Thyroid Trouble: The Hidden Root of Low Energy, Mood & Brain Fog

Foreign. I'd like to welcome everybody to today's presentation on stress, thyroid hormones and mood. I'm your host, Dr. Donnelly Snipes. Today we're going to identify the connection between thyroid hormones and mental and cognitive health, learn about the impact of autonomic nervous system imbalance on the HP axes. We'll identify some helpful blood tests and explore the connection between what we will call a trauma, organized nervous system and RT3. Then we'll explore the interaction between thyroid hormones and the availability of neurotransmitters, gonadal hormones, etc, and finally move on to practical strategies for nurturing that thyroid axis to help the person live their rich and meaningful life, even if they have some sort of thyroid issue. So what is the thyroid? I mean, a lot of us have heard about hypothyroid, but, you know, have we really? Do we really know what it is? The thyroid is an organ, and the thyroid hormones support normal brain functioning as well as energy. In our body, thyroid dysfunction causes both mood and cognitive symptoms. Because thyroid hormones influence brain metabolism and neural communication, it influences how fast we send signals or if we're sluggish. And our brain uses about 20% of our blood glucose every day. Our brains are big users of blood glucose. So if our thyroid is not helping the body release blood glucose, then we may have some problems. Hypothyroid, or slow thyroid, is associated with higher rates of depressive symptoms, low energy, slow thinking and memory and attention problems. Everything is just sluggish. Hyperthyroid or high thyroid can present with anxiety, irritability, restlessness, sleep disruption and emotional ability, sometimes mimicking primary anxiety or mood disorders. Sorry, y', all, I had to move my cat. I couldn't read through him. Okay, so let's talk about thyroid hormones and mental health because we see a lot of people in clinic who present with anxiety or depression, and they don't show a lot of progress in terms of their energy levels in ter, sometimes in terms of their mood or their pain. Thyroid imbalances, particularly hypothyroid, are associated with increased pain perception and increased irritability of those pain receptors. So it's important to recognize that a lot of these symptoms, symptoms that people talk about, especially the, the somatic symptoms, and that people talk about when they've got depression, may be correlated to thyroid imbalances. Likewise, high stress, chronic stress, trauma developed stress, being hypervigilant with sympathetic dominance all the time, that can also throw thyroid hormones out of whack. So everything's bidirectional. However, we do know that 30 to 50% of patients experience inadequate antidepressant response. Because there's a lot of things. It could be nutrient deficiency, circadian rhythm disruption, or one of the ones that's really easy to test for is whether their thyroid and their thyroid hormones are imbalanced. If people are having thyroid problems, and we're going to talk more specifically about it later, but if the thyroid's out of whack, they can experience ir, irritability, anxiety, mood swings, sleeplessness, restlessness. If it's hyperthyroid, and if it's hypothyroid, we often see depression, fatigue, difficulty concentrating, difficulty with memory and perceptual function, difficulty with language and executive functioning. Think about when you're really, really, really sleep deprived and you know, it's really hard just to think and do okay. That can be the result of severe sleep deprivation, but it also can be similar to what a lot of people with hypothyroid experience. People with hypothyroid, because the thyroid also helps manage our energy utilization, also often struggle with weight gain and it impacts our gonadal hormones. So they experience reduced libido and reproductive challenges. So there's a lot of somatic symptoms that we often attribute to depression or anxiety that may be caused by something else. And no amount of talk therapy is going to alter the some of these things, especially if they have, for example, autoimmune thyroiditis. Autoimmune thyroid, thyroid diseases like Hashimoto's and Graves disease are tied to increased depression, anxiety, and cognitive complaints even when hormone labs are near normal, suggesting immune inflammatory effects on the brain. So one of the things that we're going to talk about when we get to blood tests is testing for interleukin 6 and, and CRP C reactive protein. Both of those are blood markers of inflammation. Because if the thyroid labs are normal and the person is still experiencing symptoms, there's maybe something under the hood causing it. It could be cognitive, it could be environmental, or it could be something else. And if we can identify what is precipitating or help them identify what's help precipitating the inflammation, then we can address it. If it's cognitive, that's something that's in our lane as therapists. If it is medical, then that's something their doctor can work with them on. So basically, how does the thyroid impact or play into the stress response? We talk a lot about the stress response as the HPA axis, the hypothalamic pituitary adrenal axis. And yeah, that's kind of Your main stress axis, but it recruits its buddies, the HPT axis, the hypothalamic pituitary, thyroid axis and HPG axis, hypothalamic pituitary, gonadal axis. Now why do we have the HP for all of these? Because it all starts out with the hypothalamus and then it sends signals to the pituitary and then the pituitary kind of sends other signals out. So there's a stressor, any type of stressor in any piece of life that triggers that stress response. It can be pain, it can be illness, it can be high blood sugar or low blood sugar, cognitive stress, it doesn't matter, triggers the stress response. The hypothalamus activates and signals the pituitary and the gonadal axis. Okay, well cortisol, our main stress hormone, when it's secreted, suppresses gonadal releasing hormone. This is the hormone that, you know, triggers the release and attachment, if you will, of gonadal hormones. So we see the gonadal axis automatically jump into function when there's a stressor. The body says, hey, there's a threat out here, not time to procreate. Cool. Now gonadal hormones are responsible for a whole lot more than procreation. But for this purpose right now, let's just say the body says not the time to procreate. So gonadal hormones are suppressed, estrogen, testosterone, etc. The pituitary releases thyroid stimulating hormone. This is the hormone that tells the thyroid to start secreting T4 and which is then converted to T3, which is great. And the pituitary also activates the adrenal glands which release cortisol. So all this happens in a fine tuned symphony, if you will, to make sure that everything is doing its job. When the stress is passed, then the thyroid stimulating hormone kind of backs off. So we're not releasing as much T4 and everything stabilizes. It's all wonderful when stress is ongoing. And for people who have a history of trauma, whether their diagnosis is ptsd, generalized anxiety, cptsd, borderline personality, you name it. If they've got a history of trauma and they can, can currently still feel somewhat unsafe and disempowered, then they may have ongoing stress and under the hood, ongoing hyper vigilance. That's stress, that's I don't feel safe, I'm going to scan constantly. When this happens, the body says, yeah, we need to conserve from some energy for when we actually need to fight or flee. So it hits what we call the metabolism Breaks, if you will. And that is reverse T3. Reverse T3 shows up and starts breaking down, or, yeah, breaking down T3. So there's not so much in the system. It says, you know what, I'm glad you're here to help. You know, I'm glad you're kind of revved up and ready to go, but not right now. We need to conserve some energy. So RT3 kind of steps in and overrides everything that's going on and says, no, no, not right now. Unfortunately, that means there's less T3 available and the person starts feeling hypothyroid. So you're going from rev to survive or rev to run to slow down for safety, slow down to conserve. Chronic stress is associated with both hyper and hypothyroidism and related to increased estrogen, oxidative stress and inflammation. We know that under chronic stress, people may start initially having a lot more cortisol in their system, and then the cortisol receptors start saying, no, you're overstimulating me. I can't, I can't. I just can't pay attention. So they become glucocorticoid resistant. The cortisol starts losing its ability to do the things that it does, like rev us up and suppress inflammation. So one of the things we start to see in people who have chronic stress is that they have more inflammation, they have more oxidative stress, they have more pain. And as that goes up and as inflammation goes up, interestingly enough, the body perceives that as a stressor and thyroid tends to go down. Depression and anxiety are both associated with increased inflammation. And we're going to keep coming back to this theme because it's kind of what I want want you to take home today. So what are these thyroid hormones we talk about? It's actually pretty simple. You have tsh, thyroid stimulating hormone, which tells the thyroid, hey, release the thyroid hormones, open the gates. So then T4, which is thyroxin, is the main high thyroid hormone and it's released. All right, well, unfortunately, T4 is inactive. It just kind of sits there and the body goes, well, what do I do with this? T4 has to be converted into T3 in the gut, the liver and the kidneys. So you can see where one of the first problems might happen. If somebody has a disrupted gut microbiome, they're going to be less efficient at converting T4 to T3. If they have kidney or liver problems, they're going to be less efficient at converting T4 to T3. So you have this Thyroid hormone, that is basically the raw product you need, but it's inactive and it has to be converted to T3. But if all of the converting mechanisms are less than optimal, it's not going, the person's not going to make enough T3 or as much as they need. So these are some things that they can look at in terms of nurturing their thyroid system, making sure that they are taking care of their gut microbiome with an anti inflammatory diet, probiotics, prebiotics, which is fiber that can help a lot, and talking with their doctor about anything else they can do to heal their microbiome. We know the microbiome changes under stress, even if you're doing all those things, good things for it, probiotics, prebiotics, etc. If you're under stress, the PH of your gut changes and then your stress microbes, if you will start to proliferate. So healing the microbiome is not just about diet, it's also about stress management and healing that parasympathetic nervous system, helping the person get to the point where they're mindful, they notice when they're starting to feel stressed and they can trigger that relaxation response. Kidneys and livers naturally become less efficient with age. So your older adults tend to have more problem with thyroid imbalances, which is why a lot of older adults are on thyroid medication. Interestingly, the range is pretty big for both hyper and hypothyroid. T4, as I said, is inactive until it's converted to T3. And T3 increases metabolism, blood sugar and energy consumption. So that's really when you start getting the fuel to help you go, to help you think, to help you fight or flee. Now, RT3 doesn't naturally just show up. RT3 shows up as a metabolic break when T3 has been, is too high, when there's too much thyroid stimulation going on for too long and the body says no, we need to go into conservation mode. And a lot of people that we work with who have trauma histories or generalized anxiety, they get to a point where feeling depressed. One of the reasons could be they were so stressed out for so long that their nervous system has adjusted and downshifted into a conservation state and that will impact their thyroid hormones. However, the doctors normally do like a TSH and a free T3 and a free T4 and that may show up as normal. They really need to also look at the, that reverse T3 and see if they've got that bugger coming in and breaking down the T3 before it can do its job. T3 tests are most useful for diagnosing hyperthyroidism. Not as useful for hypothyroidism, especially without also looking for looking at reverse T3. Reverse T3 indicates that persistent stress and metabolic breaking and even with normal levels of T3. So if your body's saying we're not going to use as much energy, we're not going to use as much blood sugar, we're going to put a break on your metabolism, think about how you're going to feel it. It doesn't feel good. Thyroid stimulating hormone tests detect whether the thyroid is being triggered to release T4. Well, that's important, but not what happens after that. So just like neurotransmitters, we stimulate the release of a hormone or a neurotransmitter. Okay, that's the first part of the process. Does that happen? Well, if it does great, TSH is fine, then does enough. In this case, T4 gets secreted. If the T4 free T4 levels are adequate. Great, that's, that's wonderful. But then how Effectively is that T4 broken down into T3? If everything's functioning well and T4 is efficiently getting broken down into T3, that's fabulous. So your T3 is probably going to look fine. But then if you look at that RT3, if you've got somebody with chronic stress and this can be chronic pain, this can be trauma, you're often going to see an elevated RT3. So it's breaking down that T3 before the body can use it and contributing to. I haven't gotten there yet, but non thyroidal, Non thyroidal inflammatory syndrome, which is basically saying people are presenting with hypothyroid symptoms even though the labs that they typically run look pretty normal. Acute stress activates the thyroid axis. All right, we already talked about that. But prolonged stress suppresses activity. So you have that resistance and breaking. And I'm going to say that a couple more times today because it's so important for us to put into perspective when we are working with people who have been anxious, stressed, traumatized, feeling unsafe and powerless for an extended period of time. Eventually the body tries to protect itself by going into a breaking. And, and when I say breaking, I mean like your car breaks. B R A K E Significantly lower thyroid stimulating hormone and T3 levels. And higher RT3 levels have been found in populations reporting stress related mental health problems. Now we can understand why. However, you know, it's a, unfortunately is a downward spiral because when RT3 is high and T3 is low people feel depressed, people feel stuck, people feel maybe get angry because they don't. They feel helpless and hopeless, which triggers more stress, which further suppresses the thyroid axis. So it's a downward spiral that we need to address. And one of the things that is really important in my opinion, is educating our clients about all of the different things that are going on in a stressed person and all of the different avenues we may have to address it. Antidepressants. As I already said, Only 30 to 50% of people really feel significant improvement on them. So we want to take a look and go, hmm, you know, because a lot of people think when they're depressed, the, the only thing to do is throw an antidepressant at it. No, that's actually not it at all. Let's look at some other things. Let's consider other things that are causing fatigue, increased pain, low mood apathy. Because thyroid hormones impact availability of gonadal hormones which impact the availability of. Drumroll please. Neurotransmitters, including dopamine, hyper and hypothyroidism are stressful on the body. And when people have one or the other, it's associated with increased oxidative stress and inflammation in the body. And we know that inflammation is a stressor which is going to further throw things out of whack. Glucocorticoid resistance also keeps inflammation high. When cortisol loses its ability to suppress inflammation because the person is has been too stressed for too long, basically then we start to see more systemic inflammation. A lot of times people will have high levels of cortisol in their bloodstream, but again, they're showing glucocorticoid resistance. Why? Because they have a lot of it floating around, but it's not triggering the receptors. Think about it from the point of view, or using the analogy, if you will, of alcohol. People with who have been drinking alcohol for a long time and high amounts can drink a lot of alcohol and really not show much in the way of symptoms. People who don't drink alcohol much or at all and then they have a drink, they feel symptoms because their receptors are receptive. So people who are chronic alcohol drinkers tend to be able to have a whole lot more alcohol floating around in their system before it really feels like it does anything. Glucocorticoid resistance keeps inflammation high. High inflammation plus cortisol suppress the thyroid hormone and push thyroid meta metabolism toward low T3. So it's not converting T4 to T3 as well. It's suppressing TS thyroid stimulating hormones. So not as much T4 is even getting out of the chute. And if it's chronic, then the body's also secreting reverse T3 to break it down. In chronic trauma states, cortisol output may stay high but its breaking effect is reduced leaving inflammation and stress physiology just clicking along. Non thyroidal illness or non thyroidal illness syndrome or sometimes called low T3 syndrome is a stress illness pattern where the body makes less active T3 from T4 and often more RT3 so the cells get less usable thyroid energy. Even If TSH and T4 look normal. Which is why if and and doctors generally the if they're going to run thyroid at all, a lot of times it's TSH only or TSH and and free T4. Some will go as far as TSH, free T4 and free T3. But most of the time they need to be encouraged by the patient if the patient has a history of chronic stress to also look at the RT3 if they are exhibiting signs of significant depression, hypothyroid or chronic diffuse pain and circadian rhythm disruption. How many of our patients fit that? Especially our patients that have the diagnostic criteria for depression. Chronic HPA axis activation also increases inflammatory signaling which further suppresses T4 to T3 and promotes RT3 production, amplifying fatigue, low mood and cognitive slowing. If your metabolism drops and your body's use of blood sugar drops, remember I said the brain uses about 20% of our blood sugar. Guess what? It's going to slow the fuel to the brain too. So everything's going to slow down. Well think about people who are experiencing moderate to major depression. What does their cognition look like? Is it slowed? What does their motivation look like? What does their energy level look like? What do their circadian rhythms look like? What's their pain like? And yes, I know pain is not in the DSM diagnostic criteria, but most people with moderate or major depression will also complain of aches and pains and their body feeling like it's super heavy. Stress related disruption in the HPG axis, the gonadal axis can shift thyroid thyroid set points and responsiveness because sex, steroids, estrogen, testosterone modulate HPT thyroid axis sensitivity. So when our go nettle hormones get wonky for some reason it impacts the thyroid. There are I believe the statistic is somewhere around 20% of people may develop of women may develop hypothyroid when they're pregnant or immediately after giving birth. And that's something to take a look at, especially if you're working with somebody who's got postpartum depression. Let's get that thyroid checked. Because the hormones are poof, all over the place postpartum. And that can contribute at least temporarily to thyroid imbalance. The thyroid is tightly linked to the autonomic nervous system. When we feel stress, it triggers the thyroid axis to help us get that sugar that we need for the fight or flea. It's also tightly linked to hpa, the stress axis, the hpg, argonadal axis, and the HPT axis. Well, the thyroid is the HPT axis. I guess that was kind of redundant. Anyway, chronic dysregulation in any one of those systems can cause dysregulation in all of the rest of the systems. So it's important to understand that since a lot of the people that we're working with have some level of sympathetic dominance or dysregulation of their autonomic nervous system, their sex hormones and their thyroid hormones may also be less than optimal. They may still be within that, quote, normal range. But are they at the optimal range for them? Not. We can't diagnose that. We're not medical doctors. But we can encourage them to talk with their physician about that. Chronic prolonged stress and illness and sympathetic dominance cause sustained high cortisol, which lead to increases in RT3. Clinically, this can look like depressed, flat, foggy, exhausted, and even irritable. Even if TSH and T4 and sometimes even T3 appear normal. The ANS, HPA, HPG. So dysregulation of the body can create a functional thyroid energy problem without a classic primary thyroid disease. Because in primary thyroid disease, a lot of times you expect to see insufficient TSH or low T4. But in primary thyroid disease, in, in primary thyroid disease, but in non thyroidal illness syndrome, you may, those numbers may be very normal and, but the person is still experiencing symptoms. That's when we start looking at the other stuff. Neurotransmitter imbalances can also alter gonadal and thyroid hormones and vice versa. Thyroid imbalances can alter neurotransmitter availability and those gonadal hormone levels. A lot of our neurotransmitters are regulated by the stress response. When we're stressed, we get more glutamate, we get more norepinephrine, we get more adrenaline. You know, we're fighting, we're fleeing, we're angry, we're anxious. When we are relaxed, we get more gaba, we get more serotonin. Dopamine shows up both places. But it's important to understand that all of this works in a symphony. When thyroid activity is low, the liver makes less sex hormone binding globulin, the main carrier that regulates how much testosterone and estrogen are available in circulation. So people with thyroid hypothyroid have less of this stuff circulating through their body to make those gonadal hormones available. Even if the gonadal hormones are being released, if they're not binding and getting where they need to be. Not helpful. Gonadal hormones, testosterone, progesterone, progesterone, estrogen, are integral in the availability of neurotransmitters and serve neuroprotective functions. So it's not just gonadal hormones are not just about sex. They're about making neurotransmitters available, making other hormones available, and protecting our nervous system. They are neuroprotective. And when those, when thyroid is low and gonadal hormones start to drop as well, then we see reduced libido. But we also see increased inflammation, which is a stressor on the body. When we're talking with men who have thyroid imbalances, we're often going to see reduced libido and erectile dysfunction in both hyper and hypo. Interestingly. And men with hyperthyroid also may exhibit increased estrogen and gyno gynecomastia, which is the development of more fat tissue in the breast region, which you know is aesthetic. But more fat can also increase inflammation. When our estrogen goes higher, higher than it's supposed to be, when our adipose tissue is higher than it should be, triggers more estrogen, which triggers inflammation. Women with hypo and hyperthyroid have greater prevalences of menstrual disturbances. And many women with depressive symptoms may have autoimmune, hypothyroid and or polycystic ovarian syndrome. And I have another video that talks about how trauma is really highly correlated with pcos. The, the numbers are just staggering. So if you have a patient who is female, is having irregular periods, fertility issues, some of that could just be stress. If you will, increased facial hair, thinning head hair, persistent acne, abdominal weight gain, and they also report like really significant sugar crashes. If they eat carbs, then they just want to go to bed, encouraging them again to talk with their doctor to be evaluated. For pcos, there are things that can be done to treat it. And it's important to understand how trauma and stress impact the thyroid and the gonadal system and can contribute to the development of pcos. One of the things you'll most notice the easiest, some of the easiest things to see in patients again is the really thin head hair. A lot of women with pcos, you can see their scalp and they struggle a lot with facial hair on the chin and, and on, you know, where men would typically grow facial hair. Really, really oily skin and persistent acne are another sign. And again, that central weight gain is another clue that something may be going on. It may not be pcos, it may be insulin resistance caused by something else. But those are all things that are going to increase inflammation or indicate that there's something going on out of whack, under the hood, so to speak, that the doctor may be able to help them with. Hypothyroidism is associated with obesity and or chronic stress which are associated with increased estrogens and secretion of pro inflammatory hormones and cytokines. I know people don't like hearing this, but when we have too much adipose tissue, it raises estrogen in both sexes and increases inflammation. Study after study have shown it sustained stress in any piece of life, including aging. Because as we age, our hormones change. You know, you go through menopause, you don't have certain types of estrogen anymore at all. Andropause, you know, your dhea, your, your testosterone are dropping over time and they're not being replaced with anything. So the body's having to adjust to not having that mechanism there. And we already talked about how gonadal hormones do so much with making neurotransmitters available as well as neuroprotection. So sustained stress in any piece of life, including aging, can increase sympathetic dominance, stress, inflammation and dysfunction in any of these axes. Symptoms of thyroid dysfunction experienced in the elderly due to changes in gonadal hormone levels are often misinterpreted as a sign of the aging process, such as fatigue and neurological disorders. So as gonadal hormones go down, it brings thyroid hormones down. When thyroid hormones go down, we, we start to see more inflammation in older adults and we start to see cognitive fatigue and confusion and cognitive slowing. Sometimes that can simply be be due to an imbalanced thyroid. There are a lot of people over the age of 60 that are on thyroid meds. In adults over 65, the rate of hypothyroidism, hypothyroidism, whether it's subclinical or full on clinical, is between 10 and 19%. So almost one in five people may have some level of thyroid disruption. High RT3 also contributes to non thyroidal illness syndrome. If the person, and we see this a lot in seniors is struggling with poly pain or ongoing illness, we're going to see RT3 go up. Polypharmacy can also sometimes increase RT3 but polypharmacy, them being on a lot of medications is often the result of them having ongoing illness and or pain. So we do want to look at reverse T3 in older adults. After menopause or late life testosterone decline. The body carries more systemic stress and inflammation and the usable t3 often falls. So important to recognize because it can be ameliorated if they're willing to take medications and or if they're willing to take some lifestyle strategies to better reduce inflammation and stress on the body. Naturally, hyperthyroidism in individuals older than 60 ranges from 1 to 15%. So one 1 to 3% is your clinical level. The rest of them are typically subclinical hyperthyroid. But a lot of times it's caused by over treatment. And I could go into a whole dissertation on all the different ways that older adults may be being over medicated with levothyroxine for their thyroid. However, it's important that older adults work with medical providers who are trained in geriatric medicine. You cannot use the same parameters for thyroid hormones for a 20 year old, for a 60 year old just isn't going to work. Hyperthyroidism, particularly very elevated free T4 was associated with increased risk of dementia. Cortisol triggers TSH and the release of T4 and inhibits conversion to T3. We see increased frailty and decreased functional capacity increase in older adults who have hyperthyroidism. We want to get it under control, encouraging them to pay attention to how they feel and if they're feeling off, if they're feeling wired, if their circadian rhythms are, you know, wonky, encouraging them to talk with their doctor about could it be thyroid. Just a recap on the neurotransmitters. Serotonin, norepinephrine, acetylcholine, glutamate, your main stress hormone, all are positively correlated to T3. When T3 goes up, those tend to go up. GABA inhibits the release of thyroid stimulating hormone. GABA is our calming neurotransmitter. So GABA is saying, hey, we don't need to be secreting T4 right now. Everything's fine. Long term cortisol release inhibits T4 to T3 and increases RT3. I know I've said that like seven times already. But it's that important for us to understand from a trauma informed perspective. Dopamine is positively correlated with T3 levels. This is also important because people with Parkinson's or restless leg syndrome are often given medications to increase their dopamine, which may increase their T3 and cause symptoms of hyperthyroid. Just something that needs to be tweaked medically. People with schizophrenia tend to have high dopamine levels, so they're taking medications that often inhibit dopamine. Well, when you're inhibiting dopamine, you're also potentially impacting the availability of T3. So you may see people with schizophrenia feeling really lethargic and slow and have cognitive slowing that's not related to their disease, but more related to thyroid issues that may be being caused or contributed to by their medications. Other things we want to look at. Iodine, vitamin D, iron and B12 deficiencies can impact thyroid functioning, leading to hypothyroidism. Iodine is. Well, most of these are kind of Goldilocks, but iodine definitely is Goldilocks. Too much iodine can actually suppress thyroid functioning too. So more is not always better. Most of the time you want right in the middle, just right. Alcohol is something else that is going to stress the body. It often makes the kidney and the liver less functional. And when the kidney and liver are less functional, then the body has more difficulty converting T4 to T3. And medications, steroids like prednisone that people may be on if they're on them for a long time can negatively impact thyroid functioning. Just something to watch out for. If somebody has chronic pain and they're on steroids for indefinitely, be on the lookout if they're on. I know when my daughter would get a respiratory infection, the doctor would put her on a short course of steroids, you know, three to five days, not to worry. But when you're looking at a longer course, it can have an impact on the hypothalamic pituitary. Thyroid axis. Lithium, a common mood stabilizer, directly impacts thyroid hormone availability. Dopamine agonists and antagonists. Agonists increase dopamine, which are going to increase T3 and antagonists are going to decrease dopamine and potentially decrease T3. Opioids. Long term use of opioids can impact the thyroid functioning. Propranolol, which is a beta blocker, can impact thyroid functioning. Some of your anticonvulsants and then proton p. Proton pump inhibitors aren't something to really be all that concerned about unless the person is taking levothyroxine because people who take proton pump inhibitors have less effective absorption of the T4 from Levothyroxine Levothyroxine delivers T4 to the body and if they're on PPIs, then they may not absorb it at nearly as well. Thyroid Thyro Stress is an emotional and cognitive condition that is associated with thyroid dysfunction. Is characterized by extreme apprehension, discomfort or dejection caused by the challenges and demands of living with thyroid disorders such as hyper or hypothyroidism. Especially for people who keep getting told, your TSH and your T4 levels are fine, there's nothing wrong with your thyroid. Well, let's look at that again. It's important to, to validate how they're feeling. Now, if all of their tests come back perfectly normal, RT3 is low, you know, everything else and their inflammatory parameters are low, okay, or maybe all of their thyroid comes back just fine. RT3 is very low, everything looks good, but their inflammatory markers are high, their CRP C reactive protein is high. Something's going on and we want to validate that for people so they don't feel like they're being told it's all in your head. What challenges do people, especially with hypothyroid experience, physically, you know, feeling like they're carrying a 50 pound rucksack everywhere they go, easily fatigued, easily exhausted, difficulty sleeping, you know, walking up and down stairs in their own house may feel overwhelming because they just ain't got the energy. Interpersonally, a lot of people don't understand hyper or hypothyroidism and may not fully be able to validate, if you will, the experience of the person with thyroid problems. So they may feel judged or rejected by their social supports interpersonally. Okay, we just talked about that. Emotionally. Well, thyroid imbalances impact the balance of our neurotransmitters. So even if we weren't feeling unsupported, judged, hopeless, helpless, if our neurotransmitters are out of whack, we're probably not going to have the emotional range or control that we would hope to have. Cognitively, mental slowing, difficulty with all of that executive functioning, because executive functioning requires a lot of blood sugar. And if T3 is not adequate, blood sugar ain't going to be adequate. So the brain is not going to have the fuel it needs. And environmental challenges that we face. People with hypothyroid walking, you know, going to the mall and parking out in Timbuktu and having to walk in may feel like an insurmountable task. Cleaning the house may feel like an insurmountable task, and I keep saying feel, but for many people with hypothyroid it is, you know, an insurmountable task. They just ain't got the energy. It's not a cognitive issue, it's a hormonal issue. So helping people figure out how can they reduce stress and live a rich and meaningful life with their thyroid issues as they are right now. Can the thyroid improve? Hopefully yes, but we don't want to wait thinking about, okay, well in six months, if they get all of your hormone prescriptions right, you know, you'll be feeling better. There are a lot of things we can do right now to support the body to reduce unnecessary stress and mitigate unavoidable stress. Physically gonadal hormone testing, C reactive protein and thyroid hormone testing, including TSH, T4 and free T3. Definitely important. If the person has a history of chronic stress, chronic pain, anxiety, trauma, then RT3 may certainly be worth taking a look at to see if that T3 is getting broken down too quickly. Nutrient monor monitoring can also be helpful. Iodine, selenium, iron, zinc, copper, vitamin D, B12 and calcium. Now I have homocysteine right next to B12. Why is that? Because recently the American Medical association has started saying that, you know, homocysteine may be a better test than just free B12. Now, homocysteine levels go up if B12 is are not doing its job. Homocysteine levels also go up if your folate isn't doing its job. Etc. Homocysteine, what we're measuring goes up with low folate, low B12, kidney impairment, hypothyroidism. There's a clue. Smoking and other stresses. It tells you the methylation pathway is struggling. Oh, there's that word again. We talked about it a few few weeks ago. Methylation. Methylation is a process that happens in your body that helps the body turn on or off genes. So if you are in a stress profile, if you will, and all of the stress genes are turned on, okay, you're in fight or flight. Hopefully that's short lived. If the methylation process is working, then when the stressor passes, the body can turn off those stress genes and turn on the relaxation genes. Oversimplified, I know, but if the methylation pathway is struggling, then the body may not be able to effectively turn off the stress response. Yeah, so the person may kind of be stuck in overdrive, hyper vigilance. Which is why understanding epigenetics actually starts helping us understand why some people feel stuck. And even when we're talking to them, and even when they're doing cognitive, behavioral Therapy. Well something may be going wrong in their methylation pathway. Some of the things we can do to support that an anti inflammatory diet. Probiotics like fermented foods, yogurt, kefir, sauerkraut, great stuff. Prebiotics. Anything with fiber in it can be really helpful. And that's going to come from your fruits and vegetables and whole grains. You don't really need to go out of your way. And antioxidants, which means add color to your diet. So add things that have fiber to them. Whole grains and legumes, those are great. And antioxidants, foods with color to it, red, yellow, purple, green. Maintain a healthy weight. So excess adiposity, excess fat tissue is not increasing estrogen and inflammation. Strengthen the parasympathetic nervous system. Best way to do that is by monitoring your heart rate variability. Get a Polar H10 chest strap. It's kind of the gold standard for over the counter type stuff. And then there are apps you can get on your phone that will take the data from the polar chest strap and monitor your heart rate variability. And as your parasympathetic nervous system improves then your heart rate variability will improve. Monitor patients on lithium antipsychotics and tricyclic antidepressants who are on for for thyroid functioning. Make sure that people who have addictions, whether it's behavioral or chemical, it's stressful on the body and addictive behaviors trigger a surge of endorphins and dopamine and other things. So whether again whether it's chemical or behavioral, it's stressful on the body and can contribute to sympathetic dominance. Chronic stress and which will eventually suppress thyroid Adequate quality sleep and circadian rhythm regulations. Since thyroid function is known to be influenced by the sleep wake cycle and your circadian rhythms, your circadian rhythms are out of whack. It's going to alter when certain high thyroid hormones are released. Sleep studies may be necessary for people with sleep apnea or unknown causes of sleep problems. Meditation can help people learn how to downregulate. Not for everybody. If they've got a trauma history they may not be interested. If they've got adhd. Meditation may be more stressful than helpful. Moderate regular movement will help improve heart rate variability, improve the parasympathetic nervous system's ability to kick in and and help us down regulate when stressors have passed. Great helpful tip. People can start doing right now. Daily micro downshifts every break they have at work including their meals. Taking two or three minutes to slow their breathing. Daily micro Downshifts just slow that vagus parasympathetic nervous system, activate that vagus nerve. Interpersonal Strategies CO regulation is really important. We need social support, so having regular brief contact with a support or with a few healthy supports is important. So you're always kind of just tagging that lifeline, making sure that they're still there. Animal assisted therapy can also be helpful for CO regulation. If you're holding and petting an animal the they've shown it helps release oxytocin, trigger the parasympathetic nervous system and then you end up sinking a lot of times with the animal. Especially animals who tend to be more calming, more grounded. Cats if they're willing to dogs can be really good about this. A lot of times they'll just sit there and be calm for you. Horses are great at it. Self esteem and self efficacy development so the person feels safer and more empowered in their own skin and relationship building with self as well as with others. Using cares for secure attachment, consistency, attention, responsiveness, encouragement and safety. Emotionally cognitively encouraging mindfulness throughout the day so they don't wait until they're into a full sympathetic overdrive to say hey, I'm starting to get a little riled. They can notice it early and down regulate if there is not an acute reason to be revved. Help them develop distress tolerance skills and coping skills to reduce stress responses including unhooking saying I have a feeling, I have a thought that this is going on. Okay, now what am I going to do with that? I have a feeling I'm have this feeling that I'm anxious right now because of this. Now what am I going to do with that anxiety? Or you know, you get where I'm going. I'm having the thought that I have to have relief from this right now. Now what am I going to do with that thought? Unhooking from it makes it easier to figure out what to do with it. Whether you want to carry it or get rid of it. Hardiness, commitment, control and challenge. Looking at and noticing all of the things that you're committed to in your rich and meaningful life. Identifying what aspects of those things you can control either improve or just nurture and viewing using your energy to move toward your rich and meaningful life and not getting distracted by all the shinies as a challenge engaging fit cat the facts in this context at this time or feel facts, exceptions, explanations, alternate ones and the likelihood that this is going to happen. Either one of those mnemonics can be really good or for addressing when I'M feeling anxious or angry. Addressing what's going on in the present moment and reframing what's going on for function. If I am feeling exhausted, if my thyroid is dysfunctioning, not viewing it as a character flaw or a weakness, but recognizing, hey, my body is downshifting, it's metabolically breaking because I've been too stressed for too long, my body's trying to help me survive. Okay, well, it may not be where I want it to be, but I understand it's not a flaw. It is an adaptive reaction. Address chronic trauma and stress to reduce cortisol and help regulate that stress system. Encourage the person to engage in behavioral activation, doing something every day that either makes them laugh or brings them joy or curiosity, or even just helps them feel content. Effective treatment of thyroid abnormalities may reverse cognitive issues. For a lot of people, their difficulty remembering, learning, focusing, planning, even slow recall, feeling like they can't find the word or their brain fog all the time. If they have hypothyroid, addressing these issues often provides them a lot of relief. And we do in the interim, want to help them reduce cognitive overload. Doing too much work. You know how if you've been in a seminar for eight hours in a day and you're trying to take it all in, you get home and you feel like you ran a marathon, well, your brain was, you know, on fire all day long using a bunch of energy. So we do want to reduce cognitive overload. People who have hearing difficulties, that contributes to cognitive overload and stress and they found dementia. Making sure that especially with older adults, if they are experiencing exhaustion, depressive symptoms and if they have hypothyroid, also have their hearing checked and reduce over stimulation so people don't feel like they have to be hypervigilant all the time because there's just everything zipping around environmentally. Reduce toxins. Maintain a comfortable and adequately stimulating, but not over stimulating environment. Consider adding weighted blankets or vests. Fidget devices to help the person feel more grounded. And look at feng shui, especially the use of mirrors and furniture placement so you can see people coming in and out and it reduces your need to be hypervigilant. And finally add calming and empowerment triggers to the environment so when people look around, they they don't feel immediately stressed. Thyroid hormones can be altered by stress in any piece of life. It may not be an underlying dysfunction of the thyroid gland. It could be, and in many cases it often is, the result of longstanding stress, hypervigilance and sympathetic dominance. Thyroid hormones via the HPT axes are intertwined with the hpa, the adrenal axis, and the hpg, the gonadal axis. Dysfunction in one produces dysfunction in all the others. Many cognitive, emotional, and behavioral symptoms commonly seen in behavioral health settings may have some underpinnings in thyroid dysfunction.