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Why Subclinical Hypothyroidism Shouldn’t be Managed With Thyroid Medications

Hormone Circuit

By: Michael Lam, MD, MPH; Carrie Lam, MD; Jeremy Lam, MD

An image of a woman holding her throat while a doctor shows her imagesIf you have Adrenal Fatigue Syndrome (AFS), you will experience a range of physical problems and symptoms. Subclinical hypothyroidism is a very common problem associated with AFS. Unfortunately, if you go to your doctor with this problem, they will probably prescribe thyroid medication to you. Research is starting to show that this may not be the most helpful strategy as it does not necessarily alleviate all symptoms long term, even though there may be benefits. And if you have AFS, it may actually worsen your condition and increase the time before you find a way to manage and reduce the underlying problems associated with this disorder.

What is Subclinical Hypothyroidism?

When you have hypothyroidism, your body is not producing enough thyroid hormones. An early stage of this is known as subclinical hypothyroidism. Clinical symptoms of hypothyroidism are generally mild and often not very significant. At this stage, the serum level of thyroid stimulating hormone (TSH) may be only a little higher than usual and the level of thyroid hormones in the blood are still within the normal range or borderline low. The high TSH levels are a sign that your body is struggling to keep the thyroid hormones at normal levels and is having to release more hormones than usual to make this happen.

Even though the thyroid hormones help to regulate your brain, heart, and metabolic functions, they are also the leading cause of a variety of diseases and disorders. When the hormone levels start to drop, you may experience a range of symptoms and issues. Between 3 and 8 percent of people have subclinical hypothyroidism and in some cases, this can progress to full hypothyroidism. There are many causes for problems with thyroid function, including:

  • Thyroid injury because of an accident or surgery.
  • Certain medications that affect the thyroid such as iodine or lithium.
  • Radioactive iodine therapy.
  • Certain inheritable diseases such as Hashimoto’s disease.

There are often no apparent symptoms for subclinical hypothyroidism and they can be vague and non-specific if any. Some of the most common symptoms are:

  • Fatigue.
  • Depression.
  • Weight gain.
  • Goiter.
  • Constipation.
  • Hair loss.
  • Memory problems.
  • Brain fog.
  • Cold intolerance.

These symptoms are also common in people who have AFS, which is why people with this disorder are often put on thyroid medications.

Subclinical Hypothyroidism and AFS

Subclinical hypothyroidism is very closely linked to AFS, which is caused by stress. The NeuroEndoMetabolic (NEM) stress response is designed to help your body cope with stress. But when this system is active over a long period of time, it can become fatigued. The NEM stress response is designed to activate to increase alertness in response to a threat to your life and then shut down. It is very unhealthy for this stress response to be active over long periods. This type of prolonged overuse is just as unhealthy for the NEM stress response itself, because the organs and systems that are a part of it can become fatigued.

When the NEM stress response is overused, the adrenal glands will begin to struggle to keep up with the body’s ongoing demand for cortisol. Cortisol is a stress hormone that is responsible to make you feel alert and ready to respond. But if the demand for cortisol is high on an ongoing basis, the adrenals can start to break down and the hormone levels become abnormal. As a result of the breakdown of the adrenals, other systems in the body will naturally become dysregulated as well given that all the systems in the human body are interconnected. This can lead to a very damaging and frightening degradation of all the systems in your body.

AFS and the Hormonal Circuit

The hormonal circuit is often one of the first to be affected when you have AFS. This circuit plays an important part in maintaining hormone balance in the body and includes the adrenal glands, the thyroid and the ovaries or testes. Dysregulation of this circuit has a negative impact on your body, especially when the adrenals become fatigued because of overuse that causes AFS. The thyroid is regulated by the Hypothalamus-Pituitary-Adrenal (HPA) axis, which is an integral part of the NEM stress response. When this stress response starts to malfunction because of AFS, it will naturally cause the thyroid to become dysregulated and cause conditions like subclinical hypothyroidism.

An image of a doctor holding a thyroid glandThe thyroid gland is also affected by the body’s general poor health and exhaustion. As your health declines because of AFS, the adrenals start to focus on survival. Firstly, the adrenal glands down-regulate energy production, by reducing the production of thyroid hormones. Given that the body is exhausted and is on the verge of collapse, the adrenals role in lowering energy output and the body’s workload, helps to cope with this extreme state of exhaustion. It is also common at this stage for your body to increase thyroid binding globulin (TBG) levels. This causes low levels of T3 and T4 in the blood for measurement, which can confound thyroid testing. So, your doctor may believe that you have subclinical hypothyroidism due to your low hormone levels and normal or high TSH levels when in reality, the reasons behind it are much deeper.

Along with the hormonal imbalance due to your thyroid and adrenal glands, the balance and the function of the ovaries and testes are affected as well. These organs are hormonally interconnected and reliant on each other. So, as the adrenals are increasingly dysregulated because of stress, the thyroid, as well as the ovaries and testes will continue to malfunction. These malfunctions will further disturb the hormonal circuit significantly. The result will be worsening AFS symptoms and increased thyroid malfunction, adrenal fatigue, and issues related to the ovaries or testes.

How AFS Can Look Like Hypothyroidism

The symptoms and problems caused by AFS are very similar to the symptoms of subclinical hypothyroidism. In fact, these two conditions are very commonly mixed up. If you go to your doctor with general fatigue, cold sensitivity, and inexplicable weight gain, they will very often examine your thyroid function based on your symptoms. If high TSH levels are noted, your doctor may decide to address the thyroid problem with medication. However, this tactic will be ineffective at best or damaging at worse if you actually have AFS. Unfortunately, many healthcare professionals are not aware of adrenal function and adrenal fatigue, which means that adrenal dysregulation is often overlooked by them.

The real issue is about low thyroid gland function or primary hypothyroidism. In primary hypothyroidism, the condition occurs when the thyroid is unable to produce the hormones T3 and T4 because of gland problems. This happens when you have a medical condition such as Hashimoto’s thyroiditis and your immune system attacks your thyroid gland. Secondary hypothyroidism occurs as a result of low gland function when the thyroid is affected by changes in other parts of the body. If you have AFS or a disorder in the hypothalamus, not enough thyroid stimulating hormone is released causing secondary hypothyroidism. The organ system and circuit malfunctions that are characteristic of AFS can affect the function of the thyroid and cause this type of mix-up. When you have too much cortisol, it informs the brain to slow down the production of hormones, thus also decreasing the thyroid function. In addition, when your body is stressed, the thyroid glands reduces its activity by producing more inactive reverse T3 hormone rather than its active form, therefore causing more hypothyroid symptoms.

AFS can cause the same kind of symptoms as subclinical hypothyroidism as well as an ongoing dysregulation of the thyroid gland, resulting in impaired thyroid function and high TSH levels. However, if your doctor is not aware of the underlying problem, they will try to manage only the thyroid issues. This will not only be ineffective at alleviating your symptoms, the strong medications will also increase your stress levels and worsen the underlying AFS. This kind of situation is a common experience for people who have AFS and can result of in long term confusion and ongoing medical interventions without relief from worsening symptoms and problems.

AFS Versus Hypothyroidism

Whether you have AFS or subclinical hypothyroidism, you will experience a range of symptoms that appear very similar. Here are some of the most obvious symptoms and how they differ in these two conditions:

  • Weight Gain
    Hypothyroidism causes general weight gain, people in the early stages of AFS can experience the same problem.
  • Body Temperature
    Both disorders tend to cause problems with low body temperature. However, in AFS, temperature regulation tends to fluctuate a little more than hypothyroidism.
  • An image of a man with hair lossHair Loss
    Both disorders can cause hair loss or a change in hair health.
  • Mental symptoms
    AFS and subclinical hypothyroidism can cause brain fog, slow thinking and even depression, though depression is more common with thyroid problems.
  • Skin and Nails
    If you have AFS, your nails may become thin and brittle and your skin dry and thin. However, people with thyroid problems tend to have oily or moist skin of normal thickness. Nail thickness is usually normal as well.
  • Infections
    Frequent infections are common with AFS but not with thyroid problems.
  • Fatigue
    This is the most obvious and sometimes troubling symptom of both disorders.

These symptoms are extremely similar, which is why you need to get expert help if you are going to improve your health and overcome these types of problems.

How Thyroid Medications Can Worsen AFS

There are several ways that your overall condition may be affected if you take thyroid medications when you have AFS. These include:

  • Additional physical stress
    Taking very strong medications when you are already unwell can increase your body’s stress levels, particularly if those medications are not necessary. Your body will need to process the medication and expel wastes, and if it’s already overloaded with toxins and struggling, this can add to its stress.
  • Paradoxical reactions
    When you have AFS, your system will already be sensitized by the overload of toxins and inflammation. As a result, it may have a paradoxical reaction to any medication you take, which means that it may cause more damage or harm to your thyroid and other systems.
  • Increased emotional stress
    If you are taking thyroid medication and yet there is no improvement of your health, it may cause more emotional stress, which will worsen your AFS.
  • Increased financial pressure
    Thyroid medications must be taken on an ongoing basis, which may increase your financial stress and worsen your AFS.

Subclinical hypothyroidism is a serious disorder that can severely affect your quality of life and your ongoing health and wellbeing. It is important to seek professional help and see a doctor to find a way of managing it. It is important to acknowledge and address any disorder such as AFS that could be underlying the more obvious problem.

Managing Subclinical Hypothyroidism

Current practices claim that thyroid hormones are the best option for adults with subclinical hypothyroidism. There are two main hormones produced by the thyroid, known as triiodothyronine (T3) and thyroxine (T4). These hormones are responsible for regulating many systems and processes in the body. Current guidelines for managing this problem is to prescribe thyroid hormones to adults whose TSH levels are over 10 mIU/L. People who are young or have troubling symptoms may be given these hormones even when their TSH levels are lower. Normal TSH levels are between 0.4 and 4.0 milli-international units per liter.

A recent study was performed that included 21 trials and 2192 participants who had subclinical hypothyroidism. The study found that thyroid hormones produced no clinically relevant benefits. The participants did not get relief from depressive symptoms, weight gain, or general fatigue. There were also little effect on mortality or cardiovascular events. However, further research and follow-ups are needed to confirm the findings.

These results suggest that changes should be made in the management of subclinical hypothyroidism. Thyroid medications will probably not alleviate the symptoms if their adrenals are well optimized. It also adds lifestyle burdens in terms of lifelong management and financial considerations. Long term use of these medications may cause irreversible harm to the body and therefore it is important that there are alternate strategies in place. These strategies may include long-term health monitoring and drastic lifestyle changes.

The Takeaway

An image of a doctor explaining things to someoneIf you experience subclinical hypothyroidism as a result of AFS circuit imbalances, then thyroid medications may not be the solution. In fact, in certain cases they can do more harm than good. Instead, you need to work with a trained, experienced medical professional who is aware of AFS and can help you address the underlying problems and imbalances. This is the best way to bring your body back into balance, alleviate adrenal fatigue, and help to correct any problems that are causing your thyroid dysregulation.

© Copyright 2020 Michael Lam, M.D. All Rights Reserved.

Dr. Lam's Key Question

Typically, subclinical hypothyroidism is addressed using thyroid medication. However, this may not have the desired effect on the quality of life or thyroid symptoms and may cause more health and lifestyle problems over time. That’s why monitoring of thyroid function and other measures may be more effective.

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