How Graves' disease can affect mental health

Also known as Graves’ hyperthyroidism, Graves’ disease is an autoimmune disease that damages the thyroid gland. Symptoms can include muscle weakness, fatigue, intolerance to heat, irregular heartbeat, increased sweating, and unintended weight loss.

Graves’ disease can also cause thyroid eye disease (TED), a condition that causes the eyes to bulge forward. Other symptoms of TED include dry eye, inflammation around the eyes, and eyelid retraction.

In addition to these physical symptoms, Graves’ disease can also affect a person’s moods, emotions, and thinking.

The link between thyroid health and mental health

Located in the throat (and sometimes described as being shaped like a butterfly), the thyroid gland produces thyroid hormone. Thyroid hormone regulates the function of nearly every organ and system in the body—the heart, lungs, digestive organs, skeletal muscles, metabolism, reproduction, and more. All of these organs and systems require a careful balance of thyroid hormone to function. If there is too much or too little, problems arise.

Graves’ disease causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism), which leads to symptoms like those described above.

Another organ that relies on a careful balance of thyroid hormone is the brain. Too much thyroid hormone affects the parts of the brain that control moods, emotions, and thinking.

• Nervousness, anxiety, and irritability are common symptoms of Graves’ disease.
• Cognitive changes (difficulty thinking) are also common. These include problems with focus, decision making, and memory.
• Insomnia (difficulty falling asleep or staying asleep) is also common. Too little sleep can contribute to low moods, irritability, anxiety, and difficulty thinking.
• Changes to physical appearance—such as a thyroid gland that is visibly enlarged (goiter) or bulging eyes caused by TED—can also negatively affect mental health.
• Hyperthyroidism has been associated with structural changes to the brain, including reduced brain volume and a loss of neural connections.
• Graves’ disease and other autoimmune disorders have been found to promote the development of depression as well as other emotional and cognitive disorders.

The demands of living with a chronic condition

Graves’ disease is considered a chronic condition. While there are treatments that can stabilize thyroid levels in the body, treatment will often be a lifelong process. This process can involve healthcare appointments, medications, radioiodine therapy, and surgery. Conditions that occur as a result of having Graves’ disease (such as TED) will require additional treatment.

Living with a chronic health condition is often mentally and emotionally demanding. It can also be isolating, as symptoms like fatigue and pain can leave less energy for relationships, self-care, and meaningful activities. Having a chronic health condition increases the risk of depression. Having depression also frequently makes it more difficult to manage a chronic condition, and the relationship can be cyclical in many cases.

Making mental health a part of treatment

As with any aspect of treatment for Graves’ disease, your healthcare providers will be your best source of information. Mental health is an important topic to discuss during your appointments.

You can get started by writing down how you are feeling and what you are experiencing. Keeping a journal or notes to refer to can help you describe your experience to your healthcare providers. Here are some ideas:

• How has life changed as a result of Graves’ disease?
• What do you find difficult or challenging about living with Graves’ disease? For example, fatigue, uncertainty, or stigma.
• What physical symptoms are you experiencing? Do you feel these are affecting your moods or emotions?
• How are you sleeping? How many hours are you sleeping on an average night? Do you feel rested after sleep?
• Do you have any concerns about your treatment plan for Graves’ disease? Concerns can be about things like side effects or cost of treatment.

Ask your healthcare providers what can be done to help you meet these challenges and improve your quality of life while living with Graves’ disease.

When living with a condition like Graves’ disease, it’s never a bad idea to be proactive about mental health. Consider working with a mental health professional, such as a therapist, counselor, or social worker. Also consider an in-person or online support group where you can connect with other people who are living with thyroid disorders.