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Have you heard the term “subclinical hypothyroidism”? Today, I want to help provide guidance on this term, and what it means for your health. Did you know that nearly everyone that you hear uses this term actually is not using it the right way? We will also help clear up some of that confusion, and find out whether or not you have it – or have to worry about it – today.
The biggest thing that we need to do today is to clarify the term itself, and then we can understand the theories and the signs and all of the other things that go into subclinical hypothyroidism. We also want to talk about the different “worlds” of medicine, both alternative and conventional.
Subclinical Hypothyroidism in Alternative Medicine
In the circles of alternative medicine, I have heard subclinical hypothyroidism being used in a different way than it has been defined.
Subclinical hypothyroidism is often being used to reference someone who is hypothyroid and has symptoms but has normal blood tests as defined by the conventional world, currently defined as:
- A TSH at more than 4.5 (mIU/L) (1)
- Having a low level of free T4 under 0.8 ng/dl.
Key Insight: In this case, if someone is feeling sick or feeling hypothyroid, a doctor could look at their tests and assume that they were perfectly fine – that nothing was wrong at all.
Unfortunately, what I am here to tell you today is that while many have described subclinical hypothyroidism as this state of being, that is not what it is! What do I mean? Well, let’s talk about the important and definition of “clinical findings.”
What is “Subclinical Hypothyroidism”?
The main error in the world of alternative medicine is a misunderstanding of the term “clinical findings.”
Key Insight: “Clinical Findings” are the kinds of things that you can find by talking to a patient about how they feel. This can include symptoms that they are feeling, which could speak to their overall health.
Let’s think about this, for example. Let’s say someone walked into my office and told me that they were:
- Feeling run down
- Noticing that their hair was thinning
- Saw that they were gaining weight for no reason at all
All of those things are symptoms, and we can also understand them as clinical findings. This constitutes a “clinical” situation, so it is no longer a subclinical one. It’s a clinical illness, so why are we treating it like it is not?
If I did subscribe to the idea that subclinical hypothyroidism was reliant on testing, I might test this person that just came in and notice that there TSH and their free T4 scores were perfectly fine. Even though they just finished telling me about some critical symptoms impacting their life, I might find myself writing those off as being symptomatic of something else.
In Conclusion: If we adhere to the alternative “standard” of subclinical hypothyroidism, we are discounting a key element of clinical findings which speak to hypothyroidism in patients.
Subclinical Hypothyroidism in Conventional Medicine
Now, let us turn our attention towards the conventional world of medicine. In this area, subclinical hypothyroidism has come to be understood in the following way: it is essentially hypothyroidism with no symptoms.
Here, hypothyroidism is referred to as:
- The elevated TSH (more than 4.5)
- A low level of T4
Key Insight: When it comes to your TSH, some might even say more than 10 is the minimum for diagnosing hypothyroidism. This is obviously something which I cannot get behind at all.
Taking things a step further, the three qualifiers for subclinical hypothyroidism are:
- No clinical symptoms of hypothyroidism (2)
- High TSH
- Low T4
In the conventional world, the majority of discussions happening surround treatment for those who have subclinical hypothyroidism. How do you treat someone, and how do you subsequently evaluate them, if they do not have any symptoms? Do you place them on medication, even though they might otherwise feel fine? That is something that has definitely been debated, back and forth, for quite some time now.
Key Insight: Did you know that subclinical hypothyroidism might actually play a role in infertility? Research has shown that subclinical hypothyroidism and thyroid autoimmunity can be behind a lot of women’s fertility struggles (3).
Thyroid Hormone Therapy for Subclinical Hypothyroidism
Recently, I saw a study that I want to talk to you about – surrounding thyroid hormone therapy, being used on older adults, to help treat subclinical hypothyroidism (4). In theory, this sounds like a good and productive study, but the results will have you questioning what exactly it is that we know about subclinical hypothyroidism.
All the research did was compare the results of those who received treatment, against those who did not. The conclusion of this study was that there was no clear benefit from treatment because there was no change in symptoms. You know what the funny part is? They did not have symptoms, to begin with, so there was no change to something that did not even exist in the first place.
In Conclusion: If there are no symptoms being exhibited in the first place, it becomes increasingly difficult to compare it to something else when therapy is attempted. This obvious limitation definitely gets in the way of how we can understand and treat subclinical hypothyroidism.
At some point, the researchers themselves admitted that this was an obvious limitation. There was no reporting of feeling better because patients did not feel bad to start off the study.
They also did not see clear changes in disease outcomes for those tested. Another drawback that the researchers mentioned was that the TSH scores never reached the level that most think is optimal (below 2.0 or closer to 1.0).
Key Insight: I have talked about it before, but the distinction between “normal” and “optimal” is absolutely critical when it comes to understanding our TSH scores. Normal encompasses a huge range, and just because you are in that range does not mean that you are healthy. We want to aim for optimal, and I think we can learn from that!
I would argue that if you were able to treat it to the point that you were actually able to bring down the TSH, that you would help mitigate the risk of disease development down the road. Overall, when TSH runs higher than 2.0, or 2.5, we see higher rates of:
- Cardiac disease
- Thyroid cancer
- Liver cancer
Arguably, subclinical hypothyroidism should be treated. But, as we have seen in the alternative world, people have begun classifying it as “subclinical” even when the condition is clearly “clinical.” This causes a bit of a mixup when it comes to not only understanding what subclinical hypothyroidism is, but how people go about treating it.
In Conclusion: If you have thyroid symptoms, but your doctor says you are fine, that is most certainly not subclinical hypothyroidism. Instead, it is just a case of a doctor needing to know better how to get optimal lab values (versus normal lab values).
In most cases, subclinical hypothyroidism is simply Hashimoto’s disease that has not yet been diagnosed. In the scenario of someone having symptoms, but normal TSH and normal free hormones, they may:
- Have higher thyroid antibodies
- Have a TSH that is not optimal
- Have free T3 that is not optimal
- Have an enlarged thyroid
- Have some nodules present on their thyroid
In these cases, we can definitely see how subclinical hypothyroidism may well just be Hashimoto’s disease that has not yet been picked up on yet.
Expand Your Understanding
Have you been told that you have subclinical hypothyroidism, or have you been told that you do not? Whether or not you have, it always benefits us to learn more about the status of our thyroid and how we can ensure that it is fully-functioning and helping our health.
We talked today about subclinical hypothyroidism, and how it is often simply a case of Hashimoto’s disease that has not yet been diagnosed. If you are at all worried about this, take the Thyroid Quiz (5) today. No matter where you fall, it can help give you a better understanding of your health today.
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, cure diabetes, and regain energy. Learn more about the surprising story that started his quest.