The Anxiety Thyroid Connection

By Dr. Nicole Cain ND, MA

Is your thyroid causing anxiety?

The knock on the door to my office jarred me out of my work and I looked up to see a beautiful blue eyed, red haired woman standing in the doorway. It was Alicia, a colleague who had graduated from medical school a year after me, and she looked troubled.

“You okay?” I asked. She shook her head and put her finger to the pulse in her throat.

“I’ve been having palpitations and hot flashes since last night. I didn’t sleep at all and I’m getting more anxious by the minute. I thought I’d stop by to see if you were in the office and could check my blood pressure.”

Her blood pressure read 160/100, which is high. Her skin was hot to the touch, and her pulse was over 100 beats per minute (typical for her is 60 beats per minute).

“Funny thing is, I saw my PCP last week for anxiety and she wrote me a script for Xanax. I didn’t want to take it but I’ve been so stressed lately, I gave in, but it doesn’t seem to be helping.”

“Did she run any labs?” I asked.

She shook her head. “My insurance only covers annual labs, and she said if I started feeling worse to give her a call.”

Alicia, like many, went to her doctor for a mental health symptom, and was sent away with a prescription and a “call me if you feel worse.”

Today you’re going to learn about the relationship between anxiety and your thyroid. Stick around to the end and I’ll share with you what was going on with Alicia, and what we did about it.

If you struggle with anxiety, I want you to know: There is another solution. You don’t have to feel like this.

With every symptom, it is absolutely essential to consider the root cause. Without investigating the root-cause we cannot find comfort in a cure. Just like if you kick the dresser and stub your toe every morning, no matter how much aspirin you take, you will never enjoy a pain-free toe—that is, unless you stop kicking the dresser.

Similarly, if you do not look for the root cause of your anxiety, you may never enjoy the possibility of freedom until you investigate the cause.

While causes vary from person to person, for example: trauma, medication side effects, stress in the home or work place, there may be biological causes of your symptoms.

One important biological cause of anxiety is imbalances in your thyroid health, let’s dive in.

Can thyroid problems cause anxiety?

There are two main types of thyroid disorders:

Hypothyroidism is where your thyroid is under-active, or under-functioning.

In contrast, hyperthyroidism is where your thyroid is overactive, and over-functioning.

There are also thyroid conditions caused by your immune system, called autoimmune disorders. The main two are Hashimoto’s Thyroiditis and Grave’s Disease.

Anxiety can be seen in both hypo-and hyper-thyroidism and testing the thyroid is an important component of your annual basic blood work.

Let’s talk about how the thyroid works.

Thyroid Basics

Your thyroid gland is the command center for metabolism in your body. Located at the base of your neck, the thyroid releases hormones that control many important processes in almost every cell of your body.

When your body needs more thyroid hormone, your brain releases a hormone called thyroid stimulating hormone (which is abbreviated as TSH).

TSH leaves your brain and when it reaches your thyroid gland, it stimulates the thyroid to release thyroid hormones.

The two types of hormones released by the thyroid gland are:

99% of total T4 is bound quite tightly to a protein and is not very metabolically active and so your body has to convert T4 into T3 thyroid.

It gets even trickier than this: If your body does not have the right nutrients, instead of T4 getting made into usable and active T3 thyroid hormone (whether it is free or bound to a protein), it will make something called reverse T3 instead.

Reverse T3 looks like T3 in standard testing, but it is an inactive form of T3 thyroid. Therefore, unless we test them separately, we do not actually know if you have enough active thyroid hormone.

This means that your T3 thyroid test can look perfectly normal and you could actually have a thyroid problem!

Thyroid Testing

A thorough thyroid panel should include the following tests:

Many doctors only order TSH when doing general labs and if TSH is abnormal, they will do what is called a reflex to T4. The problem with this is that you can have normal TSH, but all of the symptoms of hypothyroidism. This is seen in a condition called Euthyroid Sick Syndrome abbreviated ESS. In ESS, we see normal TSH, normal T4 and either normal or low T3. Many doctors will stop there and tell you that your thyroid is fine, but if they went a step further they would see that your RT3 is elevated. What is happening is that your body is making T4 but it is getting converted into Reverse T3 instead of active T3 leaving you feeling exhausted, depressed, lethargic and suffering from the many other symptoms of hypothyroidism.

Here is an analogy: Let’s say you have two kids with very messy bedrooms. You’re the brain and you send out TSH that tells the kids, who in this analogy are the thyroid hormones. Your TSH tells them to clean their rooms. The doctors only testing TSH are like you, as a parent, assuming that if you told your kids to clean their rooms, that if you go check their rooms, that they will be clean. But if you’ve ever been a kid or if you have kids yourself, you know that this is not always the case. You have to go and look at the kids’ bedrooms, you have to test the T4, T3, and you should always check under the bed for RT3 in order to ensure that everything is as it should be.

Test Results in Hyperthyroidism

If you’re anxious, and if you’re wondering if your thyroid is the culprit, get your thyroid tested by your doctor. If your symptoms are due to hyperthyroidism you will see low TSH, and high thyroid T4 and or T3 on your blood test. As mentioned, symptoms of hyperthyroidism include anxiety, difficulty sleeping, racing heart, diarrhea, heat intolerance, bulging of eyes from sockets, feelings of suffocation or congestion in your throat, digestive upset, hair loss and can become severe and life threatening if not treated.

Test Results in Hypothyroidism

Hypothyroidism is much more common in this country, and this is especially so after people switched from iodized salt to sea salt. Hypothyroidism tests will show a high TSH, and low thyroid T4 and or T3 on your blood test. Symptoms of hypothyroidism include depression, fatigue, low endurance, low motivation, low blood pressure, chilliness, constipation, and much more.

Autoimmune Thyroid

There are two main autoimmune diseases associated with the thyroid gland. An autoimmune disease is a condition where the cells of your immune system attack your own cells. In particular, the two thyroid autoimmune diseases are Hashimoto’s and Grave’s Diseases.

Hashimoto’s Thyroiditis is an autoimmune disease that can cause the thyroid to alternate between hypothyroid and hyperthyroid states. As the thyroid hormones spike and drop, your symptoms may change from feeling wired, anxious and have a racing heart, to exhausted, depleted and depressed.

The tests we run for this are Anti Thyroid Peroxidase (TPO) and anti Thyroglobulin (TG).

Grave’s Disease is the most common cause of elevated thyroid hormone production. The antibody for Grave’s disease is Thyrotropin Receptor Antibodies (TRAb) otherwise known as thyroid-stimulating immunoglobulin.

If your thyroid is out of balance it is important to identify why it is out of balance. Running antibody tests gives data on exactly what is wrong so that we can work on addressing the root cause.

There are 5 main root causes of autoimmune thyroid diseases, they are:

Steps to Get to the Bottom of Your Thyroid Imbalance

If you are struggling with anxiety, the first step is to get your thyroid tested. Include TSH, Free T4, Free T3, and Reverse T3. If there are significant findings on this test, run thyroid antibodies, and if you have elevated antibodies getting to the root cause of why your body is producing antibodies against your thyroid gland is key. The good news is that this is very treatable and often times you can get to feeling better quickly with safe, and natural alternatives. Here are EIGHT steps to ask your doctor about, for addressing autoimmune thyroid.

What You CAN Do To Improve The Health of Your Thyroid

A happy thyroid equals a healthy life. In order to optimize the health of your thyroid gland we need to be mindful of what is health-promoting, and what is health-robbing.

Herbs and Supplements Your Thyroid Loves:

Thyroid Nourishing Treats

Thyroid Food Foes

Remember Alicia?

We ran a TSH, Free T4, Free T3, Reverse T3, and thyroid antibodies. Her results came back showing her TSH was extremely low, her Free T4 was high, as were her Free T3 and Reverse T3. She also had extremely elevated Thyrotropin Receptor Antibodies, she was diagnosed with Graves Autoimmune Thyroiditis.

The typical treatment for hyperthyroidism is radioactive iodine or surgical removal of the thyroid gland, but Alicia opted to try an alternative approach first. She promised her endocrinologist that if her symptoms were not improving in 48 hours, and if her blood tests were not 30% improved in 2 weeks, that she would consider more invasive treatments. Reluctantly, her doctor agreed with her proposal.

Alicia followed a protocol that included nutrient support, she cleaned up her diet, took immunomodulating botanicals, a homeopathic remedy and did daily hydrotherapy treatments.

Within 24 hours her palpitations had stopped and she got a good night of sleep. Within 48 hours her anxiety was 50% better, and within a week the heat intolerance and hot flashes had stopped. She went back to her endocrinologist, who re-tested her antibodies and found they had dropped by 80%. Her blood pressure was 120/70 and her pulse was back to 70 beats per minute.

Pleased with her progress her endocrinologist told her to keep up what she was doing and scheduled a follow up for 6 months out.


Your body is designed to heal.

If you fall off your bicycle and scrape your knee, without you even thinking about it, your body will heal that scrape by setting off a complex cascade of events involving your platelets, immune cells and other clotting factors. Why, then, would we assume that your immune system cannot re-regulate itself?

You can heal from anxiety. You can get your life back.

Alicia, a physician herself, worked as a team with her specialists, and used the wisdom of conventional and alternative wisdom, and she got her life back.

Had she accepted the pill-for-an-ill model; she would be in a seriously different place right now.

What have you been accepting as status quo?

Is there any root-cause digging that you need to pursue?

Sometimes it can be incredibly overwhelming and you don’t know where to start, and that’s why we’re here.

Our mission is to empower you with wisdom, hope, and resources to get your life back.

To get started, follow these three initial steps:

It is important to remember to avoid the allure of dogmatism. While philosophy told Alicia’s endocrinologist that she would unlikely recover from her autoimmune state without aggressive pharmacological or surgical treatment, he met her in the middle with a compromise. And while Alicia believed that her integrative methods would work, she met her endocrinologist in the middle, too. Both paradigms were honored, without dishonoring the other. They were willing to say, “Yes, and,”

You deserve a comma at the end of your sentence, too. Oftentimes we are told: You have anxiety, take this, come back if you feel worse.

But we can do better than that. We can change the status quo of mental health treatment in this country. You can write a new chapter in your story.


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This article is for educational purposes only and is not intended as medical advice. Whenever considering changing your protocol whether it includes a change of medications, supplements, diet or lifestyle, always speak with your primary care physician first.

Dr. Nicole Cain is an advocate for empowering people around the world to help themselves via her educational free resources, online courses, and membership group. You can receive the tools you need to find the root cause of your symptoms and feel healthy again.