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Hypothyroidism typically refers to an underactive thyroid gland. This means that the thyroid gland is not producing adequate amounts of thyroid hormone. Typically, to diagnose hypothyroidism, we look at several lab values to get an overall sense of the function of your thyroid gland. If we find an imbalance, it is important to look at why the thyroid may be imbalanced. Sometimes there are signs of an autoimmune condition called Hashimoto’s thyroiditis. Sometimes the thyroid can be low functioning due to nutrient deficiencies such as zinc, iodine and selenium. Sometimes the thyroid can be low functioning due to chronic inflammation, adrenal dysfunctions (stress hormones) and even low calorie diets. Sometimes it is very important to use thyroid hormone replacement and sometimes it is best to just support thyroid hormone production. Like everything else, our treatment plan is personalized and we utilized shared decision making to make the best decision we can for treatment.
Sub-clinical Hypothyroidism is defined by a slightly elevated TSH (Thyroid Stimulating Hormone) and normal T4 / T3 levels. To treat this or not to treat this is controversial. In the United States where iodine deficiency is less prevalent, the most common cause of sub-clinical hypothyroid lab findings is Hashimoto’s Thyroiditis, an autoimmune condition.
The TSH “cut-off” for treatment of subclinical hypothyroidism is felt to be a TSH of 10. If TSH is greater than 10, treatment is recommended. Treatment is also recommended for sub-clinical hypothyroidism if there are symptoms present consistent with hypothyroidism. Some of these symptoms can be vague but classically are fatigue, constipation, weight gain and temperature instability, feeling cold all the time. It is also recommended that pregnant patients and those struggling with fertility are also treated when sub-clinical hypothyroidism is present.
At Sparkle Health, we often will pay attention to sub-clinical hypothyroidism and the subtle symptoms that patients may be having to consider treatment. Treatment conventionally is thyroid hormone replacement and certainly this is a consideration. When anti-bodies for autoimmunity with Hashimoto’s is present, we are more likely to move toward direct hormone replacement if the symptoms are in alignment. When antibodies are not present, often we will try to support thyroid hormone production by looking at other influencing hormones (such as adrenal function) and micronutrients which can affect thyroid hormone production. Issues related to diet and metabolism also may be playing a role. The goal is always to look at underlying cause while factoring in quality of life and other associated medical problems that could be affected by treatment with thyroid hormone replacement.
In the case of sub-clinical hypothyroidism, there are a few large studies that show higher cardiovascular risk in patients with untreated sub-clinical hypothyroidism. There is also some association of mild cognitive impairment as well as mood disorders with untreated subclinical hypothyroidism. Therefore, it is important to weigh risk of other medical problems as well as symptomatology when deciding to treat sub-clinical hypothyroidism. Functional medicine is personalized medicine. As in other controversial areas, it comes down to shared decision making and a risk vs benefit discussion.
References:
Subclinical hypothyroidism: Should we treat?
Redford C, Vaidya B.Post Reprod Health. 2017 Jun;23(2):55-62.
Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A.Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):55-59.
Subclinical Hypothyroidism and Cognitive Impairment: Systematic Review and Meta-Analysis.
Pasqualetti G, Pagano G, Rengo G, Ferrara N, Monzani F.J Clin Endocrinol Metab. 2015 Nov;100(11):4240-8. doi: 10.1210/jc.2015-2046. Epub 2015 Aug 25.
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