Identifying subclinical hypothyroidism (SCH)

Suspecting subclinical hypothyroidism but the answer isn’t clear? By going through this blog, you’ll be able to identify subclinical hypothyroidism, possible aetiologies, the common sign and symptoms and how to manage the same, and to determine when to get the treatment.

Subclinical hypothyroidism is defined as normal serum-free Thyroxine (T4) with a slightly high level of Thyroid-stimulating hormone (TSH) and thyroid antibodies are elevated when somebody does the blood test. In about 80 percent of patients with subclinical hypothyroidism, the antithyroid antibodies are elevated. It affects around 3% to 8% of the global population.

In simple words, Subclinical hypothyroidism is a milder form of Underactive Thyroid (UAT)/ Hypothyroidism. As the name says it is subclinical means clinically one may not be able to identify or one may not feel any symptoms.

Subclinical hypothyroidism can sometimes reverse back to normal or can even progress to overt hypothyroidism that is a patient who can develop hypothyroidism over a while.

Subclinical hypothyroidism people will have no symptoms at all or may complain of very mild symptoms.

One may present with the following symptoms in the mild form:

• Lethargy
• Fatigue
• Dry Skin
• Puffy face
• Heaviness of body
• Weight gain
• Increased sensitivity to cold
• Constipation
• Hairfall
• Irritability, mood swings
• Cognitive-Memory issues- impaired memory
• Loss of libido
• Enlarged thyroid gland
• Menstrual irregularity
• Joint pain
• Myalgia

The quality of life gets affected because of mood swings, anxiety, and loss of libido, low energy, and sleep problem. Diagnosing subclinical hypothyroidism is important as they are at higher risk of developing heart/cardiovascular conditions, congestive heart failure, hypertension, and high cholesterol. SCH has an impact on the heart, it may lead to cardiovascular problems, heart rate, and rhythm variation are seen, the heart function is reduced, there are also chances of a heart attack in subclinical hypothyroid patients.

Causes of subclinical hypothyroidism:

The causes of subclinical hypothyroidism are not different from that of hypothyroidism; it is the same as hypothyroidism which includes: the most common cause is having autoimmune thyroiditis (Hashimoto’s disease) which causes an elevated level of TSH.

Other causes such as partial thyroidectomy, radiation therapy, radioiodine therapy, lack of iodine and pregnancy, some drugs such as lithium, immune response modulators. The other contributing factors for developing subclinical hypothyroidism are stress, poor sleep, poor gut health, nutritional deficiencies. Dietary factors that can cause Thyroid problems are excess or deficiency of Iodine, vitamin B12, and Vitamin A deficiency, zinc, selenium, and iron deficiency, dietary fat, goitrogens found in cabbage, cauliflower, broccoli, soy, legumes, and plants. Also consuming green tea at high doses may elevate TSH levels.

Is there is need of treatment for Subclinical hypothyroidism?

We do not know who will turn into overt hypothyroidism or whose level of TSH will come to normal only time can tell. So the one who is at high risk of developing overt hypothyroidism or who can progress into overt hypothyroidism like elderly patients, female patients, and positive anti-TPO patients needs to be treated.

Certain people with subclinical hypothyroidism do need treatment if they have an enlarged thyroid gland, it should be treated in elderly patients who are less than 65 years of age with mild symptoms of SCH, and even if their values of TSH are not more than 6 mIU/L, if one is planning for pregnancy in coming future and if they are having ovulatory problems or if they are already pregnant or if they have thyroid antibodies positive in their blood test in the form of anti-TPO antibodies or anti microsomal antibodies as they are called. Or if they are really symptomatic and last not but least if the TSH is progressively increasing over a span of time for instance if somebody’s TSH was 6 mIU/L before 2- 3 months ago and that becomes more than 10 mIU/L in another 2-3 months’ time then the person might be considered for thyroid replacement hormone therapy by the specialist only. Hence the reason why we say that leave it to the expert so that you will get the right treatment and you will have a good health outcome.

Subclinical hypothyroidism is important to treat in pregnant ladies because it can lead to miscarriage or the baby can be of low birth weight that is less than 2.5 kgs and also baby may have poor milestone development, poor neurological development after birth.

So as discussed medicines need to be started only as and when required and in asymptomatic cases starting medicines is not a good option. If one makes the necessary dietary and lifestyle changes it often helps to reduce the mild symptoms and importantly to slow down or prevent the progression of the disease.

Subclinical hypothyroidism is becoming very common nowadays.

In Life Force where we are specifically dealing with patients having Auto-immune conditions such as Vitiligo, Psoriasis, and Urticaria, etc…It has been observed that many of these patients do have co-existing thyroid disorder either sub-clinical hypothyroidism, hypothyroidism which we commonly call underactive thyroid, or hyperthyroidism. In the treatment of Vitiligo, Psoriasis, Nephrotic syndrome, Urticaria it is important to address the Thyroid issues too. In case if one is having sub-clinical hypothyroidism with other auto-immune conditions and the condition is not improving one can think to treat the Subclinical hypothyroidism too, as hormonal fluctuations may act as maintaining cause in the recovery of other auto-immune conditions mentioned above.

If one is not having symptoms then they can repeat the Thyroid profile after 6 months otherwise, after 6 to 12 weeks one needs to repeat the Thyroid profile and accordingly can discuss it with your health professional.

Dietary recommendations for patients with Subclinical Hypothyroidism:

What to eat?

• Iodine adequate food
• Selenium rich food
• Zinc, Iron, Vitamin A foods
• Anti-oxidants, beta carotenes, and omega-3-fatty acids.

What to avoid?

• To avoid an excess of salt
• Avoid goitrogenic foods like cabbage, cauliflower, broccoli
• To avoid red meat (mutton/pork)

Many really don’t know what actually subclinical hypothyroidism means and end up checking it on the internet and end up starting with the treatment we strongly advocate not to do that. If you have any TSH abnormalities in routine blood tests please consult the endocrinologist or a specialist who can guide you about this.

• Written by Dr.Mithila Kargar, Associate doctor to Dr.Rajesh Shah, MD (Hom)