Graves’ disease is known for causing physical symptoms such as muscle weakness and fatigue, but it can also worsen your mental and emotional symptoms. In fact, research shows that people with Graves’ are more likely to experience conditions such as depression and anxiety when their thyroid is overactive compared with when their thyroid hormone levels are well controlled.
That’s because excessive thyroid hormones, which is a hallmark of Graves' disease, may decrease levels and activity of serotonin, a brain chemical that, in lower levels, is linked to anxiety and depression, according to some studies.
Plus, in some cases, what may look like anxiety symptoms may actually be physical symptoms of Graves’ disease, such as rapid heartbeat and feeling shaky and nervous. “With Graves’ disease, everything is revved up — you’re sweating, your heart’s going quickly — and when you’re experiencing those physical manifestations, it feels like anxiety,” says Caroline Messer, MD, an endocrinologist and assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra University–Northwell in New York City.
Whether your symptoms are due to anxiety caused by Graves’ or other physical symptoms of the disease, it’s important to address them as much as possible until the thyroid levels are controlled. Here are some strategies to protect your mental health.
1. Stick With Your Graves’ Treatment Plan
Your first goal is likely to bring your levels of thyroid hormone back down — whether that’s with medication, radioactive iodine, or surgery. This, in turn, can help alleviate any mental-health effects you’re feeling. Similarly, taking your beta-blockers, says Messer, can also effectively treat symptoms such as anxiety, tremors, racing heart, and sleep disturbances related to the excess thyroid hormones until the levels are controlled.
If your disease was diagnosed early, it might be possible to get your thyroid — and any associated mental health issues — under control within only a few weeks, says Messer. If the disease is more severe, it takes longer.
2. Talk With a Mental Health Professional
Talk therapy can help you address anxiety, depression, or stress, and anti-anxiety medications may also be prescribed, usually for a short period of time while your doctors work to get thyroid hormones to a normal level, says Messer.
“Most people end up not needing these medications because they feel so much better so quickly once they get on treatment for their Graves’ disease, but [they] can be helpful for certain people,” says Messer.
3. Reduce Your Triggers
Anything that can worsen Graves’ symptoms can exacerbate the emotional toll of the condition as well. One common trigger, says Dr. Messer, is smoking. “Smoking makes Graves’ so much worse, so I always ask people to quit,” she says.
Psychological stress can make the symptoms of Graves’ disease worse when you’re trying to treat the symptoms of the condition. In addition, once you’ve been treated for Graves’ and the disease is in remission, it is believed that psychological stress can be a trigger for recurrence of symptoms.
Adding stress-reducing activities such as yoga, breathing exercises, or meditation to your daily routine can help not only relieve anxiety but may help reduce your risk of a relapse of symptoms.
4. Make Nutritious Food Choices and Exercise With Your Medical Team’s Guidance
While there is no evidence that any particular diet can help treat Graves’ disease, focusing on healthy eating and exercise habits, such as the Mediterranean diet, can help improve your mood, boost your energy levels, and reduce inflammation in the body, and generally improve your overall health. As an added bonus, some research has shown that it may help improve symptoms of depression.
Research shows that regular physical activity can also help reduce anxiety and boost mood. But if you have Graves’ disease, check with your doctor before starting any exercise plan. Since the condition causes hyperthyroidism, or an overproduction of the thyroid hormone, exercise can potentially increase your heart rate, which is already running at a revved-up speed; overdoing physical activity can potentially lead to increased anxiety, and in even heart failure in cases where the hyperthyroidism is not well controlled.
5. Prioritize Sleep
Getting restful sleep tends to be tricky for people with Graves’ disease, and that lack of sleep can worsen mood and anxiety. Studies have shown that having difficulty falling asleep is associated with anxiety, which can then exacerbate insomnia. Try to log at least seven hours of sleep.
To get enough z’s, practice healthy sleep habits such as limiting caffeine and alcohol in the evening, avoiding screens at least an hour before bedtime, and keeping your bedroom cool.
The Takeaway
Graves’ disease can not only affect your physical health, but can also impact your mental and emotional health.
To ease stress and anxiety, eat a healthy diet, get at least seven hours of sleep, and exercise regularly.
Seeking help from a mental health professional can help improve your mental and emotional health.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Johansson B et al. The Relationship Between Mental Fatigue, Depression, and Cognition in Graves’ Disease. European Thyroid Journal. July 2023.
Song Y et al. Graves’ Disease as a Driver of Depression: A Mechanistic Insight. Frontiers in Endocrinology. April 19, 2023.
Giordani I et al. A Short Review of Current Knowledge Regarding Long-Term Treatment of Graves’ Disease With Antithyroid Drugs. Hormones. December 5, 2024.
Ruggeri RM et al. Autoimmune Thyroid Disorders: The Mediterranean Diet as a Protective Choice. Nutrients. September 12, 2023.
Oddo VM et al. Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults. Nutrients. January 11, 2022.
Exercise and Diet Risks Associated With Uncontrolled Thyroid. Cleveland Clinic. November 26, 2021.
Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine at Mount Sinai. She completed her residency training in internal medicine and fellowship in endocrinology and metabolism at The Mount Sinai Hospital. She has been in private practice in Manhattan since 1999.
Dr. Brett practices general endocrinology and diabetes and has additional certification in neck ultrasound and fine-needle aspiration biopsy, which she performs regularly in the office. She is voluntary faculty and associate clinical professor at the Icahn School of Medicine at Mount Sinai. She is a former member of the board of directors of the American Association of Clinical Endocrinology. She has lectured nationally and published book chapters and peer reviewed articles on various topics, including thyroid cancer, neck ultrasound, parathyroid disease, obesity, diabetes, and nutrition support.
Laurel Leicht has been a writer and editor for nearly two decades. A graduate of the College of William and Mary and the master's program at the Missouri School of Journalism, she covers a wide range of health and fitness topics, including breast cancer, various chronic conditions, mental health, and cardiovascular health.
