Revised 2024

Your guide to psychological symptoms and thyroid disorders

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Also available in Arabic, Polish, Mandarin and Urdu

Content overview

What kind of emotional problems might I experience?

What about mental health problems?

What causes the psychological symptoms?

What about treatment?

Will I recover?

Some important points

People with thyroid disorders often have emotional or mental health symptoms as well as physical symptoms. This is especially the case for people with hyperthyroidism (an overactive thyroid), hypothyroidism (an underactive thyroid), thyroid related eye disease, or thyroid cancer.

What kind of emotional problems might I experience?

Whatever your type of thyroid disorder, it can make you feel more emotional than you felt before and you may find that your mood changes, sometimes rapidly and unpredictably. Common emotional problems are:

• Anxiety - a feeling of nervousness, racing heart and trembling, or from worries about managing normal daily activities while coping with fatigue and loss of energy
• Depression - low mood and difficulty enjoying things, tearfulness, loss of appetite and lethargy
• Mood swings - irritability, snappiness or short-temper

What about mental wellbeing problems?

Cognitive or processing problems that can occur, most often with thyroid underactivity, include:

• Difficulties with concentration (brain fog)
• Short-term memory lapses
• Lack of interest and mental alertness

These symptoms can cause some people to worry about permanent memory failure often associated with dementia but in fact they are rarely as severe as seen in dementia.

What causes the psychological symptoms?

Abnormal thyroid hormone levels can sometimes cause these symptoms. In particular, rapid changes in thyroid hormone levels, can unsettle your emotions. With hyperthyroidism especially, rapid and effective control of the thyroid levels is essential to stabilise the mood, and it is important to make sure that the thyroid levels remain stable.

Sometimes psychological symptoms are a side-effect of the treatment. For example, beta blockers, sometimes prescribed if you are hyperthyroid, to slow down your heart rate and reduce anxiety, can make some people feel tired, depressed, and mentally less alert. If you are prescribed steroids, these can aggravate depression.

A thyroid disorder can also cause changes in appearance, for example, facial changes due to thyroid eye disease, weight loss or gain, and hair loss. These changes can be upsetting and contribute to feelings of low self-esteem or low mood.

It is unclear whether stressful life events trigger thyroid disease. However stress can aggravate symptoms that are caused by a thyroid condition and make them much worse and take longer to settle. Learning that you have thyroid cancer is stressful. It is understandable and not unusual to have an emotional reaction before, during, or after treatment. In some patients, this can trigger trauma. Symptoms may include flashbacks, feeling emotionally numb, having difficulty sleeping or concentrating, feeling jumpy or frightened and feeling cut off from those around you. These can all severely affect your daily life. If you are experiencing any of these symptoms, please discuss them with your doctor so they can identify the right support for you.

Sometimes it can take a while for thyroid medication to become properly balanced, especially with hypothyroidism and following thyroid surgery. Coping with symptoms while medication is adjusted (particularly fatigue and lack of energy) may impact on your mental wellbeing. Learning to manage your energy levels, gentle exercise and incorporating relaxation activities can all help to improve wellbeing. 

Forgetting to take your medication can also be a factor. Some people lose motivation when it comes to daily tablet-taking or attending clinics. However, taking tablets irregularly can upset your hormone balance and aggravate the psychological symptoms.

It is also possible that other factors are contributing to your symptoms, so it is always important to look at all things that may be affecting your emotional wellbeing, such as, feeling misunderstood by others or socially isolated, not able to do valued activities, problems at work, problems with finance. 

Over and underactivity of the thyroid may put a strain on personal relationships. Once the conditions have been stabilised and treated, your emotional state and relationships are likely to improve. 

What about treatment?

Fortunately, in the great majority of cases, if the thyroid is the cause of the problem, psychological symptoms will improve as the thyroid disorder is brought under control by treatment. But this improvement may not be as rapid as you hope, and it is common for people to feel emotionally and mentally ‘not quite right’ or ‘out of sorts’ for some time even after their blood tests return to normal. But remember, there are lots of people who can help:

• talk to your doctor
• ask to see a specialist with experience in dealing with thyroid disorders
• confide in a family member or close friend who may be able to help you through this difficult time
• talk to others who have been through a similar experience - the BTF has a network of  volunteer telephone contacts,online support groups and a medical query answering service 

Do not feel awkward or embarrassed about talking to your doctor about the psychological symptoms associated with your thyroid disorder. They could be associated with your thyroid levels. Ask as many questions as you need to understand what is happening to you.

These symptoms can also have an impact on your family and friends and your work colleagues, so it is important to give them the opportunity to understand what is happening. For children and young people, these symptoms can have an impact on your school or college work, so it is useful that teachers are informed and can make allowances, especially at exam time. The BTF can provide information to explain to others how you are feeling. 

Physical symptoms such as hair loss, thyroid eye disease, weight gain or loss, can affect the way you are feeling. Your doctor can refer you to a specialist who can help.

Even though the cause may be physical, anxiety or depression sometimes require treatment in their own right. Non-drug treatments such as relaxation or talking therapies can help. If your problem is more persistent you may be prescribed a drug such as an antidepressant.

If your symptoms are especially severe, or if they continue even after a fair trial of thyroid treatment, you should ask your doctor to refer you to a psychiatrist or a clinical psychologist who has expertise in treating psychological problems associated with physical illness.

Will I recover?

The outlook for all types of most thyroid disorders is good, and even if your psychological symptoms take a long time to settle initially, most people find they make a full recovery and lead normal lives once their thyroid condition is treated. If your symptoms do not settle, this is usually because the problems are caused by something other than a thyroid disorder and further assessment and treatment may be needed to manage this situation.

Some important points….

• Your emotional and mental health problems should improve as your thyroid condition stabilises, and the long-term prospect is good
• If your symptoms do not improve with treatment, it may be that they are slow to respond and more time is needed or that they are caused by something else, which may need further investigation
• Confiding in a family member or close friend or talking to someone (for example, a BTF volunteer) who has been through this experience can help you during this difficult time
• Speak to your doctor who should be able to help, or you can ask to be referred to a specialist

Thyroid problems often run in families and if family members are unwell, they should be encouraged to discuss with their own GP whether thyroid testing is warranted.

If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you. You may also contact the British Thyroid Foundation for further information and support, or read our booklet 'Looking after your Psychological Wellbeing'.

www.btf-thyroid.org/psychological-wellbeing-booklet

Find more resources, including patient stories, films and details of our support network here

Living with thyroid disorders

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The British Thyroid Foundation

www.btf-thyroid.org
The British Thyroid Foundation is a registered charity: England and Wales No 1006391, Scotland SC046037

Endorsed by:

The British Thyroid Association - medical professionals encouraging the highest standards in patient care and research
www.british-thyroid-association.org

The British Association of Endocrine and Thyroid Surgeons - the representative body of British surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal)
www.baets.org.uk

First issued: 2008
Revised: 2011, 2015, 2018, 2024
Our literature is reviewed every two years and revised if necessary.
© 2024 BRITISH THYROID FOUNDATION

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