Hypothyroidism and Anxiety: What’s the Connection?

Hormone level issues can cause heart and panic attack-like symptoms

When your thyroid gland isn't producing the right amount of thyroid hormone, you may feel shortness of breath, heart palpitations, and other symptoms associated with anxiety.

This most often happens with hyperthyroidism, which is the production of too much thyroid hormone, because the excess hormone speeds up your metabolism. However, you can also feel anxiety if you have hypothyroidism, or an underactive thyroid. One cross-sectional study found that 63% of 100 people with hypothyroidism experienced anxiety.

This article explains the connection between anxiety and your thyroid. It discusses possible causes of anxiety symptoms, the thyroid levels that may lead to them, and some treatment options.

 Verywell / Gary Ferster

What Is Hypothyroidism?

Hypothyroidism is a treatable condition that occurs when the body produces too little thyroid hormone, which it needs to regulate metabolism and other functions.

The most common type of hypothyroidism in the United States is called Hashimoto’s disease, or thyroiditis. It can sometimes cause unpredictable releases of thyroid hormones, typically leading to hypothyroidism. Less often, it may lead to an overactive thyroid instead.

There are a number of other causes of hypothyroidism as well. They may include previous surgeries, the use of certain medications, an underlying genetic cause, or an autoimmune disease history.

Why Does Hypothyroidism Cause Anxiety?

Researchers aren't entirely sure why hypothyroidism may cause anxiety, but they have some theories. One potential reason has to do with thyroid hormone's role in creating and regulating neurotransmitters such as dopamine that affect mood and well being. Low thyroid levels can throw off your mood by decreasing the production of these chemical messengers.

Hypothyroidism may also induce anxiety indirectly because of the other health issues it can cause, such as fatigue or joint and muscle pain. People may not be anxious due to the condition itself but may be concerned and upset about the way hypothyroidism is making them feel.

When you're anxious, it might be more difficult to stick to your treatment plan and take the proper medication to control your hypothyroidism. This can create a vicious cycle in which your anxiety makes your condition worse, which only causes more anxiety.


Aside from anxiety, other symptoms of hypothyroidism include:

  • Constipation or hard stools
  • Feeling cold
  • Fatigue
  • Irregular periods
  • Joint or muscle pain
  • Paleness
  • Sadness or depression
  • Weakness
  • Weight gain
  • Puffy face, hands, and feet
  • Slow heart rate


Usually, most people who have thyroid conditions find that once they're properly treated, the symptoms, including anxiety, go away. Treatments may include medications, radioactive iodine, or surgery for people with overactive thyroids.


Hypothyroidism is commonly treated with hormone replacement therapy. Synthroid (levothyroxine) is the most common drug used for hypothyroidism. As a synthetic form of the T4 thyroid hormone, it can be used across a lifetime to maintain thyroid function.

In some people, the medication can actually bring on or cause more anxiety. Speak to your healthcare provider if you're experiencing new or worsening anxiety or other symptoms, such as a rapid heart beat, rapid weight loss, restlessness, or abnormal sweating.


Tapazole (methimazole) and Propylthiouracil (PTU) are drugs commonly used to limit the thyroid's access to iodine in the body. In some cases, a healthcare provider may recommend surgery to remove the thyroid.

Often, a blood pressure medication called a beta-blocker is given too. These drugs include Inderal (propranolol) and Tenormin (atenolol). Beta-blockers don't treat hyperthyroidism, but they do ease panic-like heart symptoms such as a fast heart rate and palpitations.

You may need additional thyroid treatment measures if you have heart failure or other significant heart problems, or a severe hyperthyroidism diagnosis itself. For example, thyroid cancer may require surgery, radiation, chemotherapy, or a combination of treatments.


There are also treatment options for combatting anxiety that don't involve treating the underlying thyroid condition that's causing it. Treatment options include:

  • Cognitive behavioral therapy (CBT): This is a type of psychotherapy that involves working with a licensed mental health provider to change patterns of thinking and behavior.
  • Stress management techniques: Exercising regularly or practicing mindfulness or meditation has also been shown to relieve anxiety.
  • Medication: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed drugs for anxiety, but some of them, such as fluoxetine and amitriptyline, may interact with hypothyroidism medication or affect the production of thyroid hormone. If you have hypothyroidism, always speak to a healthcare provider about how anxiety medications may affect your condition.


Although anxiety is more commonly a symptom of hyperthyroidism, it can also be a symptom of hypothyroidism, which is when the thyroid gland produces too little thyroid hormone. This could be because of the condition itself, or because of other symptoms associated with hypothyroidism, such as fatigue and joint pain.

Many people find that their symptoms go away once they begin taking medication.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto's Disease.

  3. Lee, EH., Kim, SM., Kim, CH. et al. Dopamine neuron induction and the neuroprotective effects of thyroid hormone derivativesSci Rep 9, 13659 (2019). doi: 10.1038/s41598-019-49876-6

  4. Urology of Virginia. Hypothyroidism and anxiety: What's the connection?

  5. MedlinePlus. Hypothyroidism.

  6. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670-751. doi:10.1089/thy.2014.0028

  7. MedlinePlus. Anxiety.

  8. John Hopkins Lupus Center. Thyroid medications.

Additional Reading

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution."