Sunday, March 17, 2013

Responding to comment

Hi again.  I have received some great comments on here and I just wanted to take the time to respond to this latest one publicly so everyone can learn from it:

Hi Panic Remission,
I am panic attack patient like you and I have several phobias which make my life terrible.
I am also writing a blog in Turkey regarding panic attack and phobias.
Just keep sharing , I think we may be of help to other people.
May I learn whether you have any of the following health problems as well :
Autoimmune Disorder
Heart Rythm problems
Vitamin D deficiency.

I have been suffering frm Panic Attack since 2007 , and I am both on medication and therapy.

I have Hashimoto thyroiditis, had Heart Rhythm problems which was fixed via EPS Ablation.
I dont know whether I have allergies and Vitamin D deficiency.I will search for it .
I just wanted to eliminate all physical problems that may cause panic attack:(
But I recommend you, if you have not visited yet , visit an Endocrinology doctor for hormonal controls and please share whether you have any of these problems Thanks a lot
And wish you best ! 

Thanks for your comment!!  I am sorry that you are struggling with panic attacks and phobias and think that your life is terrible =(  Just keep working on it and think positive - things will get better, I promise!  I am not personally diagnosed with any of the health problems that you list above - but certainly it is possible that I have one or more of those, as I have not seen specialists that would be able to make the diagnoses.  But it is interesting that you bring this up.

There are a lot of medical problems (physical) that can mimic or cause panic attacks.  Certain cardiac issues for sure, thyroid problems as you mention, autoimmune diseases such as celiac disease (where you have to go on a gluten-free diet because your immune system is attacking the wheat that you eat and it damages your intestines).  This is definitely all true and that is why in my first post about what to do when you are starting your panic disorder treatment, I recommend getting a full evaluation from a doctor to make sure that everything checks out.  And I am specifically talking about just a regular primary care doctor here.  I'll explain why.

Many of us with this disorder have related problems with hypochondria.  A panic attack is associated with intense fear - specifically fear that something may be wrong with our bodies.  So we may constantly go to the ER with the fear that we are dying or having a heart attack.  Or constantly visit the doctor, desperately trying to find a physical explanation for what is causing all of this.

But you know what?  I don't want to live my life like that.  I don't want to go to the ER all the time, or go see a million specialists all of the time and get put on a ton of medication.

I am actively choosing to believe that my panic attacks are caused by anxiety, not by a physical disease.  And by making this choice, I acknowledge the fact that I may be wrong.  Maybe I do have a heart problem or thyroid problem that leads to my panic attacks.  Maybe I will have a heart attack and die tomorrow.  But to overcome this disorder, I need to, and I do, 100% believe that my panic attack is just a panic attack.  And I want to emphasize again that it took me a very long time to be able to have this mindset.  But it is very powerful if you manage to get there.

And so far, it is working for me.  The brain is a very powerful organ and so even if I had an actual physical disease, it wouldn't surprise me that this type of thinking would still lessen or prevent panic attacks from happening. 

And now, just because in my "real" life I have a lot of experience with endocrinology (not as a patient, in fact I have never seen an endocrinologist as a patient), I'm going to turn on the science a little bit and explain why it is unusual - but not impossible - for panic attacks to be associated with Hashimoto's, which typically causes hypothyroidism.  Feel free to ignore this paragraph if you want =)

Hashimoto's thyroiditis is an autoimmune disease where your immune system accidentally thinks your thyroid is a foreign pathogen (like a virus or bacteria) and thinks that it needs to destroy it.  The thyroid is a very important gland in the body as it regulates everything from your metabolism to growth to organ function (liver, heart, etc).  Very important.  It does this by secreting two hormones: T3 and T4 - these then go around to the rest of the body and help regulate everything.  But how does the thyroid know how much T3 and T4 to make and how much?  It gets a signal from the brain in the form of a hormone called TSH (thyroid stimulating hormone).  So the brain releases TSH, this goes to the thyroid and tells the thyroid to make T3 and T4.  If the thyroid successfully makes T3 and T4, these can go up to the brain and tell it "Yep, here we are, you can turn off the TSH now".  This is called a feedback loop: TSH tells the thyroid to make T3/T4, then once enough is made, the T3/T4 tell the brain to stop making the TSH.  Okay back to hashimoto's.  So your immune system starts attacking your thyroid.  And so your thyroid starts getting pretty bad at making T3 and T4.  And because you don't have enough T3/T4, you get symptoms like: decreased heart rate, tiredness, weight gain, muscle weakness, hair loss, etc.  This is called hypothyroidism because your thyroid is underproducing T3/T4.  The opposite of this is hyperthyroidism where your thyroid produces too much T3/T4.  The symptoms of hyperthyroidism are: fast heart rate, anxiety, weight loss, sweating.  Hyperthyroidism is the endocrine disorder that typically leads to panic symptoms.  Now how can hashimoto's cause this too?  As the thyroid is being destroyed by your immune system, the parts that are still working start to work EXTRA hard to make up for the parts that are damaged.  So sometimes you can get extra T3/T4 in the body and cause the symptoms of hyperthyroidism, including panic attacks.  Depending on how much damage is done, a person actually cycle between hyper- and hypo- thyroidism, until finally the whole thyroid is damaged and it just can't make T3 and T4 anymore and you would have permanent hypothyroidism.  Luckily both of these conditions are treated with excellent drugs so there is nothing to really worry about with these disorders!

But anyway back to my reasons why you need to visit your primary care doctor: if you go to the doctor and describe your symptoms of anxiety, they will most likely order a bunch of blood tests to rule out many of the physical diseases associated with panic attacks.  And I am fairly confident that they will order a test to measure your TSH or T3/T4 because hyperthyroidism is one of the most common physical reasons for panic attacks.  And they will listen to your heart.  And they will check all of the other good stuff.  Now, if they tell you that you are okay, please listen to them.  If you go to a cardiologist, they might find some tiny heart murmur or if you go to an endocrinologist they might find a small nodule (non-cancerous lump) in your thyroid.  These things are most likely not causing your panic attacks but will require you to go to a billion doctors all of the time and I think it just lowers the quality of life and causes a lot of unnecessary worrying.  Especially for those of us who have panic disorder and are hypochondriacs. 

One more medically related note: I will look in the literature but I currently do not know of any published, peer-reviewed studies linking allergies, diabetes or vitamin D deficiency with panic attacks. 

Oh wow sorry this is so long.  I will leave you with this piece of advice that I have been following after learning the cognitive behavioral therapy (with the note that I am currently not diagnosed with any physical diseases so I don't have to see any specialists):

I go to the doctor for my regular physical (no more than once per year, I usually do every other year)

Other than that, I will only go to the doctor if someone else tells me that I should go to the doctor.  (i.e. I am so sick that my mom or friend or whoever says "dude you should really go to the doctor")

Thanks again for reading.  Please write a comment or email me with any questions you may have.  I am here to help!


  1. Aww thanks a lot for replying back. !
    By the way my therapist recommended me to read C.padesky's book "evinizdeki terapist" I think original name is "mind over mood" ,and our therapy is mostly based on the chapters of this book.
    It is really helpful by the way, but surely with the help of therapist.
    I will be following your blog ;) Best wishes...

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