How to Manage Stress If You Have Autoimmune Thyroid Disease

Thyroid conditions such as Grave’s disease (hyperthyroid) and Hashimoto’s thyroiditis (hypothyroid) are worsened by chronic stress so learning ways to lessen stress is your key to better health.
Jennifer Lutz for EndocrineWeb
Feeling stressed has the added disadvantage of stressing your thyroid, the endocrine gland responsible for your body’s metabolism and regulation of vital body functions. For individuals who suffer from an autoimmune thyroid disorder, or may be at risk due to your family history, understanding the interplay of stress and thyroid hormones can be an important step in safeguarding your health.

However, not all thyroid conditions are affected equally; thyroid conditions most influenced by stress are the autoimmune thyroid disorders—Grave’s disease, and Hashimoto’s thyroiditis.1,2 Hashimoto’s thyroiditis is a hypothyroid condition caused by an underactive thyroid gland whereas Grave’s disease is noted for hyperthyroidism (when the thyroid gland is overactive). Breathe easy, stress alone, won’t cause a thyroid disorder, but it may contribute to a worsening of your symptoms.

Your body has a very effective system for dealing with stress, called the hypothalamus-pituitary-adrenal (HPA) axis. Essentially, a “danger” message is sent to your hypothalamus, which triggers a cascade of neurohormones responses, including the release of glucocorticoids, such as cortisol, which increases circulating estrogen.

The HPA axis is beneficial if you are faced with an emergency requiring you to flee to save your life. However, when the same stress response becomes a chronic condition, the HPA response can go into overdrive, increasing circulating levels of glucocorticoids, even when you may be snuggled in bed watching puppy videos. There is evidence to support concerns that prolonged HPA axis activation leads to chronic stress and maintaining high levels of circulating glucocorticoids, which promotes an inflammatory response and raises the risk of autoimmune thyroid disorders.1

As confirmed by a comprehensive review,2  “numerous studies have indicated a connection between stress and autoimmunity and that stress may trigger or worsen an autoimmune disease.”

Stress Exacerbates Autoimmune Thyroid Diseases

Researchers not only found a link between stressful life events and the onset of Graves’ disease but also showed a correlation between self-reported stress and disease progression, suggesting that “stress management is effective in improving the prognosis of Graves’ hyperthyroidism”.3   

Although there is less research on the link between stress and Hashimoto’s thyroiditis, the relationship between the HPA axis and the hypothalamus-pituitary-thyroid (HPT) axis may offer more insight into this interrelationship.1,2

Stress can simultaneously suppress the release of thyroid-stimulating hormone from the pituitary gland, and decrease conversion to the more active form of thyroid hormone, triiodothyronine (T3). While cortisol may limit T3 production, adrenaline may enhance selected responses to T3, suggesting that chronic, but not acute, stress may disrupt thyroid function.

Hypothyroidism, itself may have a negative effect on stress regulation, due to the bidirectional relationship between the HPA axis and the HPT axis, making stress management especially important for people with an underactive thyroid, including subclinical hypothyroidism, as the disruption of this fragile system may increase symptoms.

How to Cope When Life is Full of Stressors

For most of us, stressful events arise daily, so learning how to manage your stress when you have an autoimmune thyroid disorder is very important to your long-term health. What to do?  While there is no simple or definitive solution to eliminating or avoiding stress, there are some very effective therapeutic recommendations to guide you.

Problem one: chronic stress and an increased inflammatory response.  In particular, cytokines are proteins (peptides) that have many overlapping functions, including as the primary communications vehicle sending signals to immune cells.  Promoting an anti-inflammatory response rather than causes a rise in the pro-inflammatory response is a key to managing autoimmune thyroid disease.

There are a few strategies you can implement to limit and decrease this problematic inflammation. While chronic stress may boost the inflammatory response, acute stress can have just the opposite effect, essentially counteracting chronic stress, thereby lessening inflammation.

Answer: Exercise in the form of resistance training is one of the best ways to put your body in a state of acute, controlled stress. A review of research on the anti-inflammatory effects of exercise found that resistance training can play a major role in reducing circulating levels of cytokines, and thereby, inflammation.4

For example, in one study,5 researchers found that women who followed a moderately high resistance training program for 24-weeks had lower levels of circulating cortisol. Participants were instructed to lift weights four times a week, progressing to more difficult exercises and alternating between endurance (high reps for 2-3 sets) and strength (1-6 reps repeated for 4 sets). Similarly, decreased circulating cortisol levels were reported after just 8-weeks of resistance training that encompassed a full-body workout.6

Answer: Diet is another powerful de-stressing tool. However, there are many well-promoted diets that claim to detoxify, eliminate stress, and fight inflammation, and while most are no more than overpromises, some, such as the Mediterranean diet, come with solid science behind them.7,8 The Mediterranean diet may be effective in reducing inflammation due to its focus on plant-based foods such as fruit, vegetables, legumes, nuts and whole grains, all of which are powerhouses of antioxidants.7

The goal of nine servings of fruits and vegetables is a wise strategy for anyone looking to reduce risks for many chronic diseases such as heart disease and diabetes in addition to autoimmune thyroid conditions.7 A few other factors—generous use of virgin olive oil,a glass of red wine, and regular exercise also boost the value of this lifestyle approach. In a report published in Current Pharmaceutical Design, researchers suggested that a compound in extra virgin olive oil has similar anti-inflammatory properties to ibuprofen.10 

Problem two: Stress appears to produce a disruption of the bidirectional relationship between the HPA axis and the HPT axis. Chronic stress can lead to a vicious circle between the thyroid response and the stress response. Fortunately, there are a few things you can do to interrupt the stress/inflammatory response and break the cycle, including exercise,4-6 but also getting sufficient, sound sleep,11 and incorporating mindful relaxation (eg, meditation, yoga, and breathing exercises) into your daily routine.12

Now you know more about the beneficial effects that exercise can have on your emotional wellbeing—promoting improved mood, and reduce anxiety and depression

The good news is that most any movement will do. So, walk, do pilates, dance, practice yoga, take an exercise class at your local Y, go for a hike, or watch your favorite show while exer-cycling; whatever moves you. Exercise can also help you sleep better, an imperative for better health.

For those times, when you just can’t manage to take a break to go for a walk to get to the gym.  Consider essential oils as a powerful relaxation tool. Lavender can act as a stress-reducer;13 so add a few drops to your pillowcase or porr some into a warm bath.

Breath.  While we all breath without thinking, most of us do not breath properly—that is deeply from the diaphragm. Breathing fully is another powerful tool to decrease your day-to-day stress. In fact,  there are many breathing techniques that can help you combat stress. You may want to begin with this simple, diaphragmatic nasal breathing technique,recommended by the researchers at Harvard Medical School.

Breathing through the nose (rather than the mouth) lessen stress by stimulating the parasympathetic nervous system, (rest and digest), rather than the sympathetic nervous system (fight or flight) that is triggered by stress. So, rather than constantly fleeing that imaginary bear, inhale slowly and deeply, and exhale slowly, until you feel yourself relax.

One of the many benefits of yoga is the constant reminder you are given to focus on your breathing.  Most of us tend to breathe from our chest, shallow breaths, rather than breathing fully from our diaphragm—which gives you a deep, settling (some might say cleansing) feeling. The act of breathing slowly and deeply can break your chronic state of distress.

Make Lifestyle Adjustments to Bring Your Adrenals into Balance

Adrenal stress is almost always caused by something else that’s gone array in your body.14 Common causes include anemia (low iron), blood sugar swings (poorly controlled glucose), gut inflammation, food intolerances, essential fatty acid deficiency (easily avoided with enough dietary omega-3 fatty acids), exposure to environmental toxins, and psychological distress.

Having a thyroid condition can make every-day living more challenging.  When your thyroid is thrown off balance, a healthy response to stress may be more difficult to muster, but don’t worry, you’ve got this.

Here is a cheat-sheet of strategies that will help you de-stress:

  • Choose an eating plan that is mostly plant-based and provides plenty of omega-3 fatty acids found in flax, wild Pacific salmon and herring, cold-pressed, extra virgin olive oil, and walnuts. This will go a long way to assure that you are fostering good blood sugar levels, and are maintaining a healthy body weight.
  • Create an exercise routine that you actually look forward to and that fits into your daily routine. Even if it’s walking the dog, pushing a stroller around the local park, or meeting a friend at the mall; any movement is good and made even better when its done with others.
  • Give yourself a spritz of lavender.
  • Breathe deeply and meditate if you are so inclined.

These essential lifestyle factors will go a long way in helping you to manage your stress, break the cycle of distress, and find some peace in being able to control your anti-inflammatory reactions so you are promoting a healthy thyroid.