Early or Subclinical Hypothyroidism

[captainform id=”1220620″ lightbox=”1″ text_content=”Take%20the%20Early%20Hypothyroid%20Survey” bg_color=”FF0000″ text_color=”FFFFFF” position=”left” type=”floating-button”]Early or Subclinical hypothyroidism, also called low thyroid or hypothyroidism is diagnosed when thyroid hormone levels are with normal reference range but TSH is mildly elevated. 

Thyroid disorders are more common among women than men. Dr. David Peterson at Wellness Alternatives says, 

“Sex dependent hormonal fluctuations occur in women due to pregnancy, menopause, contraceptive use, and hormonal replacement therapy. Because hormone surges can occur, these contributing factors make women 7 times more likely to develop a thyroid condition than men. The body can interpret a hormone surge as an alarm to turn on or off other important signaling in the body that can lead to faulty thyroid function.” 

While screening patients for thyroid disease, physicians often order labs measuring only thyrotropin-stimulating hormone (TSH) levels in patients. Sometimes labs will show increased thyrotropin-stimulating hormone (TSH) levels in patients whose free thyroxine (T4) levels are not below normal. This state, termed “Subclinical Hypothyroidism,” is most commonly an early stage of hypothyroidism.

TSH can be elevated up to 3 to 5.5 mIU/L even if thyroxine (T4) levels are within the normal reference range, indicating subclinical hypothyroidism. At this stage, the TSH test is especially useful because it could be pointing to the underachieve thyroid function before some patients develop clinical findings, goiter, or abnormalities noticeable in other thyroid tests.

The most common early symptoms of hypothyroidism, such as fatigue, constipation, dry skin, and weight gain are ‘nonspecific? and could are associated with many other diseases and conditions. The symptoms can also be present in subclinical hypothyroidism, when TSH is in the range of 0.3 and 10 mIU/L but T4 and T3 hormones are normal.

 

If the only lab tests run are only thyroid markers. There is no way anything other contributors to “low thyroid” symptoms can be considered. 

Other Causes of Subclinical Hypothyroidism

Other causes of borderline hypothyroidism include mild thyroid failure due to thyroid surgery, previous radio iodine therapy and external radiation therapy as well as temporary subclinical hypothyroidism after pregnancy or silent and subacute thyroiditis. 

Other Patterns of Hypothyroidism

The symptoms experienced by the patients are caused by factors involved in five other patterns of Hypothyroidism described in Dr. Kharrazian’s book, “Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal”. None of which improve by thyroid drugs or supplements. The following bullet points introduces the patterns and their primary causes: 

  • Hypothalamic – Pituitary – Thyroid Axis (Hypothyroidism Secondary to Pituitary Hypofunction) )(page 78)
    • Primary Cause
      • Pituitary gland fatigue
      • Active Stress Response
      • Ischemic Penumbrae of Parasympathetic Withdrawal
        • Decreased blood flow to Hypothalamus, Pituitary and Brain
        • Hormones traveling through the blood stream needed for production of Thyroid Stimulating Hormone (TSH) never get to the pituitary 
    • Secondary Symptoms
      • Symptoms of Low Thyroid
  • Thyroid Hormone Underconversion (page 81)
    • Primary Cause
      • Oxidative stress
      • Inflammation in the body
      • Immune reactions
      • Detoxification processes
    • Secondary Symptoms
      • Symptoms of Low Thyroid
  • Thyroid Hormone Overconversion (page 82)
    • Primary Cause
      • Insulin resistance
      • Polycystic Ovarian Syndrome (PCOS)
      • Low DHEA
      • Increased androgens
      • Increased Testosterone
    • Secondary Symptoms
      • Fatigue
      • Weight gain
      • Hair loss
      • Symptoms of Low Thyroid
  • Thyroid Hormone Binding Elevation (page 83)
    • Primary Cause
      • Birth Control
      • Oral Contraceptives
      • Hormone Replacement Therapy
    • Secondary Symptoms
      • Symptoms of Low Thyroid
  • Thyroid Resistance (page 84)
    • Primary Cause
      • Elevations in cortisol
      • HPA axis
      • Adrenal Uncoupling
    • Secondary Symptoms
      • Symptoms of Low Thyroid

No part of the body can be understood separate from the whole. Patients experience varicose veins or hemorrhoids, inflammation, blood sugar imbalances, stress in their lives and may have used birth control or hormone replacement throughout their lives. Never once thinking that these Patterns of Hypothyroidism may be may be the cause of their symptoms as they are trained to associate everything with low thyroid.

If these condition remain untreated and unchanged, within a few years in some patients, overt hypothyroidism develops, with low free T4 levels as well as a raised TSH level. Thus becoming a “real” Thyroid problem. Unfortunately, for most they will have been prescribed Thyroid medications for years because no one bother to consider any other factors. Thus, creating an Iatrogenic Thyroid problem. 

For most, these patients may have never had a thyroid problem to begin with. Their “Low Thyroid” symptoms were caused by one or more of the five other patterns of Hypothyroidism described in Dr. Kharrazian’s book, “Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal”. Which are not true thyroid problems.

Immune Suppression

Too often, inflammation and immune response are suppressed with NSAIDS or Hydrocortisone drugs. The immune system becomes unregulated. This leads to the likelihood that Hashimoto’s will develop and detectable antithyroid antibodies will show up in lab tests. Thyroid Antibodies

Studies have shown that thyroid antibodies can be detected in 80% of patients with borderline hypothyroidism. Autoimmune thyroid disease or Hashimoto’s is the most common cause of elevated TSH. The majority of patients with subclinical hypothyroidism have THS lower than 10 mIU/L. 

SERUM LIPIDS

Patients with subclinical hypothyroidism sometimes have subtle hypothyroid symptoms and may have mild abnormalities of serum lipoproteins and blood sugar, which are indicators for insulin resistance. Only patients with definite and persistent TSH elevation should be considered for thyroid treatment. 

In patients with full-blown hypothyroidism, serum levels of triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol are elevated. In patients with subclinical hypothyroidism, not surprisingly, the same changes are present but are less marked and less consistent. This pattern of lipid abnormalities, of course, is important because it is a risk factor for atherosclerotic cardiovascular disease.

Coincidently, the same elevation of serum levels of triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol occurs. 

CARDIAC FUNCTION

In several studies, a sensitive measure of myocardial contractility, the ratio of pre-ejection period to left ventricular ejection time (PEP:LVET) was shown to improve significantly in patients with subclinical hypothyroidism who were treated with levothyroxine, compared with patients who were treated with placebo.

Should We Treat Subclinical Hypothyroidism?

Indications for treatment in subclinical hypothyroidism are not established, but general guidelines can be offered. Also, patients who complain of fatigue, dry skin, constipation, muscle cramps or other common symptoms of hypothyroidism may possibly benefit from treatment of the five Patterns of Hypothyroidism, even if their TSH level is elevated.

The presence of symptoms that might be related to mild hypothyroidism also increases the potential benefit of treatment. However, these same symptoms may be related to one or more of the five Patterns of Hypothyroidism in the Kharrazian book, which are not truly a thyroid problem. In these five Patterns of Hypothyroidism, treatment is directed towards the underlying cause, which is not the thyroid

Treatment of Subclinical Hypothyroidism

Treatment is similar to that recommended in patients with overt hypothyroidism. But first and foremost, make sure it is hypothyroidism. As you can see from the Table 1, multiple issues can cause symptoms associated with hypothyroidism. 

Risk of harm to the patient by treating only the thyroid, against the potential benefits of supporting the Pattern of Hypothyroidism must be balanced. Clinical experience and success is the only way to determine which approach works. If the patient responds with treatment of the non-thyroid Patterns of Hypothyroidism, there is no reason to treat the thyroid.

Follow the Money!!!

But as they say – Follow The Money. Twenty, Thirty or more years on thyroid supplements or drugs is financially profitable. People are well trained to expect to be on supplements and drugs for a lifetime. Why let them think anything else. It is not only hypothyroidism, but insulin resistance would fall into this category. They call it “Pre-Diabetes” preparing you for the inevitable lifetime of drugs. It takes a little longer to get there but with all the “co-morbidities” associated with Diabetes. It is good for their business. But not so good for your health and quality of life.

Final Comment

At this point in time, the focus is only on routine laboratory screening for hypothyroidism, but very few will take the time to consider any other possibilities contributing to low thyroid symptoms. 

If you are tired of the status quo. It is time for a change.If you are doing the same thing over and over expecting your health to change.  Ask yourself. Are you ready for a different approach? If you are call today. 530-615-4083

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