Thyroid Reference Guide
Link Between Hypothyroidism and Anxiety

The Link Between Hypothyroidism and Anxiety: Exploring the Relationship

While hypothyroidism is widely known to be linked to depression, it is also frequently connected to anxiety. Discover the reasons behind this association and learn how to improve your well-being.

Hypothyroidism, a disorder characterized by feelings of lethargy, weight gain, and mood fluctuations, is understandably linked to depression. However, it is also related to unease symptoms. A study released in June 2018 in JAMA Psychiatry revealed that individuals with hypothyroidism have over double the risk of developing anxiety disorders compared to those without the condition. Moreover, 29.8 percent of all related disorders have been found to be connected to autoimmune thyroid disease.

Hypothyroidism arises when the thyroid gland’s cells are unable to produce sufficient thyroid hormone, which is essential for maintaining energy levels and proper bodily function, as stated by the American Thyroid Association (ATA). Discerning the difference between hypothyroidism and anxiety can be challenging, as their initial symptoms are often quite alike. “When a patient presents with irritability, persistent worry, and muscle tension, I not only treat them for anxiety but also recommend a thyroid test to assess their hyper- and hypothyroidism levels,” explains Diane Solomon, PhD, a psychiatric nurse practitioner based in Portland, Oregon. “This is particularly relevant for women in their late thirties or early forties.” This age group of women are in a phase known as perimenopause, which spans 5 to 10 years before menopause begins. During this time, some women may undergo hormonal changes that can influence their thyroid function.

Hypothyroidism can impact both women and men due to various factors, as stated by the ATA. These can encompass autoimmune diseases like Hashimoto’s thyroiditis, using particular medications such as lithium, or having an imbalance of iodine in the body.

Understanding Anxiety

According to the American Psychiatric Association, a sense of unease is a natural reaction to stressful circumstances, keeping us vigilant during critical short-term situations such as a job interview or ensuring a toddler doesn’t dash onto the road. However, if this sense of dread surfaces too often and becomes embedded, it may escalate into a problem. Dr. Solomon clarifies, “Most people suffering from this level of worry are oblivious to it as it’s their usual state of being.” This condition could take the form of generalized apprehension, panic disorder, social unease, or specific fears like aviophobia (fear of flying). “If this state of alarm hinders your ability to perform daily tasks, it could be a sign of an anxiety disorder,” Solomon notes.

Anxiety is prevalent in individuals with hypothyroidism and can coexist with depression or present independently, according to Solomon. A study involving 100 hypothyroidism patients, published in the July-August 2016 issue of the Indian Journal of Endocrinology and Metabolism, revealed that 63 percent exhibited varying levels of apprehension.

The Root of Anxiety in Hypothyroidism

Why are those with hypothyroidism at a higher risk of developing anxiety? “One hypothesis suggests that merely having a physical issue like hypothyroidism can elevate angst levels,” explains Cheryl R. Rosenfeld, DO, a spokesperson for the American Association of Clinical Endocrinologists (AACE), a partner at North Jersey Endocrine Consultants, and an adjunct clinical associate professor of medicine at Touro College of Osteopathic Medicine in New York City. “Hypothyroidism symptoms, such as poor concentration, reduced memory, and challenges in carrying out everyday tasks, can contribute to anxiety.”

Inadequate treatment for hypothyroidism can also exacerbate anxiety. People commonly use Levothyroxine to treat hypothyroidism. However, Rosenfeld states that taking an excessively high dosage can trigger anxiety directly and induce symptoms like rapid heartbeat and trembling, thus exacerbating anxiety.If hypothyroidism remains untreated, symptoms like dry skin, cold sensitivity, hoarse voice, and mood fluctuations will continue. Over time, untreated hypothyroidism can lead to heart complications like a weak pulse or heart failure, which may induce additional apprehension.

Furthermore, anxiety can impede adherence to hypothyroidism treatment if it causes forgetfulness in taking medications, difficulty visiting the doctor, or obstacles in maintaining a healthy lifestyle.

Intriguingly, anxiety may still persist in women treated for hypothyroidism. A study published in December 2019 in the International Journal of Environmental Research and Public Health discovered that despite receiving levothyroxine treatment and restoring normal thyroid function, women diagnosed with hypothyroidism exhibited a 13 percent higher prevalence of anxiety compared to women without the condition.

Strategies for Managing and Treating Anxiety
Distinguishing anxiety or panic attacks from the symptoms of thyroid disease and its treatment can often be challenging.

Signs of Apprehension to Look Out For

If you have been diagnosed with hypothyroidism, be vigilant for the following apprehension symptoms:

  • Sleeplessness
  • Persistent edginess
  • Muscle stiffness
  • Uncontrollable worrying
  • Accelerated heartbeat
  • Perspiration and tremors
  • Fluctuations in appetite
  • Breathing difficulties
  • Alterations in bowel patterns

“Distinguishing anxiety or panic attacks from the symptoms of thyroid disease and its treatment can often be challenging,” Rosenfeld acknowledges.

Strategies for Managing and Treating the Disorder

Fortunately, both hypothyroidism and anxiety are highly treatable conditions. Solomon highlights effective methods for managing anxiety, which include:

  • Collaborating with a therapist
  • Engaging in regular exercise (particularly aerobic)
  • Participating in mind-body activities such as yoga
  • Practicing meditation or other mindfulness techniques
  • Adhering to hypothyroidism and anti-angst medication regimens

Solomon strongly advocates teaching her clients mindfulness as a means to counteract anxious thoughts. “Observe your thoughts without judgment. Then inquire, ‘Is this thought accurate? Is it overly pessimistic?'” she advises. “Subsequently, ask yourself, ‘Can I replace this thought with a more optimistic one?'”

In some instances, treating hypothyroidism can fully resolve anxiety, especially when angst symptoms emerged suddenly due to insufficient thyroid levels, says Solomon. However, in many situations, hypothyroidism and anxiety need to be addressed simultaneously. Treating one condition though can help alleviate the other.

Monitoring Anxiety

If you are dealing with both hypothyroidism and anxiety, it is crucial to collaborate with your doctor in monitoring both conditions. “The initiation and adjustment of thyroid hormone treatment should be directed by both lab testing and symptoms. This ideally happens under the guidance of a compassionate and knowledgeable healthcare professional,” Rosenfeld suggests. “Individuals with anxiety or panic disorder may need more frequent thyroid lab tests. Distinguishing between thyroid dysfunction and mental health issues can be challenging” she further explains.

Additionally, since mental well-being is just as vital as physical health, cooperate with your doctor to address anxiety. Apply methods such as therapy, adopting lifestyle practices like mindfulness and yoga, or a combination of strategies.


  1. National Institute of Mental Health (NIMH): They offer a thorough overview of anxiety disorders, including information on the symptoms, causes, and treatments available. This resource will help you understand the intersection of anxiety and hypothyroidism.
  2. WebMD: The Link Between Hypothyroidism and Anxiety. Various articles from WebMD delve into the relationship between hypothyroidism and anxiety, explaining the symptoms, causes, and treatments for both conditions. They also provide tips on how to manage anxiety related to thyroid disorders.

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