{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:20:51Z","timestamp":1783358451087,"version":"3.54.6"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Generalized anxiety disorder (GAD) and hypertension (HTN) exhibit a clinically significant bidirectional relationship characterized by neuroendocrine dysregulation and autonomic dysfunction. Their comorbidity presents diagnostic and therapeutic challenges due to overlapping symptoms and fragmented care pathways.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report a 61-year-old male with 26-year refractory HTN and new-onset GAD triggered post-thyroidectomy. Despite triple antihypertensive therapy (nifedipine, arotinolol, sacubitril\/valsartan), blood pressure (BP) remained uncontrolled (176\/105 mmHg) with severe anxiety (HAMA\u00a0=\u00a036). Secondary HTN investigations were negative. Multimodal management combining pharmacotherapy (escitalopram, tandospirone), transcranial magnetic stimulation (9 sessions), biofeedback (14 sessions), psychotherapy, and lifestyle interventions achieve: mean BP decreased significantly from 176\/105 mmHg to 125\/72 mmHg during hospitalization; significant anxiety reduction (HAMA\u00a0=\u00a03), mean BP stabilized at 131\/77 mmHg with 50% reduction in antihypertensive dosages, normalization of elevated ACTH (99.9\u2192normal pg\/mL) and cortisol (18.7\u2192normal \u03bcg\/dL) and sustained improvement at 6-month follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case demonstrates thyroidectomy-induced endocrine disruption as a novel trigger in the GAD-HT bidirectional loop. Multimodal therapy targeting shared neurobiological pathways (HPA axis, autonomic regulation, serotonin signaling) effectively breaks this cycle, underscoring the imperative for integrated mental-cardiovascular care in treatment-resistant cases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1600910","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T05:34:52Z","timestamp":1759383292000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Generalized anxiety disorder and hypertension: a bidirectional loop unraveled by integrated 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