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Around 3% of the general population has a psychiatric disorder called obsessive-compulsive disorder, abbreviated as OCD. Interestingly, those with autoimmune thyroid disorders have higher rates of OCD than the average population, according to a recent 2022 study. 

What is the connection between these two very different medical conditions? In this article, we'll explore how thyroid hormones, especially low levels, may influence the development of OCD.

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In OCD,  anxiety-provoking thoughts lead to very specific symptoms of that anxiety, namely repeated activities, and rituals that are seeking relief. These rituals can become so frequent that they interfere with daily life and the ability to function effectively.

OCD is typically diagnosed during the teen and young adult years. The exact causes of OCD are unknown but may be due to the following:

• Changes in brain structure and functioning
• Environmental factors
• Family history
• Impairment of the immune system

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As mentioned, OCD sufferers typically have chronic obsessions and compulsions. These obsessions could be thoughts, mental images, or urges that can cause anxiety. For instance, obsessions could include a fear of germs or losing something.

A common sign of compulsion is a behavior that you do repeatedly to help reduce your anxiety or obsessive thoughts. Examples of compulsions include:

• Checking a locked door repeatedly to ensure it is indeed locked
• Checking a stove to ensure that it's turned off
• Washing your hand's dozens of times a day 
• Counting, checking, or arranging things in a particular way
• Fear of germs or contamination that leads to avoiding handshakes or touching doorknobs
  
  

If you notice any of these psychiatric symptoms or behaviors, make an appointment to talk with your healthcare provider about them. They will likely do a complete exam and take a detailed medical history.

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Your thyroid gland, located at the bottom of your neck, produces two thyroid hormones: T4 and T3. These thyroid hormones have many roles in our bodies, including brain growth and maintaining the health and function of your neurons.

Our bodies regulate thyroid hormone production through the hypothalamus-pituitary-thyroid axis. A change in this axis alters how much thyroid hormone your thyroid produces.

There is conflicting evidence on how OCD affects this axis. Some studies show a blunted thyroid-stimulating hormone (TSH) response with decreased T3 and T4 levels. In contrast, others show a normal TSH level. Other studies show the exact opposite that OCD can cause high thyroid hormone levels (hyperthyroidism). As you can see, the results are quite different for each study or case report.

Symptoms of thyroid dysfunction differ based on whether your thyroid levels are too high or too low (hypothyroidism). Yet, both can cause symptoms related to how your brain functions, including:

• Memory changes
• Mood disorders such as anxiety or depression
• Mood swings

Panic disorders, major depressive disorders, and generalized anxiety are commonly associated with hypothyroidism. But why is this?

Thyroid disorders can alter neurotransmitters in your brain. Neurotransmitters are chemical messengers that deliver messages from your brain to nerve cells throughout your body. The three common neurotransmitters linked with OCD include the following:

• Serotonin
• Dopamine
• Glutamate

As the makeup of the above neurotransmitters in your brain changes, mood disorders may start to appear. As seen in hypothyroidism, low thyroid hormone levels can alter these neurotransmitter levels. Thus, contributing to the development of OCD or other mood disorders.

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OCD, Hashimoto's, and hypothyroidism can change how your immune system works. Evidence suggests that OCD may result from immune system dysfunction and inflammation.

Both of these are characteristics of an autoimmune disease like Hashimoto’s. Autoimmune disorders occur when your immune system goes into overdrive, attacking your healthy cells. As these cells die, inflammation increases in the area being attacked.

Some studies estimate that 40% of those with OCD also have an autoimmune disorder, with thyroid-related disorders being the most common. So, it may not surprise you that Hashimoto’s, is linked to OCD. In those with Hashimoto’s, the immune system attacks the thyroid gland. This results in thyroid cell damage, leading to a reduction in thyroid hormone production and chronic inflammation.

A study found that OCD was more common in patients with Hashimoto's thyroiditis, a type of autoimmune hypothyroidism, compared to the control group.

Chronic hypothyroidism can cause depressive episodes, panic attacks, and generalized anxiety, and can make the symptoms of OCD much worse.

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Thyroid hormone replacement medications replace your naturally made thyroid hormone when your thyroid can’t make enough to meet your body's needs. The most commonly prescribed thyroid hormone replacement medication is levothyroxine. Some studies have shown that as your thyroid hormone levels normalize while taking levothyroxine, cognition and mood disorders will improve.

A 2004 case report on an adolescent patient showed that OCD symptoms were better controlled when taking mood-stabilizing medications in combination with levothyroxine. When this patient attempted to stop levothyroxine, OCD symptoms became worse. So, in this case, levothyroxine helped control OCD symptoms when combined with other medications.

Levothyroxine can help improve major depressive disorder, according to a 2022 study. This study included those with hypothyroidism and those who were euthyroid (normal thyroid hormone levels). The results were similar between the two groups. When added to other medications for treating depression, levothyroxine potentiates the actions of these medications. Thus further helping to improve symptoms of depression.

Overall, there's limited evidence suggesting that levothyroxine may help improve mental health symptoms related to a mood disorder when used in conjunction with other mood-stabilizing medications.

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As we can see, there is a potential link between OCD and hypothyroidism. But, we need more studies to fully understand the link between these two medical conditions.

In the meantime, if you have been diagnosed with or have symptoms of OCD, talk with your healthcare provider about checking your thyroid function. This can easily be done with Paloma’s convenient, at-home testing kit. Our testing kit tests for TSH, free T4, free T3, and thyroid peroxidase (TPO) and only requires a finger prick blood sample.

You will get your results within a week. If your labs show an underactive thyroid, schedule an appointment with one of our Paloma Health thyroid specialists, to get your thyroid condition treated and well-managed.