Published May 13 2013
Subclinical hypothyroidism is diagnosed when the thyroid hormone levels are within the normal limits but the TSH levels are elevated. This condition occurs in 3% to 8% of the general population, and most of the time the TSH is less than 10.0 mIU/L, although in about 20% of people the TSH will be higher than this (1). Either way, many people with subclinical hypothyroidism will eventually have their condition progress to overt hypothyroidism, where the thyroid hormone levels will become depressed. The goal of this article will talk about some of the causes of this condition and whether people with subclinical hypothyroidism can benefit from following a natural treatment protocol.
What Causes Subclinical Hypothyroidism?
There are numerous factors which can cause subclinical hypothyroidism. Weakened adrenals, problems with the HP-Axis, taking high doses of iodine, receiving radioactive iodine treatment or thyroid surgery, along with postpartum granulomatous thyroiditis (1). But the most common cause of subclinical hypothyroidism is an autoimmune component (1). In other words, elevated thyroid antibodies will typically be the cause behind the elevated TSH. The thyroid antibodies typically associated with hypothyroid conditions are thyroperoxidase (TPO) antibodies, and thyroglobulin antibodies.
But why would the thyroid hormone levels be normal in the presence of thyroid antibodies? Well, what happens is that the thyroid antibodies attack the thyroid gland, causing damage, and over time this results in a decrease of thyroid hormone levels. However, it can take months, and sometimes even years before enough destruction of the thyroid gland occurs, and thus for the thyroid hormone levels to show up as being depressed. But why then is the TSH out of range? Remember that TSH is a pituitary hormone, and if the thyroid hormone levels are decreasing then greater amounts of TSH will be released. So in subclinical hypothyroidism that is caused by high thyroid antibodies, the body will do a pretty good job of adapting for months or years, and part of the reason why the thyroid hormone levels will look fine is because the higher TSH levels will signal the body to manufacture more thyroid hormone. And it usually can keep this up for quite awhile.
The first thing any medical doctor should do when they see an elevated TSH is test for the thyroid antibodies thyroperoxidase (TPO) and thyroglobulin. Many times a person’s primary care physician will detect the elevated TSH when doing a routine blood test, and will refer the patient to an endocrinologist for further testing. Either way, one wants to test for these thyroid antibodies to see if they are elevated. If they are not elevated then this doesn’t necessarily rule out Hashimoto’s Thyroiditis, as the antibodies can fluctuate. As a result, if the TSH remains high it will be a good idea to retest the thyroid antibodies in the future. But if the TSH is elevated and the thyroid antibodies remain normal after testing them multiple times then other causes need to be looked into.
When the cause isn’t autoimmune in nature, it sometimes can be challenging to determine what is responsible for the elevated TSH. For example, if someone has an imbalance of their adrenal glands, then this potentially can cause or contribute to subclinical hypothyroidism. However, there is also the chance that adrenal gland problems will be an incidental finding, and might not be related to the elevated TSH. If a problem such as hypocortisolism exists, then this should be corrected prior to initiating thyroid hormone replacement (2). Despite this, very few medical doctors evaluate the adrenal glands before recommending thyroid hormone to their patients.
How Can Subclinical Hypothyroidism Be Treated?
Some medical doctors won’t recommended synthetic thyroid hormone to their patients with subclinical hypothyroidism, while others will. If the TSH is very high then most medical doctors will recommend for the patient to take thyroid hormone, even if the thyroid hormone levels are within the normal limits. Some medical doctors will recommend thyroid hormone even when the TSH is only slightly elevated.
Many people with subclinical hypothyroidism can benefit from natural treatment methods. After all, the goal of a natural treatment protocol is to attempt to detect, and then correct the underlying cause of the condition. On the other hand, there are essentially one of two approaches with subclinical hypothyroidism when it comes to conventional treatment methods. One approach some medical doctors will take is the “wait and see” approach. In other words, if the TSH is elevated but is less than 10 mIU/L, then they might just wait until the thyroid hormone levels become depressed before doing anything. And of course if they do become depressed the treatment method most likely to be given will be synthetic thyroid hormone.
The second approach is to immediately give the person synthetic thyroid hormone. So essentially the first approach is to wait and see if the person will eventually need to take the medication, while the second approach will be to immediately give the person the medication. As I’ve stated in previous articles and blog posts, I’m not opposed to people taking synthetic or natural thyroid hormone, as I realize that in some cases this is necessary. On the other hand, my goal is to do everything possible to restore the health of the thyroid gland, along with other compromised areas of the body so that hopefully the person won’t need to take thyroid hormone for the rest of the person’s life.
And in my opinion it is even crazier to tell a person with subclinical hypothyroidism to take thyroid hormone for the rest of their life without addressing the cause. For example, with an autoimmune thyroid condition, the thyroid gland itself isn’t the root cause of the problem. The problem is with the immune system, and if one can detect and remove the factor that is triggering the autoimmune response, and stop the process of the thyroid antibodies attacking and destroying the thyroid gland, then it is possible that the person won’t need to take thyroid hormone on a permanent basis. Of course the problem is that most medical doctors aren’t trained to detect and correct the cause of the problem, although there are some medical doctors who do realize that there are actual causes of these conditions.
Does this mean that those with subclinical hypothyroidism shouldn’t take thyroid hormone? I’m not suggesting that people with subclinical hypothyroidism shouldn’t take thyroid hormone. Even though I think it’s a good idea to detect and correct the cause of the problem when possible, everything all comes down to risks vs. benefits. And so in some cases people with subclinical hypothyroidism need to take thyroid hormone. For example, studies show that “prompt treatment of subclinical hypothyroidism in pregnant women is mandatory to decrease risks for pregnancy complications and impaired cognitive development in the offspring (3) (4). Studies also show that children with subclinical hypothyroidism should be treated to prevent growth retardation (3). In cases like these it might be a good idea for the person to take thyroid hormone, and many other people with subclinical hypothyroidism may also need to take thyroid hormone, but even when this is the case the cause of the condition should still be addressed.
In summary, many people with subclinical hypothyroidism will eventually develop overt hypothyroidism. Although there can be numerous causes behind this condition, in most people the reason behind the elevated TSH is due to an autoimmune component. And while most medical doctors will either take a “wait and see” approach, or will immediately prescribe synthetic thyroid hormone, the ultimate goal should be to detect and correct the cause of the condition, and try to restore the health of the person so that hopefully they won’t need to take thyroid hormone on a permanent basis.