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Chronic Stress and Thyroid Autoimmunity

Published September 29 2014

There are numerous factors which can trigger an autoimmune thyroid condition such as Graves’ Disease and Hashimoto’s Thyroiditis.  Chronic stress can be a very big factor, which of course poses a problem since most people deal with chronic stress on a daily basis.  But how does stress specifically lead to an autoimmune thyroid condition?  In this article I’m going to discuss the mechanisms involved, and I will attempt to do this in a manner that is easy to understand.

In order to make it easier to understand the connection between stress and autoimmunity, let’s first cover the basics of what happens when someone is dealing with stress.  During an acute stress situation, the adrenal glands secrete the hormone cortisol, along with epinephrine and norepinephrine.  Epinephrine and norepinephrine are part of the sympathetic nervous system, which is associated with the fight-or-flight response.  The release of epinephrine and norepinephrine causes an increase in heart rate, increased contraction of the heart, dilation of the pupils, increased ventilation, the release of glucose from the liver, and has numerous other functions.  Cortisol is a glucocorticoid, and is also involved in the fight or flight reaction, as it is important for the production of glucose during a process called gluconeogenesis.  The glucose is used as an energy source.  Cortisol also is involved in the breakdown of fatty acids for energy.  If the stressor is acute then once it has been removed the hormone levels will go back to normal.

But what happens when the stressor isn’t removed?  Well, this describes a chronic stress situation, and when this happens, the body will continue to secrete cortisol, and eventually it does so at the expense of DHEA, which is another adrenal hormone.  So what usually happens is that DHEA will eventually become depressed, while cortisol remains elevated.  Over a prolonged period of time the person can no longer adapt to the stress, and as a result the cortisol levels will become depressed.  This is what’s commonly described as adrenal fatigue (when both the DHEA and cortisol levels are depressed), although this process involves more than just the adrenals, as it usually involves dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis).

Why Are Prolonged Elevated Cortisol Levels Harmful To Your Health?

Remember that elevated cortisol levels aren’t always a bad thing.  Cortisol has many important roles, as it is necessary to help control swelling and inflammation, along with insulin it helps to balance the blood sugar levels, it’s important for the utilization of carbohydrates and fats, and cortisol even plays a role in gastrointestinal health.  So healthy cortisol levels are important to maintain healthy blood sugar levels, to maintain a normal blood pressure, to help with immunity and inflammation, and is also involved in fat, protein, and carbohydrate metabolism.

So hopefully you understand that cortisol isn’t inherently bad.  It’s when cortisol becomes chronically elevated that we need to become concerned.  Prolonged elevation of cortisol can decrease immune system function (1) [1], lower bone density (2) [2], cause insulin resistance (3) [3], and can also cause an increase in weight gain and blood pressure (4) [4], thus increasing the risk of cardiovascular disease.  It can also inhibit the conversion of T4 to T3 (5) [5].

How Does Elevated Cortisol Affect The Immune System?

Stress suppresses the immune system, and therefore can make someone more susceptible to infections, and even conditions such as cancer.  On the other hand, stress can also exacerbate the autoimmune response.  So how can stress suppress the immune system, yet exacerbate autoimmunity?  Well, chronic or long-term stress can suppress immunity by decreasing immune cell numbers and function and/or increasing active immunosuppressive mechanisms, such as regulatory T cells (6) [6].  However, chronic stress can also dysregulate immune function by promoting pro-inflammatory and type-2 cytokine driven responses (6) [6].  I’ll expand on this shortly.  In addition, the timing of the stress exposure can play a role, as immunoenhancement is observed when acute stress is experienced at early stages of immune activation, while immunosuppression may be observed at late stages of the immune response (6) [6].

Chronic stress can also affect immunity by decreasing secretory immunoglobulin A (SIgA).  SIgA lines the gastrointestinal tract, and plays a role in immune system defense at mucosal surfaces.  As a result, by decreasing secretory IgA chronic stress can increase one’s susceptibility to an infection (7) [7].  This infection in turn can potentially lead to autoimmunity.   Depressed secretory IgA levels are also correlated with an increase in intestinal permeability (a leaky gut), which also can trigger autoimmunity.  In the past I’ve written an article entitled “How Does Secretory IgA Relate To Thyroid Health? [8]“, and so for more information on secretory IgA I would recommend reading this.

Graves’ Disease Is More Commonly Triggered By Stress Than Hashimoto’s

I’m pretty sure that chronic stress was a big factor in the development of my Graves’ Disease condition.  I’m not suggesting that stress was the only factor, but at the very least it contributed to the development of my condition.  And many of the patients I have worked with who have Graves’ Disease also mentioned chronic stress as being a potential trigger.  In other words, months or years before they were diagnosed with Graves’ Disease they were dealing with a great amount of stress.  This of course doesn’t describe everyone with Graves’ Disease, but the literature shows a strong correlation between chronic stress and Graves’ Disease (8) [9] (9) [10] (10) [11].

But how about those people with Hashimoto’s Thyroiditis?  I have consulted with people who have this condition and thought that stress was a big factor.  However, it does seem that stress is more likely to be a trigger in those people with Graves’ Disease.  But why is this the case?  Well, in most cases Graves’ Disease is considered to be a Th2 dominant condition.  And stress may influence the expression of thyroid autoimmunity in susceptible individuals by shifting the Th1-Th2 balance away from Th1 and toward Th2 (11) [12].  And since most cases of Hashimoto’s Thyroiditis are thought to be Th1 dominant, this would explain why stress wouldn’t be as likely to trigger this condition.  This doesn’t mean that stress isn’t a trigger in some people with Hashimoto’s Thyroiditis, but it’s much more common in those with Graves’ Disease.

It’s The Perception of Stress Which Causes Problems

Although dealing with a high amount of stress over a prolonged period of time isn’t a good thing, the way one perceives the stress can play a huge role in determining whether or not the person develops a health condition.  For example, if you take two people with identical occupations which involve a high amount of stress, and if “person A” doesn’t let the stress bother her much, while “person B” is constantly worrying about trying to get his job duties done, over a period of months and years there is a good chance that the chronic stress is more likely to cause health issues in “person B”.

The good news is that one can change their perception of stress.  Although you might not be able to make this transition overnight, if you put your mind to it you can modify the way you perceive common stressors.  I’m not suggesting that you will get to the point where you are never stressed out, as this is highly unlikely, but if you make a sincere effort to change the way you perceive the stress in your life you can accomplish this within a reasonable amount of time.  And making this change will have a huge impact on your overall health.

How Can You Modify Your Perception Of Stress?

So what can you do to modify your perception of stress?  Is it just a matter of telling yourself that you’re not going to let stress bother you?  Well, this definitely is a step in the right direction.  However, it probably is a good idea to incorporate one or more mind body medicine (MBM) techniques, such as meditation, yoga, or biofeedback.  I talk more about this in an article I wrote entitled “Mind Body Medicine and Thyroid Health [13]“.  But one of the keys is to block out time each day to incorporate these techniques.  Most people who do yoga, meditation, or other MBM techniques don’t do so on a daily basis, which is very important if you want to modify your perception of stress.  You also might want to check out the Institute of HeartMath [14], which is what I personally use to manage my stress.

Can’t someone just take nutritional supplements and herbs to help with the stress?  Well, taking supplements and herbs to support the adrenals might help, and I discussed this in a blog post I wrote entitled “6 Nutritional Supplements and Herbs For Adrenal Health [15]“.  However, earlier in this article I briefly mentioned something called HPA-axis dysregulation, and this usually needs to be addressed in people with adrenal problems.  Fortunately some of the herbs I mentioned in the article (ashwagandha and eleuthero) support the HPA-axis, although sometimes other measures must be taken.  And of course eating a healthy diet is also important to help someone to better deal with stress.  However, while eating well and taking some supplements or herbs can help, this won’t be enough if you don’t modify your perception of stress.

So hopefully you have a better understanding when it comes to the role that chronic stress plays in thyroid autoimmunity. Although cortisol has many important roles, prolonged elevation of cortisol can cause many problems.  Chronic stress can suppress immunity, but it can also dysregulate immune function, which in turn can trigger an autoimmune response.  Since stress shifts the Th1-Th2 balance toward the Th2 pathway, chronic stress is more likely to lead to Graves’ Disease.  However, chronic stress can also decrease secretory IgA, which can cause a leaky gut, thus leading to either Graves’ Disease or Hashimoto’s Thyroiditis.  Also keep in mind that the way someone perceives stress is more important than the stressor itself.   As a result, it is important to modify your perception of stress, and incorporating one or more mind body medicine techniques can benefit most people.