It can have a physical component, and that deserves to be ruled out before assuming it is purely emotional. An overactive or sluggish thyroid, low B12 and ferritin, dysregulated cortisol, hypoglycemia and the hormonal swings of perimenopause can produce or amplify anxiety. Investigating the body does not replace caring for the mind, it complements it.
First, the honest framing: anxiety is a legitimate condition that deserves its own care, with psychotherapy and, when indicated, psychiatric treatment. What endocrinology and clinical nutrition add is another question, one that should be standard and rarely gets asked: what, in the body, is producing or amplifying this alarm?
In our survey on anxiety, with 658 responses, 62% marked that it comes "for no reason at all". Anxiety with no identifiable trigger is exactly the kind that most deserves a physical workup: when there is no cause in the biography, it is worth looking in the organism.
The physical causes that mimic or amplify anxiety
- •Thyroid. Hyperthyroidism is the great imitator: rapid heartbeat, tremor, insomnia, restlessness. And hypothyroidism also affects mood and anxiety. TSH and free T4 are the first thing to rule out, recommended by psychiatric guidelines themselves.
- •B12 and iron. They are cofactors in the synthesis of serotonin and dopamine, the neurotransmitters anxiety throws off balance. B12 deficiency produces neuropsychiatric symptoms, and rock-bottom ferritin travels with anxiety and fatigue.
- •Hypoglycemia. A glucose drop fires adrenaline, and adrenaline is physically identical to an anxiety attack: racing heart, sweating, tremor. Someone living on coffee and refined carbs swings between spikes and crashes all day, and feels "attacks" that are blood sugar.
- •Dysregulated cortisol. Chronic stress keeps the alarm on. High cortisol at night is nighttime anxiety with light sleep.
- •Perimenopause. The swings of estrogen, which modulates serotonin, and the fall of progesterone, which becomes the endogenous calming agent GABA, explain why so many women develop anxiety "out of nowhere" between 40 and 50. It is not weakness: it is transition chemistry.
- •Excesses and medications. Too much caffeine, alcohol (hangover anxiety is chemical), decongestants and other drugs.
The sensible path
It is not swapping the therapist for a blood test: it is doing both. TSH and free T4, B12, ferritin, glucose with fasting insulin, sex hormones according to the phase, late-night salivary cortisol when there is suspicion. If something shows up, treating it transforms the emotional care, because nobody can breathe deeply enough to compensate for an overactive thyroid.
Dr. Diego Rios · CRM-PI 8347 (Brazilian medical license)
Creator of the Reactiva Method. Five postgraduate degrees: Family Medicine, Endocrinology and Metabolism, Nutrology, Sports Pharmacology and General Ultrasonography.
The answer is not one more isolated lab test. It is reading the system.
Medicine is one. The body does not divide itself into specialties: the model does. When each symptom goes to a different office and each doctor sees one piece, you spend years circling between referrals, holding reports and missing answers. In that back-and-forth, you lose time and health.
Precise diagnosis and treatment come from the opposite path: understanding everything and going deep into one patient. Sleep, hormones, weight, energy and mind interpreted together, because that is how the body works.
Dr. Diego Rios, CRM-PI 8347
Educational content. It does not replace individual medical evaluation and is not a prescription. Patient care is provided in Portuguese.