The Connection Between Hypothyroidism and Depression

The Connection Between Hypothyroidism and Depression

Does thyroid disease cause depression?

Should taking thyroid medication, if you have thyroid disease, eliminate your depression?

What should you do if you are taking thyroid medication but still experiencing depressive symptoms?

In this post, we will discuss the connection between hypothyroidism and depression including how to approach treatment, which thyroid medications are best, and other causes of depression that result in confusion for patients and doctors alike

Let’s jump in: 

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Does Thyroid Disease Cause Depression?

It is well known and widely accepted that thyroid disease does indeed cause depression (at least this is taught in medical school). 

But the problem is that this connection has never actually been proven. 

Instead what we have are the following connections:

#1. The fact that hypothyroid patients and depressed patients exhibit similar symptoms. 

#2. The fact that depressive symptoms may be eliminated in some patients with the use of thyroid hormones/medications. 

#3. The fact that thyroid hormone can be given as a stand-alone depression medication and in place of anti-depressants. 

#4. The fact that thyroid hormones influence serotonin production in brain tissue which is the same mechanism of action as prescription anti-depressants medications. 

#5. The fact that TRH (which is part of the hypothalamic control of thyroid hormone) is sensitive to serotonin. Low serotonin may stimulate an increase in TRH and high serotonin may reduce TRH production. This may indicate a connection between serotonin, mood, and thyroid hormone production.

When you have this much smoke there is a tendency to scream fire, but why then do so many studies show conflicting results regarding the connection between thyroid disease and depression?

Much of this may have to do with the fact that we still don’t really fully understand depression. 

Like many diseases, it’s probably best to consider depression as a side effect that can be caused by multiple different types of disease states or medical conditions. 

Instead of thinking of depression as a primary condition, it may be best to consider it as a side effect of some other problem or a manifestation of some other disease. 

Why think of it in this way?

Because multiple conditions have been shown to cause depression. 

Conditions such as hormone imbalance (menopause, low testosterone, thyroid disease, and so on), nutrient deficiencies (B12 deficiency), inflammatory states, and gut dysfunction have all been shown to cause depression. 

These other causes of depression may be sufficient to “wash out” a connection between thyroid disease and depression in general population studies simply because thyroid dysfunction is only ONE potential cause of depression. 

Does this mean that there is no connection between thyroid disease and depression?

No, not by a long shot. 

But it does mean that thyroid patients should be approached differently if they have depression compared to the general population. 

Treating Depression if you have Thyroid Disease

It is clear that thyroid disease is associated with depressive symptoms. 

One of the most concerning aspects of depression and thyroid disease is that studies clearly show that patients already taking thyroid hormone (1) (meaning those who have been diagnosed with thyroid disease) have a much higher rate of depression when compared to healthy adults. 

This connection extends beyond depression and also includes anxiety. 

Studies have shown that women who take T4 thyroid medication (to treat thyroid disease) show a higher risk of developing anxiety and depression compared to euthyroid patients (2).

So what can we take from this?

Well, if we know that low thyroid hormone (states of hypothyroidism) result in depression and anxiety, but we also know that women taking thyroid hormone to treat this problem still exhibit these symptoms, then the logical assumption is that perhaps they are not being treated adequately or that their depression is multi-factorial. 

If their depression is the result of mistreatment or undertreatment with thyroid medication then it should go away once they are treated adequately but only if their depressive symptoms are not caused by something else.

With this in mind, let me ask you a question:

Is it more likely that most thyroid patients are walking around under-treated or that they have multiple conditions causing their depression?

The answer to this question is very complicated but it probably isn’t as important as you might think.

What’s more important is how to approach the treatment of women with thyroid disease who also present with depression.

It may be that there are a large number of women (thyroid patients) who remain depressed and anxious, despite taking thyroid medication because they are not on the appropriate thyroid medication or dose. 

The standard approach to thyroid hormone management is to use T4 thyroid medications such as Levothyroxine and Synthroid and base dosing off of the TSH. 

But the problem with this approach is that it does not take into account peripheral thyroid conversion or T3 levels.

If you are one of the 15% of patients who have genetic polymorphisms to the deiodinase enzyme, then using T4 thyroid medication may not be optimal for your body. 

It’s possible that issues relating to thyroid conversion may be part of the reason (perhaps the primary reason) that so many thyroid patients remain depressed and anxious despite using thyroid medication. 

So what are you supposed to do about it?

One of the easiest ways to approach this problem is to bypass the peripheral thyroid conversion step by adding T3 therapy to your existing dose of T4 medication. 

Studies have shown that adding T3 to T4 medication is sufficient to reduce symptoms of depression and improve well-being in many patients (3).

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T3 is the active and most powerful thyroid hormone and it can be given as a prescription medication that can be used either by itself or in conjunction with other thyroid medications like levothyroxine.

Other studies have shown that up to 12% of the population contains a genetic change to a specific enzyme (DIO2 polymorphism) which can limit the amount of T3 that the brain receives, which would make less effective T4 only thyroid medication (4).

Even adding as little as 5-10mcg per day of Cytomel or liothyronine may be sufficient to dramatically reduce depression symptoms in thyroid patients. 

But what if you’ve tried it and it hasn’t worked or what if your physician isn’t willing to prescribe this medication?

causes of persistent hypothyroid symptoms in patients with normal TSH

There are MANY other reasons that you may be suffering from depression if you have thyroid disease that may not be related to your thyroid. 

Conditions such as vitamin B12 deficiency, iron deficiency, folate deficiency, the stress in your work life, reduced sleep or insomnia, alcohol consumption, and so on can all contribute to depressive symptoms. 

For this reason, make sure that you ALSO assess these factors in addition to your existing medication. 

In many cases simply altering the medication you are taking (by either adding T3 to your existing T4 dose or by switching to NDT) will likely result in a reduction in depressive symptoms (but it may not eliminate them). 

Once you’ve altered your medication you can then look into other causes and treat those issues. 

Hashimoto’s & Depression (& Other mood disorders)

Another subset of patients that we need to discuss is those with Hashimoto’s thyroiditis. 

As you probably know, Hashimoto’s thyroiditis is an autoimmune disease that results in the slow and chronic destruction of the thyroid gland over time. 

Patients with this condition may eventually go on to develop hypothyroidism due to this chronic inflammatory destruction of the gland

The problem with this condition is that many patients with Hashimoto’s tend to experience hypothyroid-like symptoms (such as fatigue, depression, constipation, cold intolerance, and so on) despite having a so-called “normal” TSH

Traditionally, patients who have Hashimoto’s disease and have a normal TSH are not treated with thyroid hormone medication, even if they have symptoms. 

Studies have shown that patients with Hashimoto’s disease, even with a normal TSH, have an increased risk of developing both depressive symptoms and anxiety.

So what do you do if you have depression and Hashimoto’s but a normal TSH?

The first step is to closely evaluate your thyroid lab tests to determine if they are indeed actually normal. 

Despite having a “normal” TSH it is still very possible to exhibit low free thyroid hormones which may be sufficient to warrant treatment with thyroid medication. 

Some studies have shown a benefit to treating Hashimoto’s patients, even though they have a normal TSH (5).

It is also possible that the thyroid antibodies in Hashimoto’s may be causing depressive symptoms irrespective of their impact on thyroid function. 

What does that mean?

It means that the thyroid antibodies THEMSELVES may actually be causing depression or other problems (6).

This leads us to the second step…

The second step is to look into other therapies that may help reduce total antibodies in your body. 

This makes treating depression in Hashimoto’s patients more difficult because they have 2 reasons for these types of symptoms. 

One is from damage to the thyroid gland and hypothyroidism and the second is from the antibodies themselves. 

If you have Hashimoto’s thyroiditis and depression, then make sure you look at other therapies which may be able to calm down your immune system and help reduce the total amount of antibodies in your serum. 

Therapies such as Vitamin D supplementation, the use of LDN, certain supplements, and the use of thyroid medication may help reduce antibodies and therefore treat depression. 

You can learn more about these therapies here

Using T3 Thyroid Hormone for Depression (If you don’t have thyroid disease)

Another interesting point worth mentioning here is that several studies have shown that the use of thyroid hormone, in addition to standard SSRI (selective serotonin reuptake inhibitors (7)), helps improve outcomes in patients with depression. 

Let’s break this down:

Some studies have shown that patients who don’t respond to standard depression medications, such as Zoloft or Paxil, show an improved response when thyroid hormone is added to the mix (8).

Other studies have also shown that thyroid hormones, such as T3, can be used both as a stand-alone depression medication or used in combination with SSRIs as well. 

So what exactly does this mean?

There isn’t enough information to draw a clear picture just based on the studies, but at the very least it indicates that there is some connection, perhaps outside of our current understanding, between your mood and thyroid hormone. 

Another explanation for this connection is that there may be a large group or subset of patients walking around with the label of depression when in reality they might actually have sub-clinical hypothyroidism or hypothyroidism. 

If you are a patient who has failed multiple different types of depression medications, someone who has failed medication cocktails, and so on, then it might be worth evaluating your thyroid lab tests and considering a trial run of thyroid hormone. 

The thyroid medication which seems to work the best is Cytomel or Liothyronine. 

This medication contains pure T3, which is the strongest thyroid hormone. 

Even using small doses of T3 by itself, or in combination with SSRIs, has been shown to reduce the symptoms of depression and improve quality of life markers. 

This can be done safely to minimize any negative side effects of using thyroid medication (even in those without thyroid disease) by following a series of guidelines listed below (9):

guidelines for using T3 therapy in depressed patients
  • Close monitoring of thyroid lab tests INCLUDING TSH, Free T3, and Free T4
  • Slow titration of T3 starting at 25mcg and increasing based on tolerance and over a period of weeks
  • Set the goal TSH at the lower limit of normal
  • Maintaining Free T3 in the upper limit of the reference range
  • Close monitoring of bone density with DEXA scanning in patients who are post-menopausal
  • *Note: Observational studies have shown that using 50mcg to 150mcg of T3 per day does not result in negative effects on cardiac (heart) or skeletal (bone) tissues, but these studies are limited to 2 years in length.

*Note: These are similar steps that can also be used to help with weight loss in thyroid patients as well. 

Another interesting point is that T3 has been shown to be effective in treating mood disorders such as bipolar disorder, even in patients who have failed multiple different types of mood-stabilizing medications (10).

This indicates that there is likely a connection between brain function, mood, and the amount of T3 in circulation in the body. 

It is possible that polymorphisms in deiodinase enzymes (such as DIO2) may be responsible for reducing the total amount of T3 which enters the brain which may then trigger these symptoms (11).

This pathway can be bypassed with the use of medication such as T3 which may be superior to T4 forms of medication (for those with the polymorphism). 

The science isn’t settled, but some of the work is promising, especially if depression is severely impacting your quality of life and ability to function. 

In these situations, it may be worth a trial run of thyroid hormone. 

What to do if you Are Clinically Depressed

We’ve gone over a lot of information in this post so let’s condense it down to your next steps:

  • Check your thyroid lab panel including free thyroid hormones (Free T3 & Free T4)
  • Consider adding T3 therapy to your regimen (Cytomel, liothyronine, or NDT) – Even small doses of 5-10mcg per day may help
  • Treat nutrient deficiencies such as B12, folate, and iron deficiency
  • Focus on reducing circulating thyroid antibodies if you have Hashimoto’s
  • Treat Hashimoto’s with thyroid medication (if necessary)
  • Ensure that you are sleeping 8 hours per night
  • Practice stress reduction techniques (meditation)

Following these guidelines should help you get on the right track to treating any depressive symptoms you may be experiencing. 

Just realize that this is not a complete list, but it can serve as a starting point for many of you. 

Final Thoughts

The bottom line?

If you are suffering from depression AND you have thyroid disease AND you are on thyroid medication then you know something is not right. 

If you fall into this category then you need to look at different thyroid medication alternatives, the use of supplements and nutritional vitamins, and other factors that can influence your mood

If you don’t have thyroid disease but you do suffer from depression, then it may be time to look into alternative depression medication such as Cytomel or liothyronine. 

The connection between depression and thyroid hormone is not well understood, but it seems that this connection is strong. 

Now I want to hear from you:

Do you have thyroid disease? Do you also suffer from depression?

Do you still have depression despite taking T4 thyroid medication?

Have you tried T3 medications to treat your depression?

What has worked for you? What hasn’t?

Leave your comments below! 

#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/

#2. https://www.ncbi.nlm.nih.gov/pubmed/19751298/

#3. https://www.ncbi.nlm.nih.gov/pubmed/9971866/

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/

#5. https://www.ncbi.nlm.nih.gov/pubmed/24211158

#6. https://www.ncbi.nlm.nih.gov/pubmed/11407265

#7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC518867/

#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451035/

#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451035/

#10. https://www.ncbi.nlm.nih.gov/pubmed/19215985

#11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527224/

how your thyroid causes depression

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

32 thoughts on “The Connection Between Hypothyroidism and Depression”

  1. Hi,
    I like the quality of your information so far. There seems to be a lot of pseudo-science on the web regarding Hashimoto’s. It’s nice to have some well thought out and concise information available.
    Thanks : )

    Reply
  2. I am hypo with hashimotos. Currently I take synthroid and effexor and have gained a ton of weight. I have heard effexor makes you gain weight (did that make me gain or did the thyroid issue?) but I have some depression and anxiety. Should I get off the effexor and try cytomel instead? Will a drug like contrave work for me? My end goal here is to lose the weight, stabilize my thyroid issues and not be depressed or anxious. I have been to so many doctors and no one seems to be able to figure it out or recommend the right combo of drugs.

    Reply
    • Hi April,

      Yes, it is certainly true that anti-depressants can cause weight gain. One of the few which does not is Wellbutrin.

      Reply
  3. Your information has been THE BEST information regarding thyroid disease and it’s complexity. I had a sub-total thyroidectomy in 1978 -Grave’s Disease with toxic goiter. It’s strange that this article came up today because (literally) my husband and I just finished talking about me stopping my Zoloft RX. For 42 years I’ve been on thyroid RX – usually tablet. During my 23.5 years of active duty Army service (with world-wide assignments) I have been on numerous combinations of RX’s every 2-3 years because changing duty stations meant changing doctors. I am currently on Tirosent which seems to be the best T4 Rx medication EXCEPT for the short time I was on Synthroid tablet WITH Cytomel. But that was short lived because a new doctor at a new duty station changed my med’s. And as you know, dealing with doctors prescribing thyroid medications when your lab results are in the “normal range” is difficult to impossible. BUT, I have found that it has gotten better over the years since my thyroid was removed 42 years ago. I have also found that these days younger, female nurse practitioners or PA’s are easier to talk to and tend to want to “share” in my healthcare rather than “a white, older aged, white male” who acted like he was the boss and he knew best. I’m not being racist or sexist or anything else anyone wants to call it – that’s just been my experience in dealing with the many healthcare “professionals” that I have dealt with in my 42 year thyroid dysfunction journey. Dr. Childs-you are the first one that I’ve come across that “really gets it”. My next thyroid appt is with a female doctor via video. She is in FL and I am in PA. The appt was set up through my VA PCP and this will be my first appt with her. I will print this article and send it to her prior to my appt AND I will request the full gamut of thyroid (and related) lab tests as a starting point. Thank you for providing the information that you do. I only wish you were still practicing and accepting patients. I would be the first one at the door.

    Reply
  4. Your information is very good. I have a hard situation, and I was wondering if you might answer a question for me. I’ve been getting very depressed since my brother died in March, but at the same time I’ve been having trouble with my thyroid medicines. The doctor switched me from the natural NP one I’d been on, to synthetic T4 by Amneal and Sandoz’s generic for synthetic T3. I’ll just be completing three weeks on the new medicines today–this is one of the worst days, mentally, I’ve had. How long do you think it takes for these thyroid drugs to actually start working and help alleviate some symptoms, including depression? I’m supposed to be tested at two months….it’s not really helping any of my symptoms yet, let alone any mental ones.

    A little background: I was originally treated for Grave’s Disease in 1975-76 with five RAI drinks, spread out over a period of several months. I was between eleven and 12 years old. I did pretty well on an old formula version of Synthroid they made until 1982-83. I’ve not been very well at all, since….none of these medicines so far have helped me like the Old Synthroid did. They destroyed about 3/4 of my thyroid gland with the RAI, and said most of the rest would stop working as years went on. I’m just having such a hard time, now. If you can give me your thoughts on how long it takes a new combination of thyroid meds to work, I’d really appreciate it. Thanks.

    Reply
  5. Interesting, but from someone who actually takes T3 (myself) Cytomel has been life saving after thyroidectomy however NOT ideal treatment bc it is not time released and creates ups and downs in T3 levels throughout the day which puts one on a potential roller coaster of emotions and energy level. The ideal treatment is T4 only for this reason to get a more steady dose of hormones throughout the day. I started on 2.5 mcg daily T3 with my T4 and ended up on 10 mcg and now back down to 2.5. While I am super grateful for T3 it is NOT a quick fix and requires VERY CAREFUL monitoring. An acquaintance thought she was hypothyroid and took T3 instead of T4 (irresponsibly prescribed by her GP) and while it lifted her severe depression temporarily it threw her into a chaotic hormonal hyperthyroid state and she checked herself into a mental hospital bc she was suicidal from the hyperthyroid state caused by too much T3. She was not monitored by an endocrinologist, T3 is potentially life threatening if not closely monitored .

    Reply
    • Hi Maryam,

      Respectfully disagree. T3 is quite safe and no more dangerous than T4 if used correctly. T3 does come with more side effects, that much is true, but those side effects can usually be prevented with the right type of dosing. I say this having prescribed T3 to hundreds of patients in the past.

      Your mention of T3 spikes in the serum is mostly irrelevant due to how thyroid hormone works. T3 thyroid hormone works by interacting with nuclear receptors so a sustained T3 level in the serum is not necessary to see results.

      I would also say that T3 is usually necessary for those who are post thyroidectomy because the thyroid no longer produces the T3 thyroid hormone that it used to. Several studies have shown that providing only T4 to patients without a thyroid results in suboptimal T3 levels compared to euthyroid controls.

      Reply
      • I hear you but I am speaking from personal experience as someone who has experienced the instability and ups and downs associated when taking higher doses of T3. I am monitored by a well seasoned endocrinologist at Columbia and I have had other opinions from other respected endocrinologists at Johns Hopkins and Weill Cornell. I am super grateful for T3 bc I definitely needed it but they need to come up with a time released capsule or smaller tablets bc taking T3 in divided doses multiple times a day is really inconvenient not to mention the tablets are very difficult to cut.

        And I personally witnessed a friend take 20 plus mcg of T3 (she still had her thyroid) and her T4 plummeted and T3 skyrocketed and she became suicidal bc of it (checked herself into a psychiatric clinic) then she stopped T3 and her hormones stabilized then started antidepressants and she feels much better.

        I am just saying T3 is not ideal treatment and especially for someone who is not hypothyroid (just for depression) for the reasons I stated but I am glad it exists bc I don’t know where I would be without it. I just wish there was time released formula or smaller tablets.

        Reply
        • Hi Maryam,

          There is a SR T3 and you can compound T3 into doses as small as 0.5-1mcg 🙂 And that’s what I was talking about when I said dosed correctly. If it’s used correctly, at the right dose, in the right formulation, there’s virtually no risk. In addition, side effects can be mitigated by switching between the various formulations of T3.

          You can read more about SR T3 here: https://www.restartmed.com/sustained-release-t3/
          And you can learn about compounding T3 into any dose here: https://www.restartmed.com/compounded-thyroid-medication/

          You won’t get this type of information from your experienced endocrinologist at Columbia, though! They have limited experience in using T3, even at small doses, and they most likely aren’t familiar with the various ways that you can compound T3 to get the desired effects.

          Your experience is important because it’s a reflection of your situation. But be careful when extrapolating your experience and making general statements for others. While it may be true that some people may experience the same side effects you did, the number of people in that pool may be close to 0.5% or smaller.

          Reply
          • I have been the first one to run as fast as I can from conventional doctors. However i’ve seen many functional medicine doctors I tried everything to save my thyroid for two years and it didn’t happen. Unfortunately there’s been a lot of empty promises in the functional medicine alternative medicine community and I am also an energy healing practitioner. I am very grateful for my endocrinologist at Columbia because I personally would never mess with compounded T3 given my experience with T3 and it’s potency. It’s way too dangerous in my opinion to trust a random person to compound such a minuscule amount of T3 into a pill for it to be accurate. I’m not willing to take that risk. And while I think the T3 is an interesting treatment for treatment resistant depression as I have personally experienced the anti-depressant effects of T3 I would never recommend that to someone who wasn’t being monitored extremely closely by an endocrinologist. You can’t just give someone who has a normal thyroid function T3. all of this is to say that yes I think T3 is very important and I have I realized it’s benefits. However it’s not some thing that you can just dole out without knowledge of potential risks as if it’s a cure all.

          • Well, we may disagree on T3 but I certainly agree with you on the empty promise aspect from integrative and functional medicine. Functional medicine is more about marketing than it is about medicine nowadays which is why I have tried to distance myself from it.

            But when it comes to T3, I do believe it’s an incredible treatment for depression and bipolar disease and, generally, is well tolerated. My own wife takes relatively high doses of T3 for depression and metabolic damage from an eating disorder and has for years.

  6. I have had graves for 15 years or so i had rai done wish i never did been on synthroid an cytomel never feel good always tired but Dr says all levels are good dont know what to do just want to feel good for a change

    Reply
  7. I became hypothyroid after menopause. I was prescribed Synthroid and it did not resolve any of my hypothyroid symptoms. I was then switched to NDT. It resolved my hypothyroid symptoms, but not my depression. I now take Citalopram 10mg. and Wellbutrin 150mg. This combination along with my NDT works for me. I tried just Citalopram without the Wellbutrin and it did not resolve my depression. It was resolved when taking both the Citalopram and Wellbutrin.

    Reply
  8. I am wondering if anyone has experienced problems with their eyes when adding T3? I have tried twice and developed double vision. The first time I was on synthroid and added cytomel and switched to NDT and same thing happened. I also developed anxiety.

    Reply
    • Hi Emily,

      I can’t answer medical questions but if your email is a general question then you should receive a reply 🙂

      Reply
      • Thanks. I have been taking Armour and t3. I feel fine. But just exposed to Covid. Hi f I am optimal. We i have less chances from Covid?

        Reply
        • Hi Kate,

          I’m unaware of a connection between free thyroid hormone levels and the severity of COVID-19 infection but I haven’t really been following the research that closely. I suppose you could get there in a roundabout way saying something like, well if you have hypothyroidism you are more likely to be overweight and if that’s the case then you are more likely to have worse outcomes, but, again I haven’t seen any concrete data to support that statement.

          I am planning on diving into the research to see if there is a connection between thyroid dysfunction after COVID infection so if I see something I will certainly write about it there.

          Reply
  9. Hi. I havent raken my thyroxine fir 3 weeks now. It makes me feel really of, i cannot concentrate, and feel my brain is thick and foggy, which make me feel dizzy. I don’t have any quality of life, I feel constantly ill and miserable. Thank you

    Reply
    • Hi Lori,

      It has the potential to help but that assumes that your depression is from your thyroid. There are still many other causes of depression and if your depression is caused by something else then improving your thyroid may or may not help.

      Reply

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