How Thyroid Issues are Often Misdiagnosed as Depression

Updated: Sep 5, 2018

Most primary care doctors use TSH tests to determine if someone has a thyroid issue but it turns out these tests can be misleading. If you've been diagnosed with depression but anti-depressants aren't working, it's possible that you have a thyroid condition after all.

My intention with this article and the next is to give you a crystal-clear understanding of what's going on in your body and in the medical community when it comes to the thyroid. I'll lay out the history behind this problem and how to determine if you're dealing with a thyroid issue. But first, we should go over the basics-

What is the thyroid and why is it so important?

The thyroid is the battery of the body. It's a little butterfly-shaped organ located in your neck and it regulates everything from your metabolism and digestion to your liver function, immune system, and brain. If your battery is running low, your whole body is running low. If your battery is running hot, your whole body is overworking.

Lately, there's been an epidemic of low thyroid (Hypothyroidism) and the symptoms can be both debilitating to the patient and deceptive to a diagnostician.

Here's a list of symptoms to look out for:

- You feel exhausted.

You don't have the energy you used to. You go to bed early and you feel sluggish throughout the day.

- You feel cold all the time.

Your hands and feet are constantly freezing and you need to wear socks to bed. What's happening is that your body is conserving energy by shutting down blood flow to the skin, so you may also have dry, itchy skin as well.

- Your hair is becoming dry and brittle.

It may be falling out. The color may be changing, becoming more dull or lack-luster. You may lose the outer-third of your eyebrows. (*Note from Dr. Bruce Roberts of LightHearted Medicine- "I used to sit on the bus in San Francisco and diagnose people around me. Not on purpose! But if I saw someone who couldn't keep their eyes open and they were missing the outer third of their eyebrows, I'd be so tempted to let them know they had a thyroid issue. It could have changed their lives. But I'm sure no one wants to be diagnosed by a stranger on the bus.")

- Your fingernails have gotten dry and brittle as well.

- You're constipated.

The intestinal tract isn't working very well and has become sluggish.

- Brain fog.

Your brain uses a lot of energy, so you may be having a hard time concentrating and your memory isn't as sharp as it used to be, which can be really frustrating. This symptom is often misdiagnosed as depression.

"I was a family practice doc at the beginning of my medical career," says Dr. Bruce. "But, when I noticed that so much of people's health was related to their emotional state and stress levels, I went back to school to become a psychiatrist. What was interesting was that a lot of patients would get sent to me by their primary care doctors because they'd been diagnosed with depression and the anti-depressants they'd been put on weren't working. But it turns out, a lot of them weren't depressed at all. They just had a thyroid issue that had been misdiagnosed. So physical symptoms can often have emotional sources and emotional symptoms can often have physical sources. It's all connected."

So why are there so many cases of low thyroid these days? There are stress factors as well as environmental factors.

A lot of us are under chronic stress. We're not being chased by tigers, obviously, but those fight or flight defense mechanisms are still trying to help us out with every-day situations like giving a presentation at work, getting stuck in heavy traffic, or realizing in a moment of existential dread that you have no idea what your purpose in life is. These are the moments when your sympathetic nervous system is activated and your adrenal glands trigger the release of catecholamines, which include adrenaline and noradrenaline. Once the immediate threat is gone, a message is sent to your thyroid, the body's battery, to slow the body down for some recovery time.

Many doctors will prescribe iodine supplements to counteract a slow thyroid if they detect a problem. This is a response to the environmental reason for the influx of thyroid issues. But taking iodine in large doses can be dangerous. Dr. Bruce explains-

"Iodine is really important for the function of the thyroid. Iodine on the periodic table is a Halogen. Other Halogens in the periodic table are things like chloride, bromide, and fluoride. We've got fluoride in our water and in our toothpaste, and bromide's used as a preservative in foods. And so some people think that we've flooded the environment with so much of these other Halogens that it's displacing iodine and influencing our thyroid function."

But taking too much iodine can reverse your Hypothyroidism and send you too far in the opposite direction- all the way into Hyperthyroidism.

Hyperthyroidism isn't quite as common but the symptoms are almost the exact opposite of Hypothyroidism. Your battery becomes too powerful. So you may feel hot all the time, you may feel jittery or twitchy, you may have trouble sleeping and experience loose stool due to an intestinal tract that's working too hard. One unique symptom is that the auto-immune process can thicken the muscles around the eyes, causing them to pop out a bit. The most famous example of this was seen in Mel Brooks' Young Frankenstein. Marty Feldman, who played Igor, had Graves Disease, a form of Hyperthyroidism, which gave him those characteristic eyes.

"It does get tricky," says Dr. Bruce. "Too much or too little iodine can effect the thyroid. So I don't recommend going out and getting a high-dose iodine supplement. But perhaps eating some sea weed or using a salt with iodine in it can help. If you are using milligram doses, you need to be very cautious and should be monitored very closely by a doctor."

So if thyroid issues are so rampant, why do they get misdiagnosed so often?

This has to do with the test that's been used since the 70's to determine a patient's Thyroid Stimulating Hormone, or TSH. Stay tuned next week for a history of the TSH test, how it works, why it doesn't always work, and how to properly diagnose a thyroid problem.

-Katlyn Roberts, Community Manager at LightHearted Medicine.