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How to Spot Hypothyroidism Even When Your Blood Work ‘Seems Normal’

Your body is not failing you; it’s warning you.

“Frau Meyer, your thyroid biomarkers are fine. The TSH and Total T4 levels seem normal. The TSH is a bit in the upper range upper, yes, but still within limits.”

The doctor announced this without looking up from the blood work results.

“How can I explain, then, that my body feels so sluggish, my energy is gone, I am putting on weight and retaining fluid even when I am eating less and less every day and doing daily exercises? I‘m at a loss,” — asked Frau Meyer, with a tinge of desperation in her voice.

“I understand what you mean, but there is not much we can do for now. So, keep eating healthy and doing exercise. I’ll see you in 6 months.” It was doctor talk for ‘this-appointment-is-over.’

Frau Meyer left the doctor’s office with a helpless sensation: “Is there really nothing I can do until my blood levels worsen to the point that I qualify to take that drug for the rest of my life?”

Officially, the doctor is right: she does not fall (yet) into the medical category of “patient with hypothyroidism.”

The standard biomarkers he analyzed have not crossed the clinical threshold for the doctor to prescribe Levothyroxine, a very common prescription drug used to treat an underactive thyroid gland.

However, the message to Frau Meyer was not complete — let alone comforting.

A more comprehensive (and truthful) reply from the doctor would have been:

Actually, you may be experiencing what is called SUBCLINICAL HYPOTHYROIDISM, otherwise know as the earlier stage of CLINICAL HYPOTHYROIDISM.

Indeed, there is a lot you can do to prevent hypothyroidism.

Let’s start by broadening the biomarkers we are looking at, and even before that, let’s have a closer look at your symptoms…

Same situation, same uncertainty, but how different is the message for Frau Meyer?

Signs of Subclinical Hypothyroidism

What was Frau Meyer experiencing when she decided to schedule an appointment with her family doctor?

It had to be one, a few, or many of the following symptoms.

All of them are signs that your thyroid might be downregulating its function, i.e., slowing down:

Author’s infographic created on Canva.

Note: The last one is a bitter truth. One autoimmune disorder may increase the likelihood of developing a second one. In addition, some thyroid conditions are linked with autoimmunity, e.g., Hashimoto’s thyroiditis and Graves’ disease.

How many of these symptoms are you experiencing?

If you find that several of these symptoms resonate with you, it is advisable to check your thyroid hormone levels with your health specialist.

It’s not uncommon for people to check many of these symptoms. There is no reason to panic if that’s the case for you.

All of the above are relatively broad, general symptoms. Separately, each of them might have several different origins or root cause(s).

The idea here is to do this self-check and provide you with vital information so that you do not feel as powerless as Frau Meyer did.

What to do next? Ask for a comprehensive thyroid panel.

If you realize you have crossed several of the above signs or have been experiencing one/a few of them over a long period, it may be time to pay another visit to your doctor with a better-informed idea of what to ask for.

He may refer you to an endocrinologist to order the following more comprehensive diagnostic panel for your thyroid (a blood test) that will help to identify any potential imbalance:

Image by jarun011 on Canva

1. TSH and Total T4 (the initial, standard ones)

2. Free T4

3. Free T3

4. Reverse T3

In addition to that:

5. Hashimoto’s antibodies:

  • Thyroid Peroxidase Antibodies (TPO antibodies), and
  • Thyroglobulin Antibodies (TG antibodies).

Note: Thyroid antibodies are often elevated for decades before a change in TSH is seen in Hashimoto’s.

6. Grave’s antibodies

TSH receptor antibodies, including Thyroid-Stimulating immunoglobulin (TSI)

With these results in hand, your doctor will now have a comprehensive view of your thyroid health.

Take-away messages

  1. Your body may start manifesting slow thyroid function symptoms before the standard biomarkers, TSH, and Total T4, show any change.
  2. This stage is called Subclinical hypothyroidism.
  3. It is possible to prevent this stage from reaching a more difficult phase, i.e., Clinical Hypothyroidism and the ‘lifetime’ medications that come with it.
  4. The first step is to ask for a comprehensive thyroid panelyes, you have the right to ask for it.
  5. Suppose these results eventually show a thyroid imbalance. You can still do a lot to improve -sometimes even reverse- this condition: check potential nutritional deficiencies, and assess your overall diet, lifestyle, and main stressors.
  6. Search for a reliable health professional to accompany you throughout this journey.

© Teresa Morillas

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