Treat your subclinical hypothyroidism

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Frequently Asked Questions About Subclinical Hypothyroidism

An Exploration of Low-Level, Subtle and Borderline Underactive

Thyroid

by Shomon

What is Subclinical Hypothyroidism?

The medical definition of subclinical hypothyroidism is a

hypothyroid condition -- usually asymptomatic -- in which free

thyroxine (T4) is normal and thyroid stimulating hormone (TSH) level

is between 5 and 25 mU/L, or, if a thyrotropin-releasing hormone

(TRH) test is conducted, there's a greater than normal elevation in

TSH response.

The reality is that, while the textbooks say and some doctors

believe that TSH levels of 5 to 25 are not usually acompanied by

symptoms, many patients actually suffer substantial symptoms at

these levels. According to Dr. Ross, symptoms described in

patients with subclinical hypothyroidism include greater than

average incidence of problems with muscles and nerves, such as

weakness, muscle fatigue, and tingling extremities.

And the level of 5 as a bottom " cutoff " is actually also being

questioned.

In January of 2001, the American Association of Clinical

Endocrinologists (AACE) released a statement that said: " Even though

a TSH level between 3.0 and 5.0 uU/ml is in the normal range, it

should be considered suspect since it may signal a case of evolving

thyroid underactivity. "

And some practitioners actually believe that levels above 2 are

evidence of developing hypothyroidism.

In particular, there are practitioners who believe that a normal TSH

level, with the presence of elevated thyroid antibodies, may trigger

hypothyroidism symptoms, and may warrant treatment.

Vliet, MD, who runs the popular women's health centers,

Her Place and who is author of the bestselling book, Screaming to be

Heard: Hormonal Connections Women Suspect...and Doctors Ignore wrote

in her book:

" The problem I have found is that too often women are told their

thyroid is normal without having the complete thyroid tests done. Of

course, what most people, and many physicians, don't realize is

that...a 'normal range' on a laboratory report is just that: a

range. A given person may require higher or lower levels to feel

well and to function optimally. I think we must look at the lab

results along with the clinical picture described by the patient...I

have a series of more than a hundred patients, all but two are

women, who had a normal TSH and turned out to have significantly

elevated thyroid antibodies that meant they needed thyroid

medication in order to feel normal. This type of oversight is

particularly common with a type of thyroid disease called

thyroiditis, which is about 25 times more common in females than

males...a woman may experience the symptoms of disease months to

years before TSH goes up... "

How Common is Subclinical Hypothyroidism?

Using the TSH of 5 as a bottom cutoff, it's estimated that on

average, approximtely 8 percent of women, and 4 percent of men are

subclinically hypothyroid. The prevalence is much higher with age,

and 15 percent of women over the age of 60 and 8 percent of men are

subclinically hypothyroid.

Given the AACE's belief that TSH over 3 may be suspect, the number

of people who may be subclinically hypothyroid is likely to be far

greater than currently thought.

What are the Risks for and Symptoms of Subclinical Hypothyroidism

The risks for and symptoms of subclinical hypothyroidism are the

same as for regular hypothyroidism.

What Are the Risks of Not Treating Subclinical Hypothyroidism?

The risks of untreated subclinical hypothyroidism include:

Increased risk of heart attack and atherosclerosis

Increased risk of elevated cholesterol and high triglycerides

Increased risk of depression, anxiety, and panic attacks

Increased risk of miscarriage.

Increased risk of developmental delays in infants born to mothers

who were subclinically hypothyroid during pregnancy

Should Subclinical Hypothyroidism be Treated?

Most practitioners believe that most patients with subclinical

hypothyroidism should be treated, because treatment can prevent

further worsening of the hypothyroidism and further elevation of the

TSH, may prevent growth of a goiter, and may help eliminate symptoms.

According to D. Utiger, M.D., writing in " Health News, " from

the New England Journal of Medicine:

For people with subclinical hypothyroidism who have no symptoms,

some clinicians believe that treatment is not needed unless, or

until, symptoms or signs of hypothyroidism appear. Others argue that

even people free from symptoms should start thyroxine therapy in

order to forestall the progression to overt hypothyroidism, which

occurs in about 2 percent of people per year. Another pro-treatment

argument is that some people with subclinical hypothyroidism have

symptoms that will be improved by treatment, but that neither the

person nor a physician or family members have detected them yet.