Subclinical Hypothyroidism – An overview
What is subclinical hypothyroidism
Subclinical hypothyroidism is one of the endocrine disorders that are diagnosed by the presence of higher value of serum thyroid – stimulating hormone (TSH).
The value remains on a higher node irrespective of normal levels of serum free thyroxine. The medical condition where the cause of abnormal level is idiopathic is often described as subclinical hypothyroidism.
The TSH level present in serum has found to be linearly associated with the circulating thyroid hormone levels in the body.
It has been documented that a 2 fold change in free thyroxine is capable of producing around 100 fold change in TSH level. These inter linkage between free thyroxine and TSH helps in diagnosing the disease.
Serum TSH measurement is one of the mandatory laboratory diagnostic test that helps in ma
king a clinical interpretation of mild thyroid failure.
This test holds a good record to make a concluded diagnosis of subclinical hypothyroidism, in cases where peripheral thyroid hormone levels are within the normal laboratory values.
Subclinical hypothyroidism has a higher rate of prevalence among the normal population and is known to be occurring in 3 % to 8% of unknown thyroid disease.
With the growing of age, the probability of having subclinical hypothyroidism gets higher. The gender distribution of subclinical hypothyroidism is also greater in females as compare to male population.
The occurrence of thyroid insufficiency can be analyzed on the basis of the symptoms and the hormonal level in the serum. Biochemically, the term could be associated with the elevated level of serum Thyrotropin level in combination with a serum free T4 level.
It could be diagnosed on the basis of a relevant medical history or physical examination, done under the supervision of medical practitioner. However, the confirmation of subclinical hypothyroidism is based upon the results of laboratory tests done.
Subclinical Hypothyroidism Causes
The onset of disease is marked by the presence of many of the physiological alterations. These alterations are connected in bringing the higher level of the TSH level in the serum. Few of the major alterations that cause disturbance in the level of thyroid are briefed as:
- Presence of Auto- immune thyroid disease: It has been seen that the individual who has a positive family history of autoimmune thyroid disease, is most likely to suffer from thyroid insufficiency.
- The probability of being diagnosed with subclinical hypothyroidism is certainly high in those cases.
- Followed by a thyroid injury: The anatomical disturbance in the formation of thyroid gland can also provoke the symptoms of improper functioning of thyroid secretions. The external injury on thyroid gland can also produce undesirable levels of serum TSH in body.
- Thyroid surgery: In cases, where partial thyroidectomy is performed, the risk of getting exposure to thyroid insufficiency is certainly high. It occurs because as a response to the surgery, the secretion level of hormones gets disturbed and might end up resulting in the secretion of high level of TSH in serum.
- Radioactive Iodine Therapy: The other clinical cause that could be responsible to induce insufficient amount of thyroid in an individual could be because of a high level of exposure to the radioactive iodine therapy. These therapies are linked to bring clinical changes in case of thyroid nodules inside the thyroid gland.
- Intake of specific thyroid impairment drugs: In few conditions, drugs which contain iodine or iodine like component are found to be connected in introducing the abnormal functioning of thyroid in an individual.
These drugs carry out a strong pharmacological reaction inside the body and are known to produce impaired effects on the thyroid production. This alteration might start the onset of thyroid disturbance in an individual.
- 7. Presence of pituitary tumors: The presence of pituitary tumors is also responsible for initiating symptoms of thyroid imbalance. The tumor like growth inside the gland creates malfunctioning of the pituitary gland. This chemical alteration may result in increasing the TSH levels in the serum. Hence creating the symptoms of thyroid imbalance.
8. Genetic disorders: In rare of the cases, the presence of genetic disorders such as TSH receptor gene mutations, improper functioning of thyroid gland might occur. The alterations in the genetic make- up of the genes could result in the disturbance of TSH level in the blood.
Above discussed causes are few of the major known causes that are connected with the onset of thyroid improper functioning.
Subclinical Hypothyroidism symptoms
The presence of subclinical hypothyroidism is often confirmed by the results of laboratory tests and are followed by certain symptoms that makes the occurrence of disease, more certain. Following are the symptoms of subclinical hypothyroidism that are often documented in a major population/
- TSH level: The certainty of the disease is often based on the higher levels of TSH in serum.
- Depression and fatigue: The mental and physical disturbance of the body is associated with the onset of subclinical hypothyroidism in an individual. The patient often complaints of outbursts of frequent fatigue episodes, followed by a series of mood swings, that could result in severe depression.
- Hyperlipidaemia and Hyperhomocysteinaemia: The alteration in the level of cholesterols and abnormal raised up homocysteine in blood occurs due to the presence of subclinical hypothyroidism.
- Goiter: The raised levels of Serum TSH could also result in the occurrence of Goiter in an individual. It is associated with the enlargement of thyroid gland inside the body.
- Coarse Hair: The other symptom of subclinical hypothyroidism is the change in the texture of hair. The texture of hair shifts to be hard, rough and frizzy with the presence of subclinical hypothyroidism.
- Cold intolerance: The individuals who are suffering from subclinical hypothyroidism become totally intolerant to the exposure of cold environment. They have an increased sensitivity to the colder atmosphere.
- Constipation and weight loss: Another symptom of subclinical hypothyroidism is the regular bowel disturbance that is termed as constipation. The disturbed metabolic activity inside the body often results in excessive and abnormal weight gain.
- Mennorrhagia: Subclinical hypothyroidism often creates impact on the menstrual cycle of women. The disturbance further results in heavy and prolonged menstrual cycle in the patients.
- Slow reflexes: The deep and superficial joint reflexes get reduced with the presence of subclinical hypothyroidism.
- Bradycardia: The lowering down of the normal heart rate is known as Bradycardia. The episodes of Bradycardia are often connected to the occurrence of subclinical hypothyroidism.
- Coronary artery disease or cardiac risk factors: In many of the cases, the risk of getting harmful impact on the coronary arteries as well as cardiovascular system is often higher in patients suffering from subclinical hypothyroidism.
- Increased cholesterol levels: The raised levels of cholesterol are likely to be documented in subclinical hypothyroidism. It occurs due to imbalance of thyroid level in serum.
- Memory loss: If the symptoms of subclinical hypothyroidism are not corrected for a longer time, there are chances to get memory impairment.
- Excessive Sleep: It is also associated with the advance stage of subclinical hypothyroidism.
- Muscle cramps: The disturbance n hormonal level may act on the muscular fragmentation and could result in episodes of regular cramps. These cramps are seen more frequent in individuals who are at the higher level of subclinical hypothyroidism.
Subclinical Hypothyroidism symptoms checklist
Thyroid level has a direct and deep relation with the metabolic activities of your body. To evaluate yourself or an individual to know about the presence of subclinical hypothyroidism, below is the checklist. This checklist helps in supporting the fact of occurrence or absence of subclinical hypothyroidism.
- Is your facial skin becoming thinner?
- Having troubled sleep or altered sleep patterns?
- Getting exhausted and fatigue with minimal or no activity?
- Experiencing muscular weakness, especially in upper arm and thighs?
- Sleep duration is getting extended from 8 hours of sound sleep?
- Always looking for afternoon nap to relax yourself?
- Becoming intolerant to light exercises also?
- Troubled with less stamina or energy as compared to other peer group?
- Texture of hair becoming rough, coarse, dry and easy to brittle?
- Is your skin texture getting dry, scaly and thin?
- Is there any thinning in the eyebrows?
- Are you getting regular burst of constipation or hard stools?
- Are you becoming intolerant to cold environment?
- Are you having frequent breakouts of acne?
- Are you suffering from disturbed menstrual cycle?
- Are you getting numbness or tingling in your hands or fingers?
- Are you having regular muscular or joint aches?
- Are you having trouble in conceiving?
- Have you gone through one or more miscarriages?
- Are you feeling depressed, restless and anxious?
- Are you getting frequent puffing around your eyes and face?
- Are you getting frequent mood swings?
- Are you having trouble in recollecting the small things?
- Are your eyes getting dry?
- Are you suffering from frequent hair fall?
- Are you losing interest in performing daily chores?
- Are you becoming prone to infections?
- Are you having hoarse voice?
- Are you suffering from frequent menstrual cramps?
- Is dizziness accompanied by lightheadedness or frequent headaches?
This checklist will help you in getting a quick and brief evaluation of your condition or could help you to know, are you suffering from subclinical hypothyroidism or not!
Subclinical Hypothyroidism and Pregnancy
Pregnancy is one of the most beautiful phases of a women life. During this phase, she goes through a lot of hormonal as well as physical changes. Some of the changes are desired as well as some hormonal imbalances can raise an alarm to the health safety of the mother and the child.
Thyroid insufficiency or subclinical hypothyroidism is a very common hormonal disorder that occurs during the gestational phase of them other. The raised serum TSH level is a matter of concern and should be addressed to the gynecologist as soon as possible.
If we talk about the impending risk of thyroid imbalance in pregnancy, then one of the major risks is getting premature delivery of the baby.
One of the leading research paper on subclinical hypothyroidism and pregnancy states that, the probability of getting risk in pregnancy is fairly low as compare to other thyroid associated problems.
The chances of getting premature delivery are more than 50 % in case of subclinical hypothyroidism. This occurs because of higher level of TSH hormone in the last trimester of pregnancy.
But in few of the subclinical hypothyroidism cases, the associated risks are higher than premature delivery and should be treated under the strict observation of the health care practitioner.
The accumulated data focus on the point that the TPO antibody should be taken in account before deciding the treatment of the patient. In cases, when TPO is negative, the treatment is not recommended.
During pregnancy, the precise level of thyroid is necessary to ensure that proper development of fetus is done. In subclinical hypothyroidism, there is a low level of free thyroxine in the body.
It has been found that the level of free thyroxine is associated with the IQ level of the newborn baby. It is suggested that expected mother should go through a thorough evaluation of her condition to ensure the proper physical as well as mental growth of the child.
Henceforth, the presence of subclinical hypothyroidism is at a low risk in case of pregnancy. But one must get a proper consultation and should take medicines, if required.
Subclinical Hypothyroidism TSH Levels
Subclinical hypothyroidism as mentioned above is organically diagnosed by the help of measurement of TSH Level in the serum. If the TSH level is raised, it indicates the presence of subclinical hypothyroidism. The TSH level follows the algorithm relationship with the level of serum thyroxine.
For example, if the level of thyroxine in Serum gets doubled up from the normal value then the TSH level will be raised by hundred times. The diagnostic test done to study the level of TSH is considered as more sensitive test as compared to any other diagnostic test to study thyroid.
The reference ranges taken to define the level of hormones are taken by accumulating the maximum range of more than 95 % of population. However, the precise upper limit of TSH is still debatable. Below are the levels of TSH in subclinical hypothyroidism that should be treated through medications.
- Patients with subclinical hypothyroidism having TSH level > 10 should be treated.
- Subclinical hypothyroidism if gets diagnoses in pregnancy, should be treated.
- The symptomatic treatment should be offered in subclinical hypothyroidism in cases where serum TSH is <10 mlU/L.
These figures supports the fact that subclinical hypothyroidism should be treated with the help of proper medication course to get relief from the associated symptoms of the disease.
The elevated level of serum TSH should be lowered down to the normal value in case of subclinical hypothyroidism. It is done to ensure proper regulation of different processes inside the body should be carried out.
Prevention of subclinical hypothyroidism
It is a very meaningful proverb that states that “Prevention is better than cure.”Even in the case of subclinical hypothyroidism, important steps and care should be taken to ensure that the onset of the disease could be stopped.
In case the disease starts getting progress inside the body, regulatory steps should be taken to minimize the damage caused by symptoms of subclinical hypothyroidism.
- With the growing age, the probability of getting exposure to subclinical hypothyroidism gets high. The risk is always higher in female population. It is advisable to get a regulatory check up to rule out the presence of symptoms of subclinical hypothyroidism.
- In families, where there is a positive history of thyroid disorder, are most likely to have subclinical hypothyroidism. Individuals should get a regular check up for their thyroid level.
- If there is any previous history of thyroid injury or metabolic disturbance, the chances to get subclinical hypothyroidism gets high. Individuals, who have such records, should take extra precaution in their diet and eating habits to avoid subclinical hypothyroidism.
- Subclinical hypothyroidism is often associated with other sedentary diseases such as diabetes, vitiligo, leukotricihia, pernicious anemia. People should be well aware of the onset of symptoms of subclinical hypothyroidism and should get it corrected in the earlier stages only.
- Iodine deficiency causes the disturbance in hormonal balance and could introduce subclinical hypothyroidism. One should take regular and sufficient amount of iodine in his diet to prevent subclinical hypothyroidism.
- Few of the drug interactions are also responsible with the onset of subclinical hypothyroidism. Medicines such as interferon alfa, lithium and amiodarone should be taken in controlled manner to avoid subclinical hypothyroidism.
However, disease such as Hashimoto’s thyroiditis could not be prevented. These diseases are often associated with the symptoms of subclinical hypothyroidism.
The prevention of disease is often done by observing the onset and course of subclinical hypothyroidism. It helps in getting on time treatment to correct the underlying symptoms.
Subclinical Hypothyroidism diet
Dietary components are influential in creating impactful effects in the level of thyroid inside the body. The degree of metabolic activities carried out in a body are connected with thyroid insufficiency and can result in metabolic changes such as weight loss, poor appetite, weight gain and many more.
The lack of thyroid hormone leads to lowering down the usage of carbohydrates, protein and fat inside the body. The slower rate of metabolism results in moderate weight gain in individuals, who are suffering from imbalance of thyroid hormone.
The condition could be corrected with the addition of controlled diet. The diet is planned in order to keep focus on the alleviation of stress on thyroid gland. The other target is to correct the underlying symptoms of subclinical hypothyroidism.
There are various Dos and Don’ts that could be helpful in relieving the symptoms of subclinical hypothyroidism.
- Eliminate Gluten from your diet: This is very important component that should be prohibited strictly in your diet. This is so because the individual who suffers from subclinical hypothyroidism faces difficulties in digesting the gluten.
Gluten is a protein that is found in abundant quantity in wheat, kamut, rye and couscous. It has been documented that the prognosis of subclinical hypothyroidism is better in individuals who are on gluten – free diet.
- Add more Iodine intake in your diet: To treat subclinical hypothyroidism, iodine rich diet is beneficial. Organic eggs, sea vegetables are rich source of iodine.
The insufficient dose of iodine may provoke the symptoms of subclinical hypothyroidism. Higher the intake of iodine, higher will be the metabolic activities in the body.
- Food rich in Omega -3: Essential fatty acids help in regulating the proper functions of thyroid. Food sources rich in omega -3 such as grounded flaxseed, flaxseed oil, chia seeds, hemp seeds, wild – caught fatty fish like salmon, tuna should be included in the diet of subclinical hypothyroidism to reduce the symptoms.
- Sea Vegetables: Sea vegetables such as nori, kelp, dulse, hijiki, arame, kombu are a rich source of iodine and are helpful in lowering down the symptoms of subclinical hypothyroidism.
- Nuts: Nuts are a rich source of selenium. Selenium helps in maintaining the level of T4 & TSH in body. In subclinical hypothyroidism, selenium rich food helps in conversion of T4 into active T3.
- Probiotic rich –foods: Probiotic rich food helps in maintaining the internal functioning of intestine. It helps in maintaining the balance of gut bacteria. Food such as kimchi, natto, miso, kombucha are rich in probiotic and are useful in helping thyroid to function normally in subclinical hypothyroidism.
- Anti- oxidants rich fruits and vegetables: The subclinical hypothyroidism prevention diet should be full of plenty of fruits and vegetables. The food, rich in anti-oxidant helps in increasing the digestive properties and are good for overall health of heart and blood sugar levels.
If an individual includes the above described food items in his diet, then the chances to prevent subclinical hypothyroidism become certainly high. Similarly, there is a list of food items that should be strictly avoided to prevent the subclinical hypothyroidism
- Sugar and refined flour products: Sugar has an active role in creating imbalance in the hormonal level. In subclinical hypothyroidism, regular intake of sugar can increase the intensity of the symptoms.
Similarly, the intake of refined flour products can enhance unwanted hormonal disturbance in subclinical hypothyroidism. It should be kept in low amount in the diet.
- Dairy products: The diary products are capable of triggering the inflammatory process in the body. Subclinical hypothyroidism has already been triggered with the high inflammatory reactions.
It is advisable to minimize the intake of dairy products in the diet of an individual suffering from imbalance of thyroid level.
- Tap water: Tap water contains fluorine and chlorine in it. These chemicals might interfere with the easy absorption of iodine in thyroid insufficiency.
- Soy products: Products such as soybeans contains isoflavones in it. They might interfere with the production of thyroid hormone in an individual.
It has been suggested that in subclinical hypothyroidism, the intake of soy products should be restricted.
- Brassica vegetables: These vegetables contain high level of goitrogens in them, which are responsible in suppressing the normal function of thyroid.
In individuals already suffering from subclinical hypothyroidism, the normal function of thyroid is already disturbed. It has been advised to restrict brassica vegetables form the diet
Subclinical Hypothyroidism treatment
There has been a lot of debate over the treatment part of subclinical hypothyroidism. Many of the physicians believe that the correction of the disease should be done at the earlier stage where as few have an opinion to observe for the symptoms of subclinical hypothyroidism.
It has been found that many of the physicians have an ignorant attitude towards the symptom of subclinical hypothyroidism and they often misunderstood them with the age related changes in an individual.
For example, fatigue is a generic symptom that is found in many of the subclinical hypothyroidism patients and is often misdiagnosed with growing age.
The treatment part of subclinical hypothyroidism may vary from individual to individual, depending upon the level and nature of the associated symptoms.
- Hormonal Therapy: The introduction of external hormones may help in slowing down the progression of disease in an individual. More than 90 % of subclinical hypothyroidism in early age is because of the presence of autoimmune disorders.
The exposure to hormones in the early stages might be a relief for the patients suffering from the symptoms.
- Synthetic Thyroid hormone: In cases where thyroid level is within normal limits but the individual is suffering from subclinical hypothyroidism, many of the doctors often prescribed synthetic thyroid hormone. The protocol behind the introduction of thyroid hormone is to find out the root cause of the disease.
Once the root cause of subclinical hypothyroidism is understood, the focus of the conservative treatment shifts towards correcting it.
- Wait and watch: This protocol is often followed to know the intensity of the symptoms associated with subclinical hypothyroidism.
The above mentioned treatment options are being picked up by the consultant to correct subclinical hypothyroidism. The decision is often dependent upon the symptoms and intensity of subclinical hypothyroidism.
Subclinical Hypothyroidism natural treatment
The natural treatment of subclinical hypothyroidism is redirected to rectify the symptoms. The treatment is focused to assist the healing of thyroid. Though the treatment span is a little high but definitive results could be obtained with a little patience and intake of proper intake of natural medicines.
- Eliminate Soy: Soy is responsible for suppression of thyroid functions and can create a major imbalance of hormones. Eliminating the component of soy could be helpful in accelerating the treatment of subclinical hypothyroidism.
- Adhere to alkaline diet: Alkaline diet can boost the correction and healing of the symptoms of subclinical hypothyroidism. One should take high alkaline diet to avoid the progression of subclinical hypothyroidism.
- Balance estrogen levels: It is important to maintain the estrogen level in the body. The presence of excessive estrogen level might hinder the production of thyroid hormone. It is advisable to always keep a look on the level of estrogen.
- Exercise: Exercise is one of the most convenient ways to keep your body metabolic activities in control. Regular exercise could help in lowering down the metabolic activities inside the body.
- Hemp fiber: It is a broad spectrum supplement and is a mild laxative that could help in lowering down the aggravating symptoms of subclinical hypothyroidism.
- L- tyrosine: Tyrosine is a natural amino acid that is responsible for inducing own thyroid inside the body. It helps in dealing with the depression, an important symptom of subclinical hypothyroidism.
It should be taken in 2 -3 times in a day.
- L – Arginine: Arginine is known to stimulate the thyroid gland and the release of the hormones. It helps in improving the overall immune functions, improve fertility.
This will help in treating the symptomatic effects of subclinical hypothyroidism.
- Iodine: The intake of thyroid in a proper amount could help in correcting many symptomatic reactions of iodine deficiency in an individual.
- Chlorophyll: The supplementing of chlorophyll will help in offering an accurate amount of copper in the body. It helps in building the red blood cells and helps in high immunity system in patients suffering from subclinical hypothyroidism.
- Pears and apples: Pears and apples are known to balance hormones in an accurate level. Intake of sufficient amount of pears and apples will help in correcting the symptoms of the associated disease.
- Coconut oil: The intake of coconut oil helps in maintaining the hormonal level of the individuals suffering from subclinical hypothyroidism.
- Avoid Canola oil: The oil is known to interfere with the production of thyroid hormones. It is advised to make sure; one must have canola –free diet.
Subclinical hypothyroidism guidelines
The main focus of the treatment is to make sure reversal of clinical progression of the disease is achieved. The metabolic derangement of TSH and free thyroxine is targeted to be corrected on the priority basis.
Thyroid hormone is supplemented to match the imbalance of both the hormones. It could be achieved by providing the regular dose of Levothyroxine (LT4).
In young and healthy patients, full replacement doses of thyroid hormone are advised. In cases of elderly patients, ¼ of the expected level of thyroid hormone is being prescribed as initial treatment.
This is done to avoid any stress or load on cardiovascular system of them. After 4-6 months, the level of dosage could be increased. Clinical benefits starts within 3-5 days of administration of medicine. Once the dosage is stabilized, another important guideline is to regular monitor the signs and symptoms.
Few of the symptoms might indicate the excess of thyroid hormone in the body and it should be treated immediately.
Here are few of the treatment guidelines that should be kept in mind, while treating subclinical hypothyroidism.
- In cases where high dosage of Levothyroxine is recommended, always check for associated gastrointestinal disorders. It has been found that these disorders are also responsible for causing imbalance in thyroid level.
- Initiation as well as discontinuation of external hormones should be dome in respect with the laboratory values of Serum TSH.
- Serum TSH should be reassessed to evaluate the exact level of hormone, in case of ongoing treatment.
- Prior to the start of dose of levothyroixne, patient’s weight, lean body, mass, pregnancy status and other vital functions should be kept in mind.
- The guideline to use thyroid replacement therapy is to either start the full treatment or the dose might be started in partial levels. The main focus is to balance serum TSH level.
- Reference serum TSH level is higher in older population. The diagnostic value of serum TSH should be targeted in appropriate level.
- TSH assessment should be done within 4-6 weeks after the change of dosage.