Can Stress Make Your Thyroid Problems Worse? (SQ-133)
We all know how stress is bad for health. Long-standing stress, whether it be physical, mental or emotional, takes a heavy toll on your body and may cause or worsen health issues such as high blood pressure, diabetes, heart disease, depression and anxiety disorder.
Can stress also make your thyroid problems worse?
The thyroid gland is very sensitive and responds to various internal and external factors, such as nutritional deficiencies, leaky gut, metabolic disorders and stress.
What is the thyroid gland and what does it do?
The thyroid gland is a small gland found at the base of your neck. It releases thyroid hormones that are in control of various biological processes including metabolism, body temperature, heart rate, breathing, fertility, growth, reproduction, and sleep.
While stress alone can not cause the thyroid gland to malfunction, it can contribute in a lot of ways to harm your thyroid health.
How is stress related to thyroid disorders?
Stress affects your thyroid function in many ways. And to connect these dots, let’s take a brief look at how your thyroid gland works.
- The thyroid gland secretes thyroxine (T4) and triiodothyronine (T3), that enter the bloodstream and are used by the cells.
- When T4 and T3 levels become low, your brain stimulates the pituitary gland to make thyroid stimulating hormone (TSH).
- TSH signals your thyroid gland to produce healthy levels of T3 and T4
- Your body converts T4 into T3
- T3 travels into the bloodstream and reaches cells with the help of a transport protein called TBG
- Your cells absorb T3 with the help of T3 receptors
Looks like if you are producing healthy levels of TSH, T3 and T4, it is enough for your thyroid to function properly? Well, it is certainly not so. The thyroid produces more of T4 than T3, which is the active form of hormone. So, your body needs to convert T4 to T3.
Initially, T3 is attached to a transport protein called Thyroid binding globulin or TBG, that helps T3 to move in the bloodstream. When this T3-TBG complex reaches cells, T3 detaches from TBG so that it can now bind to and activate thyroid hormone receptors present on the cells.
Stress, along with other factors such as poor gut health and nutritional deficiencies, can play a spoilsport during these critical conversion and absorption processes. In addition, stress itself contributes to conditions such as chronic inflammation, leaky gut and high sugar levels, thus creating a vicious cycle.
Stress affects adrenal health
Under stress your body produces cortisol, the primary stress hormone. While your body knows how to deal with small amounts of cortisol (and it is important for that burst of energy you need to kick-start your day), elevated levels during chronic stress means bad news for thyroid health.
Cortisol blocks the conversion of T4 to active T3. And it encourages your liver to convert T4 into reverse T3 (rT3) hormone. While your body naturally makes some amounts of rT3 from T4, it produces more rT3 during stressful situations. This reduces the amount of T3 available for cells and contributes to symptoms of hypothyroidism.
Stress has a negative effect on T4 to T3 conversion
During stress, metabolism, thyroid function and many other processes take a backseat. It also impairs the conversion of inactive T4 into active T3.
What happens when T4 is not effectively converted into T3? In this scenario, you may have your TSH and T4 levels within range but still show symptoms associated with hypothyroidism.
Stress mess up TBG levels
Thyroid binding globulin (TBG) is a transport protein that gives a ride to T3 and helps it to move around in the bloodstream. It is something similar to how cholesterol and other fat molecules move around the circulatory system with the help of lipoproteins.
Once T3 reaches cells, it frees itself from TBG and attaches to T3 receptors. This active T3 is now ready to be used by the cells.
What happens when your TBG levels are high? Your body will have reduced amounts of free and active T3, leading to symptoms of hypothyroidism.
Estrogen dominance is one of the main reasons for raised TBG levels and is quite common in women in their mid to late 30s. This begins when progesterone levels start to decline, causing a shift in progesterone-estrogen balance. Other factors that cause high levels of estrogen in the body are prolonged use of birth control pills, hormone replacement therapy, liver disorders and obesity. Stress also increases estrogen levels in the body.
Hypothyroidism is more common in women than men and this could possibly be due to estrogen imbalances as increased estrogen signals the liver to produce more of TBG.
Estrogen dominance can also be detrimental to your overall health. It can cause painful periods, PCOS, depression, endometriosis and uterine fibroids. High estrogen levels can also increase your risk of developing breast cancer.
Stress affects T3 receptors
Thyroid hormone enters the cells by attaching itself to the receptors on the cells. Factors such as stress, genetic mutations, raised cortisol and deficiencies of fatty acids, vitamin A and zinc, can impair the function of T3 receptors.
Dysfunctional T3 receptors do not respond to T3 hormone, which means cells can’t pick and use T3. It leads to high amounts of T3 in the bloodstream, causing thyroid resistance, much like insulin resistance. Here, too much of T3 makes cells develop a resistance.
On another note, reduced levels of TBG can also cause thyroid resistance. Low TBG levels are often seen in people with elevated testosterone levels, insulin resistance and PCOS (polycystic ovarian syndrome).
Stress causes leaky gut
It is a condition where the content of your gut spills into the bloodstream. The walls of your intestines have tight openings that control what gets into the bloodstream and what remains within. In a healthy gut, these junctions allow nutrients to pass through but keep toxic content and bacteria inside.
An unhealthy gut, however, develops holes that let harmful substances to seep in the bloodstream. This is called leaky gut syndrome. When foreign substances (such as undigested food and microbes), that have no place in the circulation, enter the blood, your immune system produces antibodies to fight them off. This autoimmune response further irritates and inflames the gut.
But how is your gut health related to thyroid function?
As you know, inactive T4 needs to be converted into T3. Nearly 20 percent of this conversion takes place in the gut, where healthy and thriving gut flora provides a family of enzymes called deiodinases to convert T4 into T3. These enzymes are also involved in the activation or suppression of thyroid hormones. This makes gut health paramount to thyroid function.
In people with poor gut health, there is a lack of good and beneficial bacteria, whereas bad bacteria flourish. These imbalances in the gut flora negatively affects T4 to T3 conversion.
In addition, poor gut health adversely affects the absorption of nutrients, leading to nutritional deficiencies. Low levels of certain vitamins and minerals deficiencies is one of the most important yet an overlooked factor when it comes to your thyroid health.
Leaky gut and gut dysbiosis also set the stage for chronic inflammation, one of the risk factors for autoimmune disorders. This brings us to our next section.
Stress and autoimmunity
A healthy, well-balanced immune system produces antibodies to fight foreign invaders like bacteria and viruses. That’s how it protects you from infections and diseases.
Sometimes, your immune system produces antibodies that attacks the body’s own healthy cells and tissues. This can cause auto-immune disorders.
It is true that genetics largely defines your risk for developing an autoimmune disorder. But chronic stress – along with long-term infections, food allergies, and chronic inflammation, can also trigger autoimmune responses in the body. This 2018 study linked stress with an increased risk of developing an autoimmune disorder. 
Grave’s and Hashimoto’s are two of the more common auto-immune thyroid disorders.
In Grave’s disease, your immune system creates antibodies that stimulate the thyroid gland to grow and make more hormones – leading to an overactive thyroid.
It is the most common cause of hyperthyroidism. Emotional stress and stress caused by chronic infections can also trigger the onset of Grave’s in individuals that are genetically predisposed.
Over production of thyroid hormones can lead to a number of symptoms such as excessive sweating, anxiety, rapid heartbeat, unexplained weight loss, loss of sleep, hand tremors, muscle weakness and fatigue, reduced libido and lighter periods than normal.
In Hashimoto’s disease, your immune system attacks the thyroid. It progresses gradually over the years, causing chronic damage and suppressing the ability of thyroid gland to make thyroid hormones. It is a leading cause of hypothyroidism.
A sluggish thyroid results in a wide range of symptoms such as fatigue, muscle cramps, memory problems, slow heartrate, heavy, irregular periods, dry skin, weight gain, pain and stiffness in joints, feeling cold, constipation and hair loss.
Stress causes sugar imbalances
When you are in a stressful situation, your body produces stress hormones such as cortisol and adrenaline. The body responds by releasing more glucose into the bloodstream so that you have energy to deal with the stressor.
Constant stress and long-term infections mean your body releases these hormones even when there is no immediate threat. This causes chronic high blood sugar levels, which affect your thyroid function. People with type 2 diabetes and metabolic syndrome have an increased risk of developing thyroid disease. 
Take care of your thyroid health
If you have thyroid disorder, your risk of other health conditions increases too. For example, having a thyroid issue means your chances of developing metabolic syndrome, insulin resistance, type 2 diabetes, depression, infertility and various auto-immune disorders may increase.
How can you improve your thyroid health? Medication is important but sometimes not sufficient to treat and manage your thyroid problem. For example, medicine may increase the levels of thyroid hormone but what if the underlying problem is impaired conversion and absorption?
Thyroid management requires a holistic approach that has nutrition, diet, stress management exercise and gut health at its core.
Stress management is absolutely integral to make sure your thyroid problems don’t act up. Stress can singlehandedly worsen your thyroid issues through its negative effect on T4-T3 conversion, adrenal health, gut health and sugar levels.
While you may not be able to remove all the life stressors, you can certainly train yourself to manage them and work around them with calm and control. This can be achieved by cultivating a hobby, listening to music or engaging in mindful mediation. Laugh more and surround yourself with people you love. You can also take therapy to take charge of your anxieties.
And it is not only about managing emotional stress, you should also take steps to address any underlying chronic infections or disease. Chronic health conditions put your body under constant pressure and paves the way for more inflammation, triggering a vicious cycle of pain, stress and other damage that can get difficult to manage.
You can also get a grip on your stress and anxieties with the help of adaptogenic herbs such as ashwagandha, rhodiola rosea and chamomile. Read here to know more about herbs for stress and anxiety. Magnesium supplements also help regulate stress hormones and can be a big help in managing stress.
Address nutritional deficiencies
Certain minerals (iron, copper, zinc, selenium and magnesium) and vitamins (D, C, A and B12) are particularly important for your thyroid health.
For example, vitamin D deficiency has been linked with an increased risk of hypothyroidism and poor thyroid function. This is not surprising as vitamin D regulates immunity and reduces inflammation, which is perfect for people with an underlying risk of developing autoimmune disorders.
Studies suggest that vitamin D supplements may help improve thyroid health and may even reduce the risk of developing thyroid disease. In addition, studies further call for improving vitamin D levels to achieve better care in hypothyroid patients.   
Selenium is another thyroid-healthy mineral. The thyroid gland contains a significant amount of selenium and it is incorporated in the selenoproteins that protect the gland from the oxidative damage. Selenium and selenoproteins also plays an important role in the metabolism of thyroid hormones.  
In addition, stress depletes magnesium, vitamin B12 and vitamin C from the body. These nutrients help your nervous system and adrenals to function properly. This study suggests that, “In patients with autoimmune hypothyroidism, vit-D and vit-B12 deficiency should be investigated at the time of diagnosis and periodically on follow-ups.” 
Getting adequate sleep is the single most important thing you can do for your thyroid health. If you are not getting plenty of sleep, you may also be putting yourself at high risk of developing depression, chronic pain, obesity, diabetes and heart disease.
Exercise offers amazing benefits to your physical health and mental well-being. It keeps your weight in check, keeps your sugar levels in control, boosts immunity, improves mood and helps you sleep better. Regular physical exercise also helps in reducing stress.
Keep your gut healthy
Eating right is the key to keep your gut happy. You must focus on eliminating foods that may trigger inflammation. Refined sugar, processed foods, alcohol and dairy products can irritate your gut lining, causing leaky gut, allergies and overall inflammation.
Include foods that nourish your gastrointestinal tract and shift the balance in the favor of healthy bacteria. If you have a thyroid disorder, you must definitely avoid gluten. It is bad news for both your gut and thyroid health.
Keep your sugar levels in range
Chronically high sugar levels increase your risk of metabolic syndrome, insulin resistance and type 2 diabetes. All these conditions are an added risk factor for thyroid problems.
Incorporating these steps will keep your thyroid gland happy and healthy. It will also reduce inflammation and prevent auto-immune flare up, which is great news for your thyroid as well as overall health.
- Song et al. Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA. 2018.
- Wang. The Relationship between Type 2 Diabetes Mellitus and Related Thyroid Diseases. Journal of Diabetes Research. 2013
- Vieira et al. Vitamin D and Autoimmune Thyroid Disease—Cause, Consequence, or a Vicious Cycle? Nutrients. 2020
- Mele at al. Immunomodulatory Effects of Vitamin D in Thyroid Diseases. Nutrients. 2020
- Lawnicka et al. Estimation of vitamin D status in patients with secondary and primary hypothyroidism of different etiology. Neuro Endocrinol Lett. 2018
- Ventura et al. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017
- Santos et al. Selenium and Selenoproteins in Immune Mediated Thyroid Disorders. Diagnostics (Basel). 2018
- Aktaş HŞ. Vitamin B12 and Vitamin D Levels in Patients with Autoimmune Hypothyroidism and Their Correlation with Anti-Thyroid Peroxidase Antibodies. Med Princ Pract. 2020