Why do thyroid and anxiety symptoms look so alike? Learn how to tell the thyroid and anxiety apart when you have palpitations, restlessness and insomnia.
For some time your heart has been racing for no reason, your hands have been trembling slightly and you have been struggling to sleep at night. Everyone says "You're stressed", and you think perhaps that is it. But at the same time you notice that you are losing weight, cannot bear the heat and your hair is falling out. Or the opposite: you have lived with anxiety for years, and with every new symptom you get a blood test wondering "Could it be my thyroid?", and even though the results come back clear, you cannot feel at ease. The relationship between thyroid and anxiety is an area that both doctors and mental health professionals encounter often, and one that is very easy to confuse. In this article I explain how the thyroid gland can affect mood, why thyroid problems and anxiety can look so alike, and what steps can be taken in the face of symptoms.
What Is the Thyroid Gland, and How Does It Affect Mood?
The thyroid is a small, butterfly-shaped gland at the front of the neck. The hormones it produces regulate the body's metabolic rate: many functions, from heartbeat to body temperature and from energy levels to bowel movements, are affected by these hormones. The brain is also sensitive to these hormones; for this reason, changes in thyroid function can have marked effects on mood, sleep and the speed of thinking.
Thyroid problems generally appear in two forms:
- Hyperthyroidism: The thyroid gland producing too much hormone. The body switches into a kind of "sped-up" mode.
- Hypothyroidism: The thyroid gland not producing enough hormone. Body and mind "slow down".
Both conditions can affect mood; but the picture that most resembles anxiety is hyperthyroidism. Hypothyroidism, on the other hand, is more likely to be confused with tiredness, lack of motivation and low mood. Struggling to get up in the morning, feeling cold all day, forgetfulness, constipation, dry skin and weight gain are symptoms often described in this picture. Some people with hypothyroidism can also experience restlessness and anxiety; so the direction in which mood changes is not on its own a distinguishing factor.
In Turkey, thyroid problems are a topic that comes up often in everyday conversation. In many families you hear the sentence "My mother had it, and so did my aunt"; a thyroid test is known as one of the first tests requested in routine check-ups. This familiarity raises awareness on one hand, but on the other it can also feed the tendency either to attribute every bout of restlessness to the thyroid or, conversely, to brush it off with "Everyone has it, it's nothing". Both extremes can take a person away from proper assessment.
Why Are Thyroid and Anxiety Symptoms So Similar?
Hyperthyroidism and anxiety create a similar state of alarm in the body. For this reason the symptoms can overlap to a large extent:
- Heart palpitations and a fast pulse
- Trembling hands
- Sweating, hot flushes
- Restlessness, being unable to sit still
- Difficulty falling asleep, waking often
- Irritability, impatience
- Difficulty concentrating
- Tiredness and exhaustion
This list is almost identical to the one an anxious person uses to describe their own experience. The reason for the similarity is not surprising: excess thyroid hormone amplifies the nervous system responses involved in the body's stress response. Anxiety switches on the same system. In other words, although you enter through two different doors, you arrive in the same room: a racing heart, tense muscles and a mind on alert. This similarity can lead to confusion in both directions. On one side, a person with a thyroid problem may interpret their symptoms as "stress" for a long time and delay seeing a doctor. On the other side, an anxious person may look for a thyroid disease behind every physical symptom and keep having tests.
If you would like to know more about the link between heart palpitations and stress and anxiety, you can also read the article on palpitations and stress.
Clues That Suggest a Thyroid Cause
A definite distinction can only be made through a medical examination and blood tests. Even so, some clues may suggest that the symptoms are not coming from anxiety alone:
- Symptoms that started without any obvious source of stress and continue constantly
- Unexplained weight loss while appetite is normal or increased, or conversely unexplained weight gain
- Marked sensitivity to heat or cold
- Swelling or fullness in the neck, or discomfort when swallowing
- Prominent eyes, dryness or a gritty feeling in the eyes
- Hair loss, changes in the skin or nails
- Changes in the menstrual cycle
- A marked change in bowel habits
- A family history of thyroid disease
Anxiety usually fluctuates depending on circumstances; it increases on stressful days and eases in calm periods. Thyroid-related symptoms, however, often persist regardless of circumstances. This difference is not a diagnostic tool on its own, but it is a useful observation to share with your doctor. For example, if your symptoms continue with the same intensity while you are on holiday, spending a calm evening with your loved ones or have just woken from sleep, that is information worth sharing with your doctor.
Can a Thyroid Problem and Anxiety Exist Together?
Yes. Thyroid conditions and anxiety are not mutually exclusive; they can occur together in the same person. An imbalance in thyroid hormones can increase anxiety symptoms. Receiving a diagnosis of thyroid disease, the uncertainty of the treatment process and physical changes can also be sources of anxiety and sadness in their own right.
Once thyroid treatment has begun and hormone levels have stabilised, some of the anxiety symptoms may ease markedly. But in some people, anxiety continues even though hormone values have returned to normal. There may be several reasons for this: the person was already prone to anxiety, the period of illness has left the mind with a habit of "body alarm", or stresses in other areas of life are also contributing to the picture. In this case, working on the anxiety separately in addition to thyroid treatment is helpful.
Let's say a teacher in her thirties has been experiencing palpitations, sleeplessness and irritability for months. Because school has been going through a busy period, she sees this as stress. One day her mother notices a swelling in her neck and insists she see a doctor. Tests reveal that her thyroid is overactive, and treatment begins. A few months later, the palpitations and trembling have eased markedly. But the fear she felt during that period has turned into a habit of listening to every heartbeat. Now, even though her hormone values are normal, she panics every time her heart speeds up. In this example, thyroid treatment has put the physical side right, but the anxiety cycle left in the mind is still waiting to be addressed separately.
If the Tests Are Clear but the Anxiety Continues
Some people cannot shake off the thought "Perhaps something was missed" even though their thyroid tests have come back normal again and again. A new test with every new symptom, a brief relief after each result, and then the doubt starting all over again... This cycle is a typical example of health anxiety.
In health anxiety, the problem is less the medical uncertainty itself than being unable to tolerate uncertainty. Having tests, searching for symptoms online and seeking reassurance from loved ones bring short-lived relief; but the mind asks for this relief again every time. For broader information on this, you can read the article on health anxiety.
There is an important balance here: physical symptoms need to be taken seriously, but you also need to trust your doctor's assessment. Following the follow-up intervals your doctor recommends is much healthier than frequently having tests on your own initiative.
Let's say someone working at a bank began having palpitations during a period when pressure to meet targets at work increased. Their first tests were normal; they felt relieved, but two weeks later, with a new bout of palpitations, they went to another laboratory. Within six months they had five thyroid tests, and each time the result was normal. Each result brought a few days of peace, and then the thought "What if this laboratory measured it wrong?" would begin. In this example, the tests do not solve the problem; on the contrary, they become part of the anxiety. What helps here is not a new test but learning to cope with uncertainty.
Thyroid and Anxiety: What Can You Do in the Face of Symptoms?
See a doctor first
If you have symptoms such as palpitations, trembling, unexplained weight change or swelling in the neck, the first step is a medical examination. Blood tests assessing thyroid function are simple and widely performed. Don't brush the symptoms off by saying "It's stress".
Make a note of your symptoms
Noting for a few weeks when the symptoms started, under what conditions they increase or decrease and any accompanying changes makes your appointment with the doctor more productive. These notes also help you see how the symptoms relate to stress.
Keep up your treatment regularly
If you have been diagnosed with a thyroid condition, it is important to follow the treatment and check-up schedule your doctor recommends regularly. Changes to treatment should only be made on your doctor's decision. Hormone levels can take time to stabilise; being patient during this process also reduces anxiety.
Review your caffeine
Coffee, strong tea and energy drinks can increase both thyroid-related and anxiety-related palpitations and restlessness. Cutting down on caffeine, especially during periods when symptoms are intense, can make a difference.
Build habits that calm the body
Regular sleep, light and regular exercise, breathing exercises and muscle relaxation exercises help settle the body's alarm, whatever its cause. A few minutes of breathing with your out-breath slightly longer than your in-breath can calm the body during palpitations.
Limit symptom monitoring
Constantly measuring your pulse, checking the readings on your smartwatch or searching for symptoms online feeds anxiety. If your doctor has not recommended specific monitoring, try consciously cutting down on these checks.
Make room for your feelings too
Being diagnosed with a chronic condition, going through unexpected physical changes and adjusting to the treatment process can be emotionally challenging. Sharing these feelings with people you trust and being compassionate towards yourself makes the process easier.
Body and mind do not live in separate rooms; while listening to one, you also need to hear the other.
When Should You Seek Professional Support?
For physical symptoms, a doctor should be consulted first. Psychological support, on the other hand, can be helpful in the following situations:
- If anxiety, fear of palpitations or panic symptoms continue even though your thyroid values have returned to normal
- If you cannot shake off thoughts that you have an illness even though your tests have come back normal again and again
- If you have got into a cycle of constantly checking your body, having tests or searching for symptoms online
- If the diagnosis of thyroid disease and the treatment process are challenging you emotionally
- If alongside anxiety there is also lack of motivation, hopelessness and intense tiredness
All decisions about thyroid treatment and about medication for anxiety or mood should be made through the assessment of a doctor and, if necessary, a psychiatrist. It is important not to change medication doses on your own.
How Are Thyroid and Anxiety Addressed in Therapy?
In therapy, the psychological side of anxiety is worked on, based on your doctor's medical assessment and treatment. The aim is not to ignore physical symptoms, but to make the response to them more balanced.
In cognitive behavioural therapy, the cycle between bodily sensations and anxiety is understood first: palpitations are noticed, the thought "My thyroid is off again" or "Something is happening to my heart" comes, anxiety rises, and anxiety in turn increases the palpitations. The thoughts in this cycle are examined together. Behaviours such as constantly checking the body and seeking reassurance are gradually reduced. Work on increasing tolerance of bodily sensations and relaxation skills are added to the process.
The emotional burden of living with a chronic condition, uncertainty and adjusting to changes in the body are also among the issues that can be addressed in therapy. You can find how individual work on anxiety is carried out on the anxiety and panic page.
Frequently Asked Questions
Can I tell thyroid and anxiety symptoms apart myself?
It is not possible for you to make a definite distinction on your own. Your observations about how the symptoms behave guide your doctor, but a diagnosis is made through examination and tests. For this reason the first step should always be a doctor's assessment.
Can stress cause thyroid disease?
Stress is discussed as one of the factors that may affect thyroid-related immune processes in some people. However, genetic predisposition and other medical factors also play an important role in the onset of thyroid diseases. Reducing stress is beneficial for general health, but it does not replace medical treatment.
Why didn't my anxiety go away straight after starting thyroid treatment?
Hormone levels can take time to stabilise. In addition, anxiety habits that developed during the period of illness may continue even when the physical side has improved. In this case it is helpful both to continue follow-up with your doctor and to work on the anxiety separately.
Do thyroid changes during pregnancy or after birth affect anxiety?
Pregnancy and the postnatal period are times when changes in thyroid function can occur. Restlessness, palpitations or intense tiredness that appear during this period should always be shared with your doctor. Psychological support can also be considered separately for changes in mood in the postnatal period.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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