Depression: Is it Undiagnosed Autoimmune Hypothyroidism?

If you’re experiencing weight gain, sleep disturbance, brain fog, anxiety, exhaustion, forgetfulness, relationship issues, loss of libido, or lack of motivation, would it surprise you to know that these symptoms are present in both depression and hypothyroidism? In fact, holistic psychiatrist, Kelly Brogan, MD, author of Own Your Self and A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies and Reclaim Their Lives refers to hypothyroidism as the #1 psychiatric pretender, stating…

“The vast majority of symptoms that occur with a thyroid disorder could easily come under a ‘depression’ diagnosis.”

If this weren’t misleading enough, hypothyroidism is also vastly underdiagnosed. The standard of care in conventional medicine is to test only thyroid stimulating hormone (TSH), a pituitary hormone that stimulates the thyroid to produce thyroxine (T4). Not only is this an inadequate assessment of thyroid function, but the standard reference ranges for conventional labs are far too wide to accurately identify many who are indeed hypothyroid. So sufferers are often told, “Your labs are within range. Let’s just keep an eye on it.”

To make matters even more bewildering, many are misdiagnosed with hypothyroidism when what they have is autoimmune hypothyroidism (Hashimoto’s). In fact, medical experts claim that 95-97% of those with a hypothyroidism diagnosis have Hashimoto’s.

To diagnose an autoimmune component, testing needs to expand to include the antibodies thyroid peroxidase (TPOAb) and thyroglobulin (TgAb). Unfortunately (and again, bewilderingly), these aren’t often included in standard thyroid lab tests. (Go here for a functional thyroid panel. Just a click.)

There are three stages of autoimmunity: silent, symptomatic, and finally, tissue damage. The conventional standard of care is to ignore the silent stage and “keep an eye on it” until you experience symptoms or the inevitable tissue damage.

One of the most important things for anyone suffering from hypothyroidism/Hashimoto’s to understand is that treating Hashimoto’s with thyroid hormone replacement won’t quell the autoimmune response. This leaves you a sitting duck for not only the possibility of the onset of another autoimmune condition (MAS, or multiple autoimmune syndrome), but also thyroid gland damage. And little to no improvement of symptomatology to boot!

Women are twice as likely to take antidepressant medication than men and not surprisingly, they’re twice as likely to have an autoimmune disease (read about my personal journey here). For both sexes, the rates of antidepressant use increase with age, topping out at almost 25% of women above age 60. Shockingly, over the last decade (2009-2019), antidepressant use increased in women but not in men. When you consider that medications are often prescribed by allopathic doctors and gynecologists without any additional evaluation for underlying causes, it’s no wonder we have a whole population of women suffering from a less than stellar quality of life.

Can You be Both Depressed and Have Autoimmune Hypothyroidism?
Yes. If your symptomatology is undiagnosed and you’re told your lab values are “normal,” you’re more likely to feel depressed. Who wouldn’t? And when the symptoms seem mysterious, unrelated, and often not obvious to those around you, it takes internal fortitude to continue to trust yourself after years of family and friends saying, “But you look fine,” and doctors saying, “Your test results are normal.” No wonder so many begin to doubt themselves and start to believe it’s “all in my head.”

It’s not that autoimmune disease causes depression. It’s that the same root causes can contribute to both autoimmune disease and a psychiatric diagnosis. Dr. Brogan calls these “psychiatric pretenders.” Hypothyroidism is #1, followed by gluten/casein intolerance, blood sugar instability, nutrient deficiency, and medication reaction (hormonal birth control is at the top of the list).

Interestingly, each of these five psychiatric pretenders are also at the top of the list as “smoking guns” in autoimmune disease. These, along with a myriad of other lifestyle, dietary, and seemingly random triggers that are not generally recognized in the conventional medical community are what make autoimmune disease often difficult to diagnose.

Please know that depression rarely exists in isolation. When supporting the healing journey from a holistic perspective, it’s unwise—and mostly ineffective—to accept a simple, quick diagnosis. Most of us want to understand our why and enlist support in uncovering our root causes.

Often, when these root causes are identified and addressed, the feelings of depression start to lift—along with the other symptoms associated with hypothyroidism and autoimmune disease. And the less depressed and downtrodden we feel, the more stamina and fortitude we have to take further steps along our path towards healing.

What’s Your Approach to Your Health?
From a conventional medical perspective, depression is a catch-all diagnosis for anyone struggling with life. In many cases, an antidepressant is the quick solution, followed by symptom-chasing with: migraine medications, sleeping pills, and a variety of “remedies” to relieve digestive issues (PPIs, anyone?). If you view the body as a mechanical system, that makes sense—it’s easy to check off a “fix” for each symptom. But anyone who’s been down this path knows it’s not that simple. And it feels like a game of “whack a mole.”

An integrative and holistic approach views the body as a living, integrated system. Aside from critical distinctions (gunshot wounds, broken bones, heart attacks, etc.), a living systems approach is far superior to a mechanistic approach when you’re living with chronic illness. Most diseases in the Western world are chronic in nature and our conventional medical system is so ill equipped to support the myriad diet and lifestyle factors that need to be addressed for healing.

As someone who’s been there, I know the “list” of considerations with a holistic approach can sometimes feel never-ending. When you’re suffering and lacking knowledge in either health model, it can feel overwhelming to make your way through the choices. Each of these paths requires time, money, and commitment—and although neither can guarantee outcomes, a whole body, systems-based approach is far superior to and significantly more effective than a mechanistic approach.

What I’ve found in my 17 years of practice is that there’s a methodology and sequencing to successfully navigate the holistic model. When you start with the right foundation, it’s much easier to see the next steps, eliminating the overwhelm of what you previously thought was a “never-ending list.”

As you explore the following diet and lifestyle factors that can contribute to depression, hypothyroidism, and autoimmune disease, recognize that not all of these will apply to you. The brilliant Datis Kharrazian, PhD, DHSc, DC, teaches in his functional medicine autoimmune management models that there are multiple factors in the web of autoimmunity. The key is to discover your personal susceptibility, enabling you to address the areas of most importance for you. “The clinical goal is to improve diet, nutritional status, and lifestyle to support health and function,” states Kharrazian.

The list that follows is extensive but not exhaustive. I’ve relied on:

  • My doctorate in holistic nutrition (DSc) as the foundation for my expertise with the physical health factors.
  • My personal experience, advanced Intrinsic Coach training (CIC), and Aroma Freedom Technique (AFT) as my guide in selecting the predisposing factors.
  • My 55-year personal journey as my source of inspiration in the important area of spiritual healing and growth. I’ve only cracked that door.

Hypothyroidism and Autoimmune Disease
As mentioned earlier, symptoms of hypothyroidism and depression substantially overlap: weight gain, sleep disturbance, brain fog, anxiety, exhaustion, forgetfulness, relationship issues, loss of libido, and lack of motivation. With this list of symptoms, undiagnosed and untreated (not everyone has all of them, certainly), it’s easy to understand why someone would also become hopeless, leading to acceptance of a “quick fix” diagnosis of depression.

Functional medicine experts claim that 95-97% of hypothyroidism is autoimmune in nature (Hashimoto’s). But most patients—especially those treated by allopathic providers—don’t know this. And the reason is simple. A conventional doctor has few tools to support a patient with autoimmunity. With Hashimoto’s, the conventional standard of care is to test only TSH (and Total T4 if you’re lucky), to avoid testing for antibodies, and to keep the reference ranges wide, resulting in mis- or under-diagnosis. Undiagnosed autoimmunity explains why so many continue to suffer with debilitating symptoms, even on thyroid hormone replacement.

So let’s break this down. What are the more complex, underlying issues that are unexplored by conventional medicine and misunderstood (or unknown) by most people? And what can you do about them?

I’ll begin with physical health factors, move into predisposing factors, and finally spiritual factors.

Physical health factors that can look like depression (and contribute to autoimmune disease)…

Food Intolerance, Especially Gluten and Casein
Fact: gluten intolerance is real. And most functional/holistic practitioners feel strongly that it’s not a fad, it impacts vastly more people than those with a Celiac diagnosis, and it’s poorly tested and underdiagnosed. This belief is based on:

1) A large body of research that demonstrates the role of gluten in the development of all autoimmune responses, and

2) The extensive clinical experience of functional/holistic providers who witness near-immediate symptom improvement in clients who follow a gluten-free diet.

Gluten intolerance is exacerbated by and contributes to leaky gut—or the more medically appropriate term, intestinal permeability. The root causes of intestinal permeability are many: medications, poor diet, food intolerances, exposure to common chemicals, viral and bacterial illnesses, and more. Once the junctions in the small intestine are “leaky,” undigested food particles can pass through into the bloodstream, instigating an immune response, whereby your immune system creates antibodies to the foods that it views as an “invader.”

In some people, gluten also stimulates the inflammatory protein, zonulin. In addition to breaking through the gut lining like a karate chop, zonulin can also break through the blood-brain barrier and contribute to brain fog, fatigue, migraines, and a host of other “psychiatric” symptoms including… depression. In turn, this contributes to more advanced permeability, often invoking a loss of both digestive and oral tolerance that leaves you with increasing sensitivities, aka “I’m intolerant to everything!” (Which is never true.)

Casein is one of the proteins in dairy that is another common food intolerance. Different from lactose intolerance, casein can cause damage through at least two primary mechanisms: 1) casein protein is very similar to gliadin, the protein faction of gluten, and it can trick the immune system through a process called molecular mimicry and 2) one breakdown product of casein is casomorphine—think of your brain on opioids.

Other proteins that can be problematic are: eggs, soy, and nightshades. (Many don’t think of nightshades (tomatoes, peppers, eggplant, potatoes, etc.) as proteins, but they contain lectins that are a type of protein that some with leaky gut struggle with.)

The discovery of your specific food intolerance(s) can be a very straightforward (and dare I say, enjoyable) process—it’s something we walk our clients and students through. Keep in mind, food intolerances/sensitivities (IgG) are not the same as food allergies (IgE). And if the IgG discovery is done properly, rest assured that most foods can be tolerated after the relatively short experiment. One possible exception is gluten (and sometimes casein).

Blood Sugar Instability
Blood sugar imbalance (aka dysglycemia) creates a daily rollercoaster of emotional and physical stress. When blood sugar drops too low (Jill likes to call it “the pit,”), your brain views this as a crisis—because it is. Your brain can’t function without an ample supply of blood sugar, which is a form of fuel. And your brain is a gas guzzler. When blood sugar drops, your body begins a carefully orchestrated campaign to keep you functioning: the brain signals the adrenals to release cortisol (a stress hormone), cortisol signals the liver to release glycogen (stored glucose the body hoards just for this purpose), glycogen is released to form glucose, and insulin does its job of making sure glucose gets delivered into every cell in your body.

This system works great if it’s only called upon in a real crisis. But overuse can result in a breakdown in several areas: your adrenals get exhausted from constantly coming to the rescue, causing cortisol output to run low and your liver, which stores only a small amount of glycogen at a time, leaves you with no gas in the tank. If this goes on for weeks and months, cells can become insulin resistant, making it challenging to even get the glucose into the cells at all.

Stablizing blood sugar is, hands down, critical to supporting every aspect of immune and hormonal health, including mood, sleep, and energy.

And it significantly reduces inflammation, which is paramount in reversing any autoimmune condition or mood disorder. Blood sugar management and adrenal support, along with gut healing, are absolutely essential if you suspect autoimmunity or hypothyroidism.

One simple solution is to eat a well-balanced breakfast. No kidding. The benefits are so far-reaching, you’ll never go back to your toast and coffee. Please understand that you have the opportunity to balance your blood sugar at each meal and how you do breakfast will unequivocally affect the next 24 hours of your life. Simply eating a hearty breakfast with a solid amount of protein (20-30g) will change your life in ways you can’t imagine.

Nutrient Deficiency
The thyroid requires an ample supply of nutrients, especially minerals, to function well. Ideally, minerals are found in abundance in most whole foods. They’re also the first nutrients depleted from the soil due to modern farming techniques that are highly dependent on nitrogen-based fertilizers and petroleum-based chemicals. Nature has an amazing system of transferring indigestible minerals from the soil (think rocks) into minerals that the human body can digest. Healthy soil has all the minerals humans need: the plant roots “digest” the minerals, animals eat the plants, and humans eat the plants and the animals, effectively absorbing these nutrients from the soil.

In addition to minerals, Vitamin B12 deficiency can “play a role in psychiatric symptoms such as depression, anxiety, fatigue, and even psychosis,” according to Dr. Brogan. Deficiency is common in those with any digestive issues or autoimmune disease and you’ll often find B12  on a functional thyroid panel. Vitamin B12 is naturally present in foods of animal origin, including fish, meat, poultry, eggs, and dairy products. Vegetarian sources of B12 are spinach, beetroot, potatoes, mushrooms, and alfalfa.

(Go here for Jill’s Nutritional Springboard for her bestselling Essential Thyroid Cookbook, where you’ll find the most thyroid- and immune-supportive nutrition and where those nutrients overlap so that you get the most bang for your buck.)

The simple solution to improve any nutrient absorption is to heal your gut, eat a wide variety of whole foods (grown with sustainable farming methods), and for insurance, take a multi-mineral supplement. If you’re experiencing mood issues, try a sublingual B12 supplement.

Chemical Sensitivities, Toxin Exposure, Mold Sensitivities
Common exposures to chemicals in your environment, toxins in foods, and mold in your home or workplace are not only potential triggers for autoimmunity, but also depression and thyroid issues. There are differing levels of symptomatology: mild headaches to migraines, sneezing to asthma attacks, a small rash to full blown eczema, brain fog to incoherency, feeling a bit shaky to being unable to walk. Depending on the severity of your symptoms, you may need expert support.

Reducing exposure by cleaning up your environment, including food and water, is the place to start. In some cases, if there’s mold, removing yourself from that environment altogether may be warranted.

After reducing (or eliminating) exposure, you can certainly improve tolerance with gentle liver support, enhancing microbiome diversity, and healing leaky gut. Sweating, lymphatic drainage, and supporting healthy bowel movements are also a critical part in moving these toxins out of your body. (Speaking of sweating, we don’t recommend running like you’re being chased by a bear! Sitting in a sauna is a great way to detox.)

Predisposing factors: Depression? Autoimmune disease? Both?…

This next section includes predisposing factors that play a role in both the development of disease and your ability to seek out help that is helpful. Both our conventional medical system and our integrative/holistic medical system are chock full of help that isn’t supportive. They’re often driven by: rigid protocols, insurance company limitations, government intervention in the doctor-patient relationship, rigid dogma, over-supplementation, and ridiculous time restrictions. (Ever been to a 7-minute doctor’s appointment? Next!)  

Even practitioners who are convinced that diet and lifestyle play a role in outcomes often find it extremely challenging to deliver patient support in a way that moves the needle for their patient.

So what is help that is helpful?

In the broadest sense, it’s support that empowers you to:

  • Own your health journey
  • Value your lived experience more than lab results
  • Listen to your body
  • Instinctively trust what you hear
  • Learn the simple, foundational principles of healing that have the power to shift your health trajectory in a lasting way

Each of these predisposing factors impacts the stress response, blood sugar management, and the inflammatory cascade often driven by cortisol and insulin. Here, I’m focusing on how these factors impact your choices and your confidence in exploring non-conventional solutions, your courage to trust your own body above the “experts,” and to advocate for yourself in your closest relationships. This is where taking ownership of your health begins.

The Highly Sensitive Person
Elaine Aron, PhD, has been researching sensitivity since 1991. She’s discovered that sensitivity is normal, occurring in 15-20% of the population and that it’s innate. In addition to humans, sensitivity is observed in similar numbers in fruit flies, fish, dogs, horses, and over 100 other species. She describes a highly sensitive person (HSP) as someone who’s more aware than others of the world around them, feels more deeply, and is more easily overwhelmed than others.

Dr. Brogan describes these sensitive souls as “canaries in the coal mine,” signaling to the rest of us that something is off. In her book, Own Your Self, she flips the quick diagnosis of depression on its head by asking, “Is depression (or any chronic illness) and our painful struggle with modern life an illness, or is it a logical response to a world that is ‘off’?”

A highly sensitive person can easily feel unsure about their perspective on life. Wrong. Alone. A lone wolf. In their struggle with a world that feels “off,” they’re often pressured by others to “tone it down” and “stop being so dramatic.” When they seek help from conventional medicine and are prescribed medication, they can be more aware of or sensitive to the side effects, whereby they’re then dismissed by the “experts” who truly believe it’s “all in your head.”

Adverse Childhood Experiences (trauma)
An adverse childhood experience (ACE) and its impact on lifelong health risk factors gained a great deal of awareness with the publication of the ACE study in 2001. Researchers studied 17,337 adults from an HMO in San Diego, CA over a 3-year period. They surveyed the patients about childhood abuse, household dysfunction, personal suicide attempts, and multiple other health related issues. The focus of the study was to understand the risk of attempted suicide in those with ACEs compared to those without. They found a clear correlation with a 2 to 5 times higher odds ratio of attempting suicide at least once in the group with ACEs.

It’s common to hear mental health professionals talk about “big T” and “little t” trauma to differentiate between “big” trauma (abandonment, rape, violence, disasters) and “little” trauma (run of the mill benign neglect, harshness, or lack of connection and affection that many children experience). Research since the ACE study has demonstrated that both types of trauma feel the same to a child, especially a highly sensitive child, and can have a lifelong impact on health risk factors.

According to ACE researcher Vincent Felitti, MD, “What happens in childhood, like a child’s footprints in wet cement, commonly lasts throughout life. Time does not heal; time conceals.”

Current research on ACEs is just the tip of the iceberg in understanding the link between trauma—emotional, mental, or physical—and future health outcomes. Children who experience either type of trauma often learn that you can’t trust those who are closest to you. In turn, they often grow up to be adults who don’t trust people. They’re hyper-vigilant, constantly looking for the disaster around the next corner. In this state of constant fear (even if they look like they’re holding it all together), they easily fall prey to the “experts” who assure them safety if they follow the “proven protocol.”

Toxic Relationships
Supportive relationships are the #1 predictive factor in the success or failure of the healing journey for autoimmune patients, according to Dr. Kharrazian. In supportive relationships, your symptoms are taken seriously, you’re heard, and you’re encouraged to trust yourself. In toxic, unsupportive relationships, which are often a contributing factor in depression, symptoms are dismissed as “all in your head,” you’re talked over rather than listened to, and you’re pushed to “trust experts” above your own lived experience.

Toxic relationships leave you wobbly. Unsure of yourself. Always checking in to make sure you’re “doing it right.” You forget how to trust yourself and listen to your body. This leaves you susceptible to dominant personalities who are confident they can “fix you” if only you’ll do exactly what they say. When you try to express that you feel worse, it becomes your fault rather than their failed protocol.

Unsustainable Pace
Living life at an unsustainable pace—which is not how our ancestors lived—is an unfortunate and common phenomenon that prioritizes productivity over anything else. The body is viewed as a machine that needs to be “fixed,” the body’s cues and cries for support are ignored, and self-care is dismissed or seen as “weak.” As in, who has time for that?

With this damaging mindset, people will do anything to maintain the pace. And it’s easy to fall prey to experts with “top of their field credentials” and “quick fixes.” This is often the beginning of a long and fruitless journey of snap diagnoses and increasing medications to “manage” chronic illness. But most people find themselves on a slippery slope of worsening symptomatology and this is where many of our clients find us: at the point where they’re ready to STOP with the mismanagement, listen to their body, and learn the foundational, holistic diet and lifestyle factors that will support—and change—their life.

Spiritual factors…

The Thyroid and Our Throat Chakra
The throat chakra is one of seven spiritual energy centers of the body. That’s as “woo-woo” as I’ll get, but rest assured, it’s real. According to Dr. Brad Campbell, “The throat chakra isn’t a godless, esoteric term, it is a nerve and blood anatomical plexus that is impacted by certain emotions.”

Your thyroid sits in the center of the throat chakra and it may be blocked if you feel shut down by those around you. Perhaps you’re more sensitive than most or you’re in toxic relationships that belittle your sensitivity or symptoms. Some physical/emotional dysfunctions associated with the throat chakra can include: fear of speaking up, stuttering, inability to express yourself, sore throat, chronic laryngitis, swollen glands, throat or esophageal cancer, repetitive throat clearing, and… thyroid problems.

It’s helpful to get the support you need to deal with the emotions underlying the physical expression: feeling thwarted in life, unfulfilled, angry at being left out, or hopelessly stifled. Healing these emotional blockages can go a long way in resolving thyroid issues and autoimmune disease.

Discovering you

This is a call to own your health, your personal mental, physical, and spiritual reclamation. To dig a little deeper. To discover the root causes and address those first.

Your healthcare team is there to support you. They don’t own your health. Because let’s face it, as we’ve already discussed, the conventional medical system is going to push back against anyone wanting: different lab tests, holistic solutions, food as medicine, to take personal agency and perhaps disagree with the medical recommendation. Give yourself permission to question the beliefs that no longer make sense to you.

As Jill Grunewald expresses so well in Your Hashimoto’s Credo: 25 Tenets for Taming Hashimoto’s:

Your doctor is not an expert on YOU—your mind or your body.

Neither is your nutrition coach, naturopath, chiropractor, or acupuncturist.

Neither is your therapist.

Neither is your mom or your best friend.

Neither is your partner or spouse.

Neither is your child. 

Only YOU. None of these people live in your body. 

Managing Hashimoto’s (or any disease) requires an unconventional, off the beaten path approach. Not a prescription. Respect the wisdom and experience of others as theirs. Maybe the advice and opinions of those you trust can help you on your journey. Maybe not. Only you get to decide.

So much of the journey of life is about getting to know yourself. Not what others say about you or expect from you but what you want for yourself. It’s about listening to your physical body and listening to your heart calling and trusting what you hear. It’s about letting go of the “experts” and learning to trust yourself.

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