Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Can Thyroid Abnormality Cause Anxiety And Panic Disorder?
Question: Hi I have been having anxiety , panic disorder since 2.5 yrs. Anti depressants were of no help neither therapy. Recent blood test shows thyroid abnormality . (Reports attached) . Could the thyroid issue could be causing my anxiety. My endocrinologist thinks that the thyroiditis will self limit itself .
Brief Answer:
thyroiditis can cause anxiety & panic attacks
Detailed Answer:
Hello XXXX
I have seen your tracer study and the thyroid test report. From both of them it is evident that you are having hyperthyroidism ( thyroisitis) and your symptoms can be due to this condition.
Thyroiditis is the reason that symptoms of anxiety and panic attacks didnt respond to anti anxiety medicines.
I would like to tell you that significant number of patients of anxiety/ depressive disorder have comorbid thyroid dysfunction; thereby it is almost mandatory to check the thyroid levels in the begining of treatment.
The managment of such cases is both of hyperthyroid gland and anxiety complaints. Treating with only anti-anxiety drugs can never bring good results here.
Your doctor is also somehow right in claming that thyroid medicines them selves can bring about good response. It can happen in some similar cases. Otherwise many times treatmnet with both thyroid drugs and anxiety meds is needed.
So, according to my clinical experience - you must enter into treatment with an endocrinologist for hyper thyroidism ( thyroiditis) and if with time you feel that all symptoms have not gone sufficiently & there are still some anxiety left- then add anti anxiety medicines.
Please do not loose hope, your illness is completely treatable and commonly seen in clinical practice.
Wish you a speedy recovery!
Do ask more questions for clarification
Dr. Manisha Gopal
MD psychiatry
thyroiditis can cause anxiety & panic attacks
Detailed Answer:
Hello XXXX
I have seen your tracer study and the thyroid test report. From both of them it is evident that you are having hyperthyroidism ( thyroisitis) and your symptoms can be due to this condition.
Thyroiditis is the reason that symptoms of anxiety and panic attacks didnt respond to anti anxiety medicines.
I would like to tell you that significant number of patients of anxiety/ depressive disorder have comorbid thyroid dysfunction; thereby it is almost mandatory to check the thyroid levels in the begining of treatment.
The managment of such cases is both of hyperthyroid gland and anxiety complaints. Treating with only anti-anxiety drugs can never bring good results here.
Your doctor is also somehow right in claming that thyroid medicines them selves can bring about good response. It can happen in some similar cases. Otherwise many times treatmnet with both thyroid drugs and anxiety meds is needed.
So, according to my clinical experience - you must enter into treatment with an endocrinologist for hyper thyroidism ( thyroiditis) and if with time you feel that all symptoms have not gone sufficiently & there are still some anxiety left- then add anti anxiety medicines.
Please do not loose hope, your illness is completely treatable and commonly seen in clinical practice.
Wish you a speedy recovery!
Do ask more questions for clarification
Dr. Manisha Gopal
MD psychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor .
I have a follow up question. My initial onset of symptoms were 2.5 yrs back . That time my T3,T4 and TSH were normal . So could it be that the ongoing stress from anxiety and panic attack have caused thyroid issue or, there was thyroid issue back then also but it did not show up on report.
I have a follow up question. My initial onset of symptoms were 2.5 yrs back . That time my T3,T4 and TSH were normal . So could it be that the ongoing stress from anxiety and panic attack have caused thyroid issue or, there was thyroid issue back then also but it did not show up on report.
Brief Answer:
when reports were normal we cant blame thyroid
Detailed Answer:
Hello
If your blood test for thyroid were normal 2.5 years back- it almost rules out the possibility of having thyroid disorder at that time.
However, sometimes in cases of doubts, we do get an Anti TPO antibody test done( in an otherwise normal thyroid report) - which can be. found raised. This needs to be treated for efective response to anxiety managment.
So, for now when we donot have Anto TPO report of that time, we have to assme that thyroid was normal and was not involved in the pathophysiology of anxiety or depression.
Regarding the thyroiditis which you have developed now, there are schools of thought which support this notion that any chronic ongoing stress can lead to several auto immune disorders in body. So, the anxiety can be one of its reason. But it is difficult to pin point it as the only cause... nothing can clearly be blamed for development of thyroiditis...what ever it is , though it can be self limiting in many cases, but when it becomes symptomatic --then it should be treated.
The point that you have not shown good response to treatment previously can be due to several drug related factors also. Many time the drug given is not correct in its formulation/ dosage or duration..this can lead to insufficient or poor response. If you want, I can look out for the cause in your case; you have to provide me with drug details.
I hope the reply is helpful for you.
Please feel free to ask more questions if you have.
Dr. Manisha Gopal
MD psychiatry
when reports were normal we cant blame thyroid
Detailed Answer:
Hello
If your blood test for thyroid were normal 2.5 years back- it almost rules out the possibility of having thyroid disorder at that time.
However, sometimes in cases of doubts, we do get an Anti TPO antibody test done( in an otherwise normal thyroid report) - which can be. found raised. This needs to be treated for efective response to anxiety managment.
So, for now when we donot have Anto TPO report of that time, we have to assme that thyroid was normal and was not involved in the pathophysiology of anxiety or depression.
Regarding the thyroiditis which you have developed now, there are schools of thought which support this notion that any chronic ongoing stress can lead to several auto immune disorders in body. So, the anxiety can be one of its reason. But it is difficult to pin point it as the only cause... nothing can clearly be blamed for development of thyroiditis...what ever it is , though it can be self limiting in many cases, but when it becomes symptomatic --then it should be treated.
The point that you have not shown good response to treatment previously can be due to several drug related factors also. Many time the drug given is not correct in its formulation/ dosage or duration..this can lead to insufficient or poor response. If you want, I can look out for the cause in your case; you have to provide me with drug details.
I hope the reply is helpful for you.
Please feel free to ask more questions if you have.
Dr. Manisha Gopal
MD psychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor I was on Zapiz 0.25 twice a day and Fludac 20 mg once a day for 2-3 months. Then I changed doctors and I was prescribed Lonazep 0.25 and some other antidepressant. This again went on for 1 month and then I stopped cold XXXXXXX as it was not helping. Another question that I had was in the initial period of my panic disorder it was a case of over excess adrenalin and I was running from one place to another not it is more of a drowsiness and weakness and it is persistent ,earlier it was episodic. Is this normal for panic disorder progression?
Brief Answer:
its anxiety & many good meds are available now,
Detailed Answer:
Hello,
The earlier presentation was more similar to typical anxiety disorder in which usually fluoxetine is avoided- as it increases the anxiety many times.
This can be one of the reasons that you did not have benefit with treatment.
Another reason can be insufficient dosage- fluoxetine (if at all was effective), should have been taken upto 40-60mg daily.
Second- presently the symptoms are more of lethargy and weakness: suggestive by feeling of exhaustion and is more a case of inactive anxiety or may be depressive component being predominant.
It is not that every patient of panic/ anxiety disorder proceed like this but many do. Usually we see in clinical practice that anxiety and sadness overlap or wax and wane throughout the illness..varying in intensity..
There are several good meds available now
and help almost all such patiens in living the life they want/ desire to live.
So, donot feel helpless at all. If you want I can suggest the measures to proceed.
All the best!
Dr. Manisha Gopal
MD Psychiatry
its anxiety & many good meds are available now,
Detailed Answer:
Hello,
The earlier presentation was more similar to typical anxiety disorder in which usually fluoxetine is avoided- as it increases the anxiety many times.
This can be one of the reasons that you did not have benefit with treatment.
Another reason can be insufficient dosage- fluoxetine (if at all was effective), should have been taken upto 40-60mg daily.
Second- presently the symptoms are more of lethargy and weakness: suggestive by feeling of exhaustion and is more a case of inactive anxiety or may be depressive component being predominant.
It is not that every patient of panic/ anxiety disorder proceed like this but many do. Usually we see in clinical practice that anxiety and sadness overlap or wax and wane throughout the illness..varying in intensity..
There are several good meds available now
and help almost all such patiens in living the life they want/ desire to live.
So, donot feel helpless at all. If you want I can suggest the measures to proceed.
All the best!
Dr. Manisha Gopal
MD Psychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor,
Please let me know how to go about with the treatment .
Please let me know how to go about with the treatment .
Brief Answer:
venalafaxine can help
Detailed Answer:
Hello XXXX
I have gone through such cases and what reflects is that you should take both anti anxiety meds and drug for hyper thyroidism.
I have seen venalafaxine having good results in similar cases- starting with low dose: 37.5mg for a week and moving to 75mg later.
Adding etizolam 0.5-1mg in morning and afternoon hours will help early response.
these can be stopped later..
Carbimazole is a good molecule for treating thyroid.
Before starting meds repeat the blood tests- espically if they are three months old. Get TSH, CBC, Lipid profile, LFT, KFT and serum B12 level.
Get blood pressure monitored and treat if needed.
Increase your water intake, sips every 10-15 minutes.
Please increase socialzation, you have to push yourself for these changes..but they help a lot.
Stop junk food and cold drinks completely for some time atleast.
Please reduce tea/ coffee use, can take green tea after meals.
Please help yourself with daily walks 20min
and preffrably brisk walks.
Im sure you can do this and get well!
please start the treatment ( you may discuss with your GP or other speacilist).
Dr. Manisha Gopal
MD Psychiatry
venalafaxine can help
Detailed Answer:
Hello XXXX
I have gone through such cases and what reflects is that you should take both anti anxiety meds and drug for hyper thyroidism.
I have seen venalafaxine having good results in similar cases- starting with low dose: 37.5mg for a week and moving to 75mg later.
Adding etizolam 0.5-1mg in morning and afternoon hours will help early response.
these can be stopped later..
Carbimazole is a good molecule for treating thyroid.
Before starting meds repeat the blood tests- espically if they are three months old. Get TSH, CBC, Lipid profile, LFT, KFT and serum B12 level.
Get blood pressure monitored and treat if needed.
Increase your water intake, sips every 10-15 minutes.
Please increase socialzation, you have to push yourself for these changes..but they help a lot.
Stop junk food and cold drinks completely for some time atleast.
Please reduce tea/ coffee use, can take green tea after meals.
Please help yourself with daily walks 20min
and preffrably brisk walks.
Im sure you can do this and get well!
please start the treatment ( you may discuss with your GP or other speacilist).
Dr. Manisha Gopal
MD Psychiatry
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
