Subclinical Hypothyroidism - Thyroid Symptoms?


Are you experiencing symptoms with a normal TSH or other thyroid labs?

Having treated hundreds of patients with symptoms of hypothyroidism, I can say with confidence that many cases where a TSH test was within what is considered to be normal laboratory ranges, those patients benefited remarkably from empirical use of the thyroid medicines, usually a desiccated thyroid preparation known as Armour Thyroid™ or Nature-Throid™ or better yet, compounded Thyroid USP with Selenium.

Indeed, if we accepted the TSH test as the only indicator of the need for thyroid, countless patients in our clinic (and in clinics throughout the United States) would be suffering needlessly from symptoms of hypothyroid. Many patients have what is called "subclinical hypothyroidism". In our Santa Rosa clinic, we screen every patient for this condition and find that it is quite common.

Despite normal basic laboratory tests for hypothyroidism (i.e., the TSH test), many of our patients are indeed “sub-clinically hypothyroid.” Another way of putting this is that they have “sub-laboratory” hypothyroidism, a term coined by Alan Gaby, M.D. in his excellent review article entitled “Sub-laboratory” Hypothyroidism and the Empirical use of Armour Thyroid in 2004 (Altern Med Rev 2004:9(2): 157-179).

In this article, Dr. Gaby detailed and referenced the research in this area, explaining with great clarity how it possible and quite common to experience a "hypothyroid" state despite normal lab tests. Dr Gaby cites several important studies, reviews the evidence, safety and a rational methodology for the treatment of this condition.

Possible explanations for the disconnect between clinic and laboratory include a syndrome known as “tissue resistance to thyroid” (TRTH), defects in the conversion of T4 to the biologically active thyroid metabolite T3, possible mutations of thyroid hormone receptors in the brain, genetic variations in the deiodinase enzymes that convert T4 to T3, and the possible inhibition of peripheral thyroid hormone receptors by various environmental toxins, metabolites or byproducts of intestinal flora.

Countless patients present to physicians every day with symptoms of hypothyroidism, including:

  • chronic fatigue,
  • constipation,
  • coldness,
  • headaches,
  • female reproductive system imbalances,
  • immune system problems,
  • unexplainable weight gain,
  • problems with hair and nails,
  • and a host of other symptoms.

Understandably and quite often, these patients are frustrated when they come to our clinic for treatment. We proceed to evaluate their problems fully and, when indicated, empirically treat with thyroid hormones. We will do this if necessary and indicated, despite conventionally "normal" lab tests, always monitoring carefully with laboratory analysis every step of the way. More often than not, when appropriately prescribed, symptoms of hypothyroidism are improved or eliminated, thyroid function tests remain within normal limits and patients feel MUCH better.

While we do extensive laboratory testing, beyond simply the TSH and Free thyroxine test, to include other markers that identify a sub-clinical hypothyroidism (such as thyroid antibody tests, free T3, and reverse T3 tests), we have certainly come to rely in part on the presence of clinical symptoms for a diagnosis of hypothyroidism, which we then confirm through functional laboratory evaluation of sub-clinical hypothyroidism. Even the American Association of Clinical Endocrinologists argued back in 2004 that the upper limit of TSH be changed from 5.0 to 3.04 mU/L which should raise further questions about the validity of the TSH tests as the chief diagnostic parameter for the prescription of thyroid.

If you suspect that you are hypothyroid, despite normal labs tests, consider a full evaluation at Tru Health Medicine in Santa Rosa - Sonoma County's authoritative Integrative Naturopathic Medical Clinic for “Sub-Clinical “ or “Sub-laboratory” hypothyroidism.

Integrative Naturopathic Medical Clinic: Call 707-292-8882

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