Early or Subclinical Hypothyroidism

Dive into the nuances of early or subclinical hypothyroidism, where symptoms may persist despite conventional lab tests showing ‘normal’ TSH levels. Uncover the seven patterns of hypothyroidism often missed by standard diagnostics, leaving many without effective relief from traditional treatments. Learn how functional medicine provides a holistic approach, examining narrower health ranges to tackle underlying causes. Find guidance and support for those navigating the complexities of thyroid health in the ‘gray area’.

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 HyrSelf Functional Medicine 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.”
@thedrdave

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.

HYPOTHYROIDISM

Hypothyroidism occurs when thyroxine (T4) levels drop so low that body processes begin to slow down. Hypothyroidism was first diagnosed in the late nineteenth century when doctors observed that surgical removal of the thyroid resulted in the swelling of the hands, face, feet, and tissues around the eyes. They named this syndrome myxedema and correctly concluded that it was the outcome of the absence of substances, thyroid hormones, normally produced by the thyroid gland. Hypothyroidism is usually progressive and irreversible. Treatment, however, is nearly always completely successful and allows a patient to live a fully normal life.

Subclinical, or mild, hypothyroidism

Subclinical, or mild, hypothyroidism (mildly underactive thyroid), also called early-stage hypothyroidism, is a condition in which thyrotropin (TSH) levels have started to increase in response to an early decline in T4 levels in the thyroid. However, blood tests for T4 are still normal. The patient may have mild symptoms (usually slight fatigue) or none at all. Mildly underactive thyroid is very common (affecting about 10 million Americans) and is a topic of considerable debate among professionals because it is not clear how to manage this condition.

Mildly underactive thyroid does not progress to the full-blown disorder in most people. Each year, about 2 – 5% of people with subclinical thyroid go on to develop overt hypothyroidism. Other factors associated with a higher risk of developing clinical hypothyroidism include being an older woman (up to 20% of women over age 60 have subclinical hypothyroidism), having a goiter (enlarged thyroid gland) or thyroid antibodies, or harboring immune factors that suggest an autoimmune condition.

In early hypothyroidism, the level of thyroid hormones (T3 and T4) may be normal. Additionally, it may be necessary to also measure reverse T3. In those making antibodies to thyroperoxidase, thyroid function may appear normal because of compensation of the impaired glandular output. An abnormal serum TSH level, with normal T3 or T4 may be indicative of a subclinical thyroid dysfunction. Subclinical hypothyroidism is found in 16% of the population and is more prevalent in elderly women. Hypothyroidism and metabolic disorders like insulin resistance have an inverse relationship of which came first. Depends upon three different perspectives of thyroid comes first, pancreas (insulin resistance) comes first or look at lab results and treat what shows most predominantly.

Early and Subclinical Hypothyroid Symptoms

Early Symptoms.

Early symptoms of hypothyroidism are subtle and, in older people, can be easily mistaken for symptoms of stress or aging. They include:

Chronic fatigue
Difficulty concentrating
Sensitivity to cold
Headache
Muscle and joint aches
Weight gain, despite diminished appetite
Constipation
Dry skin
Early puberty
Menstrual irregularities (either heavier-than-normal or lighter-than-normal bleeding)
Milky discharge from the breasts (galactorrhea)

Later Symptoms.

As free thyroxine levels fall over the following months, other symptoms may develop:

Impaired mental activity, including problems with concentration and memory, particularly in the elderly.
Depression. Some doctors believe that even mild thyroid failure may increase susceptibility to major depression.
Muscle weakness, numbness, pain, and cramps. This can cause an unsteady gait. Muscle cramps are common, and carpal tunnel syndrome or symptoms similar to arthritis sometimes develop. In some cases, the arms and legs may feel numb.
Numbness in the fingers.
Hearing loss.
Husky voice.
Continuing weight gain and possible obesity, in spite of low appetite.
Some people experience less sweating, and their skin becomes pale.
Skin and hair changes. Skin becomes pale, rough, and dry. Patients may sweat less. Hair coarsens and even falls out. Nails become brittle.
Snoring and obstructive sleep apnea (a condition in which in the soft palate in the throat collapses at intervals during sleep, thereby blocking the passage of air).

	Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal
	Hypothyroidism	Abdominal Brain				Oral Infection
	Hypothyroidism	Insulin Resistance	Ischemic Penumbrae (HPT axis)	Hormone Imbalance	NEI Supersystem Imbalance	Oral Infection
Weakness, lethargy, fatigue	✔️	✔️	✔️	✔️	✔️	✔️
Dry skin	✔️		✔️	✔️	✔️	✔️
Coarse hair	✔️	✔️	✔️	✔️	✔️	✔️
Cold Intolerance	✔️		✔️	✔️	✔️
Constipation	✔️	✔️	✔️		✔️	✔️
Weight gain	✔️	✔️		✔️	✔️	✔️
Muscle cramps	✔️	✔️	✔️		✔️
Edema of eyelids, face, legs (non-pitting)	✔️		✔️	✔️	✔️	✔️
Hoarseness	✔️				✔️	✔️
Hearing Loss	✔️				✔️	✔️
Menorrhagia	✔️	✔️	✔️	✔️	✔️	✔️
Slow reflexes	✔️	✔️	✔️		✔️
Fast Heart Beat	✔️	✔️	✔️	✔️	✔️	✔️
High cholesterol	✔️	✔️		✔️	✔️
	Thyroid Markers are out of range	Normal Thyroid Lab Tests
If the only focus is on the Thyroid. Then all health problems will appear to caused by the thyroid.

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.