Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Thread: Help with understanding subclinical hypthyroid page

  1. #1
    The Big L's Avatar
    The Big L is offline Senior Member
    Join Date
    Feb 2010
    Posts
    274

    Help with understanding subclinical hypthyroid

    Primal Fuel
    Edit: Ahhh! I made a typo in the thread title. Should be "...hypothyroid". I made a hypo typo!.

    Sorry if this comes across a bit scatterbrained. I may be suffering from low thyroid hormone, so I'll just use that excuse preemptively.

    Summary version:

    I have subclinical hypothyroid -- TSH elevated slightly above reference range, FT4 in the lower 1/3 of the reference range -- apparently not due to autoimmune Hashimoto's.

    I'm not even sure if I have any symptoms. If I have any, they're mild. The only quantifiable one is a low basal temperature of just over 96 deg when I wake up.

    I'm trying to decide what to do about it, if anything. Suggestions?

    =================================================

    Long version:

    I'm in my 30's, and I had my first routine bloodwork done last year. TSH was 7.7 UIU/mL (lab reference range 0.47-5.5), which triggered a test for FT4: 1.18 mg/dL (0.89-1.76). Thyroglobulin AB was <1.8 (<4), and Thyroperoxidase AB was 0.8 (<9.0). Diagnosis was subclinical hypothyroid, and my doctor left it up to me to decide whether to treat it or let it ride and re-test in a few months.

    I was curious whether my diet rich in goitrogenic broccoli/brussel sprouts/spinach/sweet potatoes, along with giving up iodized table salt a few months before the test, might be part of the problem. So I scheduled a test for 3 months later, took it easy on the goitrogens, and added iodized table salt back into my diet. The new results were TSH 5.398, and FT4 1.09. Given that the first test was taken very early in the morning after fasting, and the 2nd test was closer to lunchtime after a light breakfast, my feeling is that the two tests didn't really show much difference at all (TSH apparently decreases by an average of more than 25% under such conditions).

    Because my TSH fell inside the reference range -- though just barely -- the lab declared my results "normal", and I haven't talked to my doctor about it since. I'm well aware of the controversy regarding what the upper limit for TSH should be, and that some people experience pretty bad symptoms unless their TSH is below a much smaller number. However, I'm really not sure that I'm experiencing any hypo symptoms. Then again, it may be that I've been living with the symptoms so long that I just regard the current state as normal. Among the possible symptoms I exhibit:

    + I've always been a "low energy" person. Though I do fidget, bounce my leg when sitting, etc.

    + Fine wrinkles around my eyes. Apparently skin aging is a symptom for some hypo's.

    + Sometimes dry skin. But since eating PB-like for > 1 year, this hasn't really been an issue.

    + Low basal temp. Recently my sublingual temps have been 96.0-96.5 in the morning, and 97.5-98.0 in the afternoon.

    + Possibly elevated cholesterol. Total/HDL/LDL/Trig was 219/84/119/27. Yeah, not that high (and I realize the ratios are great, and that it's just as likely due to PB eating), but my last test a decade ago had total levels around 130 on a SAD/junk diet. Both parents have history of low TC.

    That's about it, symptom-wise. It may be that I merely have mild symptoms because my thyroid is still doing a borderline-OK job of producing "just enough" thyroid hormone. One of the classic symptoms of hypo that I definitely do not have is inability to lose weight, or even the ability to gain weight easily. I'm thin (6'1", 150lbs), and will easily drop down to low 140's on PB if I don't keep my carbs well above 100g/day.

    Other things that add a notch in the "likely hypo" category:

    - Family history of hypothyroid. My mother was diagnosed with Hashimoto's in her 50's after being in the subclinical range for many years; her mother had hypothyroid of some sort; her brother did as well; and at least one of her nieces is hypo.

    - I have (presumably autoimmune) vitiligo, which is frequently found together with hypothyroid.

    - My blood test also showed serum creatinine of 1.4 mg/dL (0.5-1.3), which resulted in a marginal kidney GFR of 62 mL/min (>60). Hypothyroid slows down pretty much everything, and is often associated with poor kidney function.

    The only other bit of bloodwork that was out of range was a slightly high serum C02 count of 32 mEq/L (21-31). I have no idea what that could mean.

    I'm not really sure where to go from here. A few things I have considered:

    - Get more complete thyroid bloodwork done, with T4, T3, RT3,...etc. More diagnostic information is good.

    - If TSH is still high and FT4 is still marginal, do a trial of thyroid replacement medication, retest, and see if I feel noticeably better. Is it possible for a thyroid (one not being attacked by autoimmune nasties) to heal itself if given a rest? I don't know, and I didn't find much info on this.

    - Taking a very small iodine supplement (~ 150mcg/day). This seems controversial. I don't eat a lot of iodized salt, and its difficult to find out how much iodine I get from food.

    - Do nothing until/unless my annual bloodwork goes out of whack or I start experiencing obvious symptoms.

    I'm leaning toward educating myself as much as possible, and then hopefully having a good talk with my doctor (or an endo) to help figure out what the best course of action is. The trouble is that 99% of the hypothyroid information out there is geared toward Hashimoto's, or people with overt symptoms. Subclinical hypothyroid seems to be a big gray area. I can't even find any coherent information that discusses what causes it, other than iodine insufficiency...which itself is an area of controversy.

    I know I just threw a lot of ideas and words out there, but if there's anyone here who can relate to what I'm saying, or even just understand it and perhaps provide a point of view that I hadn't considered before, that would be terrific.
    Last edited by The Big L; 04-27-2011 at 10:23 AM. Reason: Note about thread subject typo

  2. #2
    JKC's Avatar
    JKC
    JKC is offline Senior Member
    Join Date
    Mar 2011
    Location
    Alberta Canada
    Posts
    1,026
    I am hypo and if my TSH gets over 3.5 or so I feel low energy. You may have been hypo for quite a while and used to being low energy, but believe me, if you get the proper thyroid supplementation it makes a huge difference in your life. Having normal energy is awesome.

    I know people say don't trust the TSH test, but it has always worked well for me, and I get symptomatic once my TSH goes out of whack.

    I would suggest trying supplementation. You are not off very much, so it would probably not be a very high level.
    Karin

    A joyful heart is good medicine

    He is no fool who gives what he cannot keep to gain what he cannot lose. - Jim Elliot

    Mmmmm. Real food is good.

    My Journal: http://www.marksdailyapple.com/forum/thread29685.html

  3. #3
    hazyjane's Avatar
    hazyjane is offline Senior Member
    Join Date
    Feb 2010
    Location
    Nashville, TN
    Posts
    1,264
    Your TSH numbers are not subclinical- they're plain old high! In functional endocrinology ranges, 3 is the upper limit for TSH (which lines up with JKC's experience).

    I would recommend that you read Datis Kharrazian's thyroid book- he outlines so many underlying causes of hypothyroidism in it and looks at it from all angles. I also recommend working with a practitioner trained in functional endocrinology. It will save you a lot of trouble in trying to sort it out because they'll know what tests you need, and more importantly, how to properly interpret your results and how to tailor the treatment to your individual situation.

    Here's his website- there's a practitioner list on it. Many will work long distance:
    New Book on Hypothyroidism and Hashimoto's by Datis Kharrazian, DHSc, DC, MS
    Last edited by hazyjane; 04-27-2011 at 01:37 PM.

  4. #4
    emmie's Avatar
    emmie is offline Senior Member
    Join Date
    Oct 2009
    Posts
    1,167
    I was 'sub-clinical' when I was initially diagnosed (along with severe symptoms), and my endo at the time said that it's very, very common. Only Rx thyroid (Levoxyl) alleviated my symptoms.

    Also, you can't really be sure you don't have Hashimoto's. I never had enough antibodies, but I had a biopsy of a thyroid nodule, and the pathologist diagnosed Hashimoto's from the fluid he withdrew. My understanding is that unless the antibodies are actively attacking the thyroid at the time the blood is drawn, there won't be enough antibodies to diagnose Hashi's. There are too many false negatives from just lab values.

  5. #5
    The Big L's Avatar
    The Big L is offline Senior Member
    Join Date
    Feb 2010
    Posts
    274
    Quote Originally Posted by JKC View Post
    I am hypo and if my TSH gets over 3.5 or so I feel low energy. You may have been hypo for quite a while and used to being low energy, but believe me, if you get the proper thyroid supplementation it makes a huge difference in your life. Having normal energy is awesome.
    I think it would be cool to have more energy than I do now. I've been low energy as long as I can remember. According to my mom I usually preferred to stay in doors to going outside and playing when I was a kid.

    But honestly, increased energy would be a secondary benefit. I'm more concerned about the other health ramifications of hypothyroid -- increased risk for CHD, kidney disease, etc.

    I would suggest trying supplementation. You are not off very much, so it would probably not be a very high level.
    Yeah, I certainly am tempted to do a trial and see how I feel after a couple months. Though part of me really would rather scrutinize my diet and lifestyle trying to figure out if there is something I can do to naturally bring things back to normal.

  6. #6
    The Big L's Avatar
    The Big L is offline Senior Member
    Join Date
    Feb 2010
    Posts
    274
    Quote Originally Posted by hazyjane View Post
    Your TSH numbers are not subclinical- they're plain old high! In functional endocrinology ranges, 3 is the upper limit for TSH (which lines up with JKC's experience).
    Well...subclinical hypothyroid is defined as elevated TSH with normal free T4. So I'll agree that my TSH is high, but my thyroid is still producing reasonable amounts of T4 -- it just has to work a lot harder (being constantly prodded by the higher TSH).

    Thanks for the link to the book! I'll see if I can get my hands on it. Unfortunately the practitioner locator didn't turn up any results for my zip code. :\

  7. #7
    marcadav's Avatar
    marcadav is online now Senior Member
    Join Date
    Mar 2010
    Posts
    2,067
    How is your Vitamin D? Ferritin? Selenium? All impact thyroid function

    You may have symptoms you aren't aware of. Not everyone gains weight when hypo. Some people lose or have a hard time gaining.
    How are your eyebrows? Losing the outer third is a hypo symptom.
    Hairloss? Constipation? Forgetfulness? Brittle nails, hair? Find yourself falling asleep easily when relaxed? Low resting heart rate?

    I can understand not wanting to go on meds until absolutely necessary. However, I also think the longer thyroid issues goes unchecked the longer healing takes.

    I would definitely get retested in another 3 months and do it fasting. Also get FT3.

  8. #8
    The Big L's Avatar
    The Big L is offline Senior Member
    Join Date
    Feb 2010
    Posts
    274
    Quote Originally Posted by emmie View Post
    My understanding is that unless the antibodies are actively attacking the thyroid at the time the blood is drawn, there won't be enough antibodies to diagnose Hashi's.
    Ah, interesting. I suppose if you have more frequent tests you're more likely to eventually end up drawing blood at a time when the antibodies are higher. I also believe there's something about a poorly functioning thyroid that actually results in the body getting pissed off and attacking it after a while. It's frustrating to not know the causes and mechanisms though, because it limits our ability to be proactive beyond shots in the dark and educated guesses.

  9. #9
    The Big L's Avatar
    The Big L is offline Senior Member
    Join Date
    Feb 2010
    Posts
    274
    Quote Originally Posted by marcadav View Post
    How is your Vitamin D? Ferritin? Selenium? All impact thyroid function
    Vitamin D was 58 (presumably ng/mL) in January. This was after 6+ months supplementing 5,000 IU about four times a week. It's worth noting that vitamin D levels are often very low in those with autoimmune diseases like vitiligo (which I have), regardless of time spent in the sun. Some researchers hypothesize the low levels are the result of a defense mechanism the body is using to try to heal itself, and that supplementation merely prevents the body from doing its job in these people.

    I have not had ferritin or selenium measured. According to fitday I appear to be getting adequate dietary selenium at any rate, and my daily multi-vitamin also has selenium.

    How are your eyebrows? Losing the outer third is a hypo symptom.
    I've had sparse eyebrows my entire life, particularly the outer third.

    Hairloss? Constipation? Forgetfulness? Brittle nails, hair? Find yourself falling asleep easily when relaxed? Low resting heart rate?
    No hair loss that I can tell. I've been averaging one BM every three days since primal, though it has gone to every 1-2 days since taking 230mg magnesium citrate before bed. Not sure about forgetfuln-- wait, what was the question again? I don't think my nails and hair are brittle, but I've always had marginal looking nails (some vertical lines) and raggedy cuticles. Never fall asleep quickly, and in fact pre-PB I would often have a lot of difficulty falling asleep at night (now it's easier). Resting pulse has always been 65-75.

    I can understand not wanting to go on meds until absolutely necessary. However, I also think the longer thyroid issues goes unchecked the longer healing takes.
    Agreed. I should probably find a good endo -- one willing to have my blood tested more frequently, order other diagnostic tests that may help understand the situation better, etc.

  10. #10
    hazyjane's Avatar
    hazyjane is offline Senior Member
    Join Date
    Feb 2010
    Location
    Nashville, TN
    Posts
    1,264
    PrimalCon New York
    Quote Originally Posted by The Big L View Post
    Thanks for the link to the book! I'll see if I can get my hands on it. Unfortunately the practitioner locator didn't turn up any results for my zip code. :\
    Dr. Brady Hurst will work with you over the phone or even do a video chat: TRUE HEALTH Center for Functional Medicine

Page 1 of 2 12 LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •