer. They found that your typical antidepressants, your SSRI, your SNRIs, typically don't impact thyroid levels at all. Therefore, if somebody is experiencing depressive symptoms because of their thyroid dysfunction, not because of serotonin dysfunction, then they may not have the hoped for response from the antidepressant. They may still need to have that thyroid adjusted. Two others that are interesting to think about, your endocannabinoids are another very, very much under misunderstood or under understood set of receptors in your brain. These are the ones that respond to you. Got it? Cannabis. But we have endocannabinoids in our body. We have natural chemicals that bind to those cannabinoid receptors, just like we have natural chemicals that bind to the opioid receptors. And those are our endorphins. So endocannabinoids inhibit thyroid hormone release and through the effects on the hypothalamus and the pituitary gland. So let's think about. Well, let me say the other part first. Thyroid hormone status also modulates the endocannabinoid system. So it's a two way interaction. Hypothyroid reduces the effectiveness of cannabinoid receptor agonists. So let's go back to the first one. Cannabinoids inhibit the release of thyroid hormone levels. Okay. Or thyroid hormones. So if you have someone who is already depressed and they start using cannabinoids, and that can be CBD or cannabis itself, they may experience increases in depression if their mood symptoms are being caused by thyroid dysfunction. Now, if their mood symptoms are not being caused by thyroid dysfunction, you know, they may have a very good reaction to it. There is a lot of information out there about how CBD can help with certain types of depression. But we do want to recognize that cannabinoids, that THC often increases anxiety and may contribute to other mood issues. But we do want to recognize that we don't understand enough about how these receptors work. But we do know that your, your can have endocannabinoids, your natural cannabinoids do impact thyroid hormone levels. And then hypothyroid, when somebody doesn't have enough thyroid hormone, it reduces the effectiveness of cannabinoids like THC and cbd. So when people take those, it doesn't have as much of an impact on them as if they had normal thyroid levels. So that's Another just kind of interesting thing, especially with cannabis becoming more and more legal and CBD oil being used a whole, whole lot more. Dopamine, our motivation chemical, is positively correlated with T3 levels. And this is another really interesting quirk, I guess, of our body. People with Parkinson's and RLS may have hypoth hyperthyroid levels. Dopamine goes up with T3 levels going up. People with, or, I'm sorry, hypothyroid levels, I always get that backwards. People with Parkinson's and restless leg syndrome don't have enough dopamine. So if they're hypothyroid, they may have a lot of movement type issues that you don't see or that you wouldn't see if their thyroid was adequate. People with schizophrenia have too much dopamine. Antipsychotics bring down dopamine. So people with schizophrenia may have hyperthyroid. You know, we want to make sure that we're addressing all of the reasons for their symptoms, not just their dopamine levels, but what's triggering those excess dopamine levels and is there anything else triggering those excess dopamine levels? So the take home is if you're working with somebody who has a condition that is contributed to by dopamine levels, you know, too low, like Parkinson's, rls, something that has movement disorders in it, or schizophrenia, where, you know, dopamine levels are typically too high, we want to make sure that their thyroid levels are evaluated. Additionally, and I'm going to say this again at the end, but additionally, people who are on tricyclic antidepressants and antipsychotic medications need to be aware of the fact that it those medications, because they are interacting with the dope with dopamine levels, can contribute to thyroid problems. Now, there's another condition that, you know, there was no neat place to put it in where it segued nicely. But thyro stress is a condition that's actually being studied now. And it's similar to diabetes stress, evidently. And it's defined as an emotional state characterized by extreme apprehension, discomfort or dejection caused by challenges and demands of living with thyroid disorders such as hypothyroidism. So let's think about it for a minute. What are some of the challenges somebody with hypothyroid might face? Well, hypothyroid is strongly associated with things like pcos. Polycystic ovarian syndrome. Polycystic ovarian syndrome produces symptoms such as obesity, oily skin, acne, excessive hair, facial hair growth, losing, thinning and Losing hair on the head. So PCOS can make people very self conscious. Hypothyroid contributes to low energy, which even if it doesn't contribute to pcos, may contribute to low libido and weight gain. That low energy can also inhibit people's desire to go out and interact with others, which can put a strain on their relationships. They may not have the energy to go on a three mile hike with somebody. You know, they may have the energy to go to the library or go out for coffee, but that may be all that they can handle. And it's hard for people, their significant others potentially to understand that the person's not being lazy. The person's, you know, it is, they actually don't have the gas to get them going. Their, their, their gas tank is much lower. Affectively, people with hypothyroid tend to be more depressed and tend to have, you know, some flatter emotions. Cognitively they tend to process things more slowly because everything's kind of going slower. Occupationally, it may negatively impact them at work because of their reduced stamina, because of their difficulty concentrating, it may cause difficulties, you know, no matter what their job is, all jobs require some amount of focus and stamina in some way. And interpersonally, as I mentioned earlier, a lot of people don't understand the far reaching impact of thyroid imbalances. So it's important to educate the client and preferably the community, but at least educate the client about, you know, the realities of, you know, the importance of thyroid hormones and normalize why they're having the symptoms they're having. So they feel like, okay, now I understand why I feel like this and they can explain it to others. Um, now going back through real quick, hyperthyroid people have physical challenges because they are more agitated, they are more restless, they have difficulty sitting still, they have sleep problems. You know, none of those things is to be minimized. Sometimes people joke and think, you know, wow, it would be great to have that much more energy. But it's not, um, lack of sleep, even if it's caused by hyperthyroid, contributes to stress on the body, which contributes to reduced immunity and a cascade of effects that we see as a result of sleep deprivation. Affectively, people with hyperthyroid may tend to feel, you know, up more, but there also tends to be a lot more agitation, mood swings, anxiety and irritability. Cognitively, people with hyperthyroid often feel like their, their thoughts are just kind of racing and also have difficulty focusing, but for that reason, not because they're think having slower processing but because they feel like they're, you know, going that much faster and they have, you know, monkey mind occupationally, people with hyperthyroid tend to do better at focusing on what they're doing. They can get things done more quickly, but they may have more interpersonal difficulties because of their mood lability, their irritability and so forth. So interventions. Proper functioning of the thyroid gland requires iodine, selenium, iron, zinc, copper and calcium. I can tell you I am a vegetarian, I'm not a vegan. You know, I love my eggs and my milk but I don't eat beef and, or I don't eat meat at all or fish and it is hard to get all of my zinc in without taking a multivitamin. I'm not encouraging people to take multivitamins, you know, that's between you and your doctor, but I am encouraging you to be aware of what vitamins and minerals you're not getting efficiently in your daily diet and, and to be cognizant of some of these things. I mean, we think of, you know, vitamin A, vitamin C, vitamin D vitamin, your B vitamins, but everything else kind of gets forgotten about and we need these things. We need selenium, iodine, iron and, and zinc, copper and calcium in order for the thyroid to function effectively. Recent studies have revealed the emerging role of excess uptake of lipids fats in the development of hypothyroidism. They're not sure how that works yet or why it happens, but they have started doing studies and finding that people who ate a higher fat diet tended to have hypothyroid. Now we can speculate that it could be, you know, chicken or the egg sort of thing. People who have hypothyroid may gravitate towards higher fat diets because fat ingestion tends to trigger high fat and high sugar foods tend to trigger the release of dopamine and serotonin. Someone who is hypothyroid is probably going to have low levels of serotonin and dopamine. So it could be almost a self medicating thing or it could be as the article that's linked to here suggests, it could be that the ingestion of high fat diets contributes to hypothyroid thyroidism. So we don't know which way it works, but we know there's a correlation. Monitoring patients on lithium antipsychotics and tricyclic antidepressants are all important because they can all contribute to hypothyroid lithium. I, I haven't worked in Community mental health in a few years now. But when I was there, lithium was still a pretty prominent prescription. So don't think that lithium's one of those, you know, first generation drugs that nobody uses anymore. Same thing with tricyclic antidepressants. Unfortunately. One trend I did see a lot of was the use of antipsychotics and atypical antipsychotics in patients who didn't have a psychotic disorder. They were used as sleep aids. And so we do have a lot of people out there who are taking antipsychotic medications, you know, altering their levels of dopamine and potentially contributing, causing themselves medication induced hypothyroid, making sure that they are just getting monitored. You know, obviously what drugs the psychiatrist prescribes or the primary physician prescribes is between them and the client. But encouraging clients, especially if they're starting to feel sluggish or starting to have any of the symptoms of hypothyroid, encouraging them to, you know, just get a blood test done. Effective treatment of thyroid abnormalities may also reverse cognitive issues, especially in, you know, especially when it's not related to a psychotic disorder. If you've got someone who is experiencing either confusion and difficulty focusing because of hyperthyroid or excessive slowing of their thoughts because of hypothyroid, a lot of times when those, that thyroid hormone level is normalized, people start to feel a lot better and think a lot more clearly. It is not going to reduce reverse dementia, it's not going to reverse Alzheimer's, it's not going to reverse something that is caused by neurodegeneration. But what we, what they have found is that, you know, they can at least stop what's going on. And the hormones themselves actually contribute to some of the cognitive issues. And when those hormones are brought under control, then it's almost like the, the screen is lifted and, and people can think more clearly. It's important for us as clinicians to not only address thyro stress, but to also address trauma and chronic stress to help people reduce cortisol and regulate their HPA axis, their threat, threat response system. Once they are able to reduce that and regulate their cortisol levels, then they don't have that nasty little cortisol in there causing problems and keeping T4 from being converted to T3. And they don't have the other problems associated with hypo associated with HPA axis or HPT axis dysfunction. So cortisol, again, we need a little bit of it to give us energy, to give us motivation to help us get out of the bed in the morning. It's supposed to peak in the morning and, and be at its lowest level at night. If it is at this, you know, steady state level all day long, all night long, then we know that it is probably impacting those other systems and the availability of both gonadal and thyroid hormones. Sobriety is another helpful tool for addressing thyroid problems. Sobriety helps address the dysfunction in the hypothalamic pituitary thyroid axis in alcohol dependence. Alcohol is so potent, toxic, whatever word you want to use on the thyroid, that they found that people who are alcohol dependent often have a lot of difficulty, a lot of imbalance in their thyroid hormones. Alcohol also contributes to systemic inflammation. So a lot of people who are alcohol dependent also evidence the autoimmune thyroiditis. Adequate quality sleep and circadian rhythm regulation are also important because they also influence thyroid levels. So that was another thing that when I did the presentation on circadian rhythms, I said, the circadian rhythms are involved in just about every function of your body. Well, this is one of those they're involved in. When people circadian rhythms are off because of shift work disorder, because of travel, because of, you know, having a new baby at home, whatever it is, it's likely going to impact their thyroid hormone levels. So we do need to emphasize the importance of sleep hygiene. And people with sleep apnea. Anybody you're talking to who reports that they quote snore a lot may need to be referred for a sleep study because sleep apnea is going to inhibit or disrupt the circadian rhythms. Sleep apnea is also associated with higher levels of depression, higher risk for stroke, and a whole bunch of other and, and later life dementia. So there's a lot of reasons to get apnea assessed and treated as quickly as possible. There is no easy way to break this cycle of, of, you know, low serotonin, low thyroid. All that except for, you know, kind of starting at the beginning and getting the body, you know, if the thyroid hormones are out of whack, you know, start there, you know, try to get the thyroid hormones normalized. That may work to help normalize serotonin and go nadal hormone levels. If not, then a lot of times, integrative health physicians will, you know, start with, okay, thyroid, we've got that stabilized. It hasn't done everything. What do we want to treat next? Do we want to address the gonadal hormones or, you know, start on an antidepressant? So there are steps and stages to figuring out what to get the, how to get the body working Most efficiently effectively address those physiological issues as clinicians at the same time, you know, the doctor's doing their thing. But at the same time, as clinicians, we can help people reduce their stress. We can educate them about, you know, where their symptoms may be coming from. We can educate them about sleep hygiene and the importance of good nutrition and reducing alcohol consumption, if not complete sobriety. So we can help them start working on some of those issues. We can also help them develop a lot more mindfulness because you know, they're coming to you, they feel flat, they feel depressed. Well, if they've got hypothyroid flat depressed, you know, they're go not have no libido. They're if, if you're dealing with a female, their, their monthly cycle may be painful and problematic and you know, even more chaotic than, you know, what they would hope they would have to deal with. So we want to help them be mindful of what's going on right now and note on a day to day basis what's going well. You know, obviously also anything that's going worse. But to note even if it's just on a scale of 1 to 5, how the day was so they can start looking to have better days more frequently, they're not going to go from having all bad days to all good days. Poof. You know, we know this, but we do need to help them start noticing those gradual improvements in, in their status and be cognizant of the changes that produce those improvements so they can keep doing those changes. And it is, you know, really interesting at, you know, we tend to think of aging as something that is going to cause, you know, problems. But a lot of the problems people experience in aging may be due to changes in their gonadal hormones, which for men and women drop precipitously one after the age of 35 and, and thyroid hormones. And if those are balanced out, the quality of life may improve dramatically in and the mood. So anyway, thyroid is really closely intertwined into mood and neurotransmitters. So please, you know, consider it when you are doing your screening for, with clients to make sure that we're addressing all of the causes of their mood and or cognitive issues. Have a great day and I will see you on Tuesday.