Frequently Asked Questions About Subclinical Hypothyroidism
An Exploration of Low-Level, Subtle and Borderline Underactive Thyroid
"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."How Common is Subclinical Hypothyroidism?
Using the TSH of 5 as a bottom cutoff, it's estimated that on average, approximtely 8 percent of women, and 4 percent of men are subclinically hypothyroid. The prevalence is much higher with age, and 15 percent of women over the age of 60 and 8 percent of men are subclinically hypothyroid.
Given the AACE's belief that TSH over 3 may be suspect, the number of people who may be subclinically hypothyroid is likely to be far greater than currently thought.
What are the Risks for and Symptoms of Subclinical Hypothyroidism
The risks for and symptoms of subclinical hypothyroidism are the same as for regular hypothyroidism.
What Are the Risks of Not Treating Subclinical Hypothyroidism?
The risks of untreated subclinical hypothyroidism include:
Should Subclinical Hypothyroidism be Treated?
Most practitioners believe that most patients with subclinical hypothyroidism should be treated, because treatment can prevent further worsening of the hypothyroidism and further elevation of the TSH, may prevent growth of a goiter, and may help eliminate symptoms.
According to Robert D. Utiger, M.D., writing in "Health News," from the New England Journal of Medicine:
For people with subclinical hypothyroidism who have no symptoms, some clinicians believe that treatment is not needed unless, or until, symptoms or signs of hypothyroidism appear. Others argue that even people free from symptoms should start thyroxine therapy in order to forestall the progression to overt hypothyroidism, which occurs in about 2 percent of people per year. Another pro-treatment argument is that some people with subclinical hypothyroidism have symptoms that will be improved by treatment, but that neither the person nor a physician or family members have detected them yet.
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