trying to understand my diagnosis - subclinical hypothyroidism

hnelson · 08-08-2009, 10:09 AM

I'm trying to keep this as succinct as possible.......

I have recently been diagnosed with subclinical hypothyroidism. I am living in Japan but don't speak Japanese, so communication with both my Endo and RE are suboptimal and I have been doing some research on my own to clarify. I would love some insight/advice from those of you who have more experience with this.

The main source of information I am currently referencing is the "American Association of Clinical Endocrinologists Medical Guideline for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism" published December 2002. Here are some key points I have found:

"Subclinical hypothyroidism refers to mildly increased serum TSH levels in the setting of normal free T4 and T3 estimates" ... while "patients with clinical or overt hypothyroidism exhibit reduced free T4 estimates and increased TSH levels"
- I have subclinical: TSH at 6.0, T4 and T3 normal, with no apparent symptoms
"Treatment of subclinical hypothyroidism remains controversial"...."We believe that treatment is indicated in patients with TSH levels >10 mcIU/ml or in patients with TSH levels between 5 and 10 mcIU/ml in conjunction with goiter or positive anti-thyroid peroxidase antibodies (or both)"
- I have also read elsewhere, but don't recall if it was from the AACE, that treatment is also recommended if there are symptoms with TSH between 5-10
"The target TSH level should be between 0.3 and 3.0 mcIU/ml"
"Mildly increased serum TSH levels during pregnancy might also increase the risk of fetal death, but whether treatment prevents this complication is not yet known. In most of these women thyroid antibodies develop - a finding that seems to be a risk factor for spontaneous abortion independent of hormone and TSH levels."
In general pregnant women with hypothyroidism will need to increase the dosage of thyroid hormone while pregnant (my paraphrase)

What I am trying to sort out/questions:

Many here seem to be very adamant that TSH must be below 3 (but don't necessarily address T4 levels - were they normal or low with the elevated TSH?). while I agree for my future (hopefully) pregnancy, from the excerpts above it doesn't seem as though the AACE would necessary treat my situation - normal T4 and no symptoms (maybe would treat for ttc).
have others dealt with Endos who differentiate between subclinical and overt hypothyroidism? (My Endo didn't give a specific name to my diagnosis - its just what I found with the research. But based upon the fact that my endo wasn't at all worried about my levels I don't know if I would have been given meds if I hadn't asked.)
Neither my RE nor my Endo seems concerned with elevated TSH and ttc - although my Endo did agree to give me the synthetic hormones when I requested it. How do other's RE/endo feel about the situation? I will be adamant to get TSH less than 3.0 asap primarily because I know pg typically increases the need for meds.

Any other insight you could give would be appreciated!

ANH_RN · 08-08-2009, 12:02 PM

I was told that my thyroid hormone was 'slightly elevated' and therefore I was put on 25mcg synthroid as well.. I don't know if they were just trying not to worry me but they were pretty blase about it yet they still wanted me to have medication. I am just happy I found out before I got pregnant. I have been taking my Synthroid for a few weeks now and I feel a little better -- although before I never really had the typical hypothyroid symptoms... just a little lethargic.

p.s. I can't imagine going through this right now in a different country. It's hard enough understanding what people are telling you in English sometimes!