By: Urmika Balaji, Contributing Writer
Edited by: Fauzia Haque, Editor; Elias Azizi, Editor in Chief
The following narrative is a personal experience.
It was 9 PM. The list of math problems I hadn’t finished was staring back at me menacingly as I stared blankly at the problem I had been working on for the past hour. I looked back at it drearily. My calculus final was in two days, and here I was blanking out on how to find the interval of convergence on the sixth infinite series problem I had attempted that day. I scribbled through my work again. It was as if I had forgotten everything I had done in the past few hours. The lo-fi in my headphones that was supposed to help me study was instead making my eyes droop further, blurring the numbers on the page. It was just 9 PM. I shouldn’t have been this tired when I still had so much more to do. The unwelcome anxiety of my finals, AP exams, and projects took over me, causing my heart to race. But my mind remained unresponsive, leaving nothing to halt the relentless spread of my anxiety. By the time I regained the composure to finish the problem, it was only to find that I had made the exact same mistakes I had made in the previous problems, along with a surplus of other careless errors. What was wrong with me? It seemed that no matter how many problems I tried to solve, my mind was only capable of blanking out or panicking. Was I just dumb?
The situation above is likely something many teens would label as “junior stress” or “anxiety.” It’s AP exams season, which means that pressure and sleep deprivation are at their highest. Everyone has different experiences with anxiety, but for me, this was at a level and frequency I had never experienced before. I would feel drained out entirely by 9 PM, the time when I would typically feel motivated to study, and I would force myself to stay up longer, only ending up with more panic attacks and less progress on my work. Even on days when I slept properly, I would still feel sluggish and continue to struggle with focusing. I was suddenly blanking out for long periods of time on tests, to a point where I could not even finish my exams to a reasonable extent. Before this point, my hard work was always getting me the results I wanted, but now, all of the effort I put in seemed to amount to nothing. At some point, I began to think that I was simply too dumb to handle my course load, which severly affected my self esteem. If you have ever felt this way, I’m here to tell you that the culprit may not be you. It might be your thyroid gland.
We often hear the word “thyroid” used in rather unamusing discussions of health between elder relatives at the family dinner table. However, the thyroid plays a crucial role in individuals of all ages, and the issues associated with it can often be overlooked as “normal”. Thyroid issues are the most common endocrine problem in children, but the seemingly “normal” symptoms can make it difficult to diagnose without a blood test (Children's Health). Many children and teens do not take blood tests as often as adults, so thyroid issues in youth can remain undiagnosed for long periods of time. Due to this, it is important for teens to be able to listen to their bodies even under the stress of school and other commitments. As a high school student who struggled with undiagnosed hypothyroidism for several months during the school year, I want to bring awareness to the effects of hypothyroidism on mental and physical health, and how it can be distinguished from the normal effects of sleep deprivation and anxiety.
Anatomy and Function:
The thyroid gland is a butterfly-shaped organ at the base of the neck that releases thyroid hormones into the bloodstream and regulates the functions of all of the organs in the body. The process of thyroid hormone release begins in the hypothalamus, where neurons release a hormone called thyrotropin-releasing-hormone (TRH) which stimulates cells in the anterior pituitary, called thyrotrophs, to release thyroid-stimulating-hormone (TSH). TSH then stimulates the cells in the thyroid to release the hormones, triiodothyronine (T3) or thyroxine (T4). The thyroid gland produces the thyroid hormones from thyroglobulin, where an enzyme called thyroid peroxidase adds iodine to form T4 or T3 (MedlinePlus). T3 has 3 iodines and T4 has 4 iodines in their molecular structures. T3 is the active form of the thyroid hormone, so T4 must undergo de-iodination, or the removal of one iodine, to form T3. Reverse T3 is also produced from this process, which is inactive due to the arrangement of iodines in the molecular structure. T4 and T3 levels in the blood then serve as negative feedback for the pituitary gland (Pubmed). High levels of thyroid hormones will decrease TSH release and low levels will increase TSH release.
Thyroid hormones impact many organs in the body. In the digestive tract, it regulates metabolism, which is the rate at which your body converts consumed food into energy (Cleveland Clinic). In the heart, it regulates the heart rate, blood pressure, and cholesterol levels (Harvard Health). They also play a key role in regulating body temperature by stimulating brown adipose tissue to break down glucose, which generates the adequate heat to maintain body temperature (Cleveland Clinic). Thyroid hormones also affect the texture and quality of the skin. In the brain, it can affect cognitive functions and mood (Pubmed). In children, it also affects brain development and physical growth.
All thyroid conditions are diagnosed based on blood tests. A typical thyroid panel consists of TSH, free T4, and total T3. “Free” refers to thyroid hormone that is not bound to proteins in the blood while “total” refers to bound and unbound hormone. The normal amount of TSH in adults is between 0.5 and 4.0 mIU/L (American Thyroid Association). In children aged 11 to 18, the range can be slightly higher, 0.6 to 5.8 mIU/L. Normal free T4 ranges from 0.93 and 1.60 ng/ml, and total T3 ranges from 80 to 220 ng/ml (UCLA Health). If your doctor observes severe abnormalities in any of these levels, they may request you to measure the levels of thyroid antibodies (thyroglobulin or thyroid peroxidase (TPO) antibodies), thyroid stimulating immunoglobulin (TSI), or reverse T3 (American Thyroid Association). These factors will show if the condition is autoimmune, cancerous, or another specified issue.
Hypothyroidism & Hashimoto’s Disease
Hypothyroidism is a condition where the body does not produce enough thyroid hormone. It is usually characterized by an abnormally high TSH and a low or normal T4 level in the blood. A TSH range of 4.5 to 10 mIU/L is considered mild hypothyroidism, while a TSH level greater than 10 mIU/L is considered severe (Endocrine Web). The most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune condition where the immune system creates antibodies to attack the thyroid cells as if they were viruses or bacteria (Mayo Clinic). After observing high TSH levels in the blood, your doctor will ask you to test for thyroid antibodies, thyroglobulin antibody (normally under 0.9 mIU/L) and TPO antibody (normally under 26 mIU/L), to see if you have Hashimoto’s Disease (Very Well Health).
Due to the increased stress on the pituitary, a person with hypothyroidism may experience brain fog, dull facial expressions, fatigue, depression, memory loss, confusion, lack of energy, or slow speech (UCLA Health). In teens, many of these symptoms could be simply overlooked as burnout due to continued anxiety, stress, and sleep deprivation. However, unlike thyroid issues, taking a break can usually cure burnout, which is why you should monitor the frequency and severity of these issues. If you find that even after a few nights of good sleep you still feel like you are running on four hours of sleep, or that even after taking a break you still cannot focus on you work, or that you are forgetting things that you usually do not forget, or that you generally feel less motivated than you did a few weeks or months ago, you may want to take a blood test for your thyroid levels. There are also a number of other physical symptoms, such as constipation, dry skin, cold intolerance, increased or irregular menstrual flow, and weight gain (UCLA Health Mayo Clinic).
Hyperthyroidism is a common struggle among many adults, but it is important to bring light to its early and unprecedented presence among teens. Many teens may struggle with hypothyroidism unknowingly, like I did, and it is easy to assume that these symptoms are just a part of our “personality” when comparing ourselves to others. It can get to a point where we start to believe that we are too dumb or too anxious handle things, and overlook everything else we have accomplished. Looking back on my experience, I am surprised at how much I accomplished over the year, despite struggling to get myself through every single day. To all the teens out there struggling with their mental health in the same way I did, don’t immediately blame yourself, and instead, listen to your body.