5 Reasons to Treat Subclinical Hypothyroidism + 5 Treatment Tips

5 Reasons to Treat Subclinical Hypothyroidism + 5 Treatment Tips

It's estimated that up to 10% of people in the US have subclinical hypothyroidism. 

Statistically speaking that means you have a pretty high chance of having this issue even if you have tested "normal" for thyroid lab tests. 

Because subclinical hypothyroidism represents a treatable condition on the hypothyroid spectrum it's critical to accurately diagnose and treat this condition early.

Failure to treat can lead to overt hypothyroidism and worsening symptoms down the line.

In this guide I will walk you through everything you need to know about subclinical hypothyroidism including 5 reasons you should treat the condition ASAP: 


What is Subclinical Hypothyroidism?

So what is subclinical hypothyroidism?

By definition, it's supposed to indicate a state of thyroid function in the body that manifests as a change in thyroid stimulating hormone (TSH) without manifesting with the symptoms of hypothyroidism.

You can think of it as a reduction in efficiency in the entire thyroid system, but still that the thyroid is producing enough thyroid hormone for the body.

Or is it?

While that's what the exact definition is supposed to mean, most patients who actually have subclinical hypothyroidism manifest in a completely different way.

Most patients with abnormal thyroid hormone levels, including abnormal TSH levels, do indeed have some degree of hypothyroidism.

But, unfortunately, due to a variety of reasons, including the current treatment paradigm for hypothyroid patients, these patients are usually ignored or given the "wait and see" approach. 

But let's evaluate that to see if it actually stands on its own. 

When you go to the Doctors office it's usually because you aren't feeling well.

Most people who think they have thyroid issues (you guys are right by the way) come in because they've done their research and they are tired of feeling poorly.

Subclinical hypothyroidism treatment outline

They often present with weight gain, fatigue, low energy, changes to their mood, hair loss, etc. (we will discuss more symptoms below).

These symptoms are not just the "normal" signs of getting older.

They are, in fact, symptoms that coincide with hypothyroidism directly and they should be treated as such.

But let's go back to the standard of care, the "wait and see" approach to managing subclinical hypothyroidism for a second. 

What is it?

In the most basic sense it is your Doctor saying to you, let's just monitor your thyroid level, even though you feel terrible, for another 6-12 months.

Once your thyroid lab tests finally go into the "abnormal" range, then we will treat you with thyroid hormone.

This approach usually leads to poor quality of life on behalf of the patients, and frustration on behalf of the physician. 

We are going to talk today about a better approach to managing subclinical hypothyroidism and what it actually means. 

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TSH Levels and Subclinical Hypothyroidism

In most cases, Doctors rely heavily on the serum test known as thyroid stimulating hormone.

They suppose that this test, in isolation, offers a perfect view of thyroid function in the entire body and that all treatment should be based on this one test.

This is in spite of studies like this (1), which show that TSH levels do not mean you have adequate T3 and T4 circulating levels of thyroid hormone in the serum. 

And studies like this (2), which show that not all patients equally convert T4 to T3 in peripheral tissues. 

Or facts like this (3), which point out that pituitary tissues have different deiodinases than peripheral tissues and so each reacts differently to thyroid hormone. 

euthyroidism and abnormal t3 and t4 levels

So what's the bottom line?

It's not hard to see that evaluating for subclinical hypothyroidism or hypothyroidism is probably best done with more testing than just the TSH.

I discuss a complete set of thyroid lab tests that you should be ordering in this post here for those that are interested.

Even though we've established why the TSH is not the best marker, it's still a decent marker for establishing if you have subclinical hypothyroidism so let's talk about the ranges for just a moment. 

From a conventional standpoint, here are the reference ranges that your Doctor will likely be using when diagnosing subclinical hypothyroidism and hypothyroidism:

  • TSH range from 5-10uU/ml is usually considered subclinical hypothyroidism
  • If TSH is between 5-10 recheck labs in 6 months
  • TSH greater than 10 uU/ml is considered hypothyroidism and is usually treated with Levothyroxine monotherapy

I don't recommend following these lab ranges, for various reasons which we will discuss above, but I am telling you what you can expect if you walk into the Doctors office. 

Now compare those standard ranges to the more optimal ranges:

  • TSH range greater than 2.0 uU/ml is consistent with hypothyroidism and therefore should be treated with thyroid replacement therapy, preferably a combination of T4 and T3 based on conversion status
  • Free T3, free T4 and reverse T3 levels should be evaluated to determine peripheral conversion status
  • Thyroid antibodies should be evaluated to determine if autoimmune thyroiditis is impairing thyroid function
  • Inflammatory markers should be evaluated to determine if they are contributing to peripheral thyroid conversion

Which of these sounds better to you as a patient? 

The more comprehensive approach should sound better and simply seem more logical than the initial and more standard approach.

But let's take a minute to talk about the symptoms of hypothyroidism so we can build our case for why you should treat subclinical hypothyroidism.

Symptoms of Subclinical Hypothyroidism

Symptoms are very important for the diagnosis of subclinical hypothyroidism. 


Because in the absence of abnormal symptoms all you have is an abnormal lab value.

You (and your Doctor) ALWAYS should be evaluating lab values with the patient in mind!

That means evaluating lab values in the context of symptoms, hormone imbalances, nutrient deficiencies and so on.

Never treat based on lab values alone.

Which brings us to the next point:

What are the symptoms of subclinical hypothyroidism?

It's important to consider that hypothyroidism, like other disease states, exists on a spectrum.

That means that each person can present differently and it means that the degree of your symptoms may change based on how bad your hypothyroidism is.

Subclinical hypothyroidism is ON this spectrum, meaning it is a form of hypothyroidism.

Usually, subclinical hypothyroidism presents with the EXACT same symptoms as hypothyroidism but just to a lesser extent. 

For instance, most patients with hypothyroidism usually have 30-50 pounds of weight gain, but most people with subclinical hypothyroidism only have 5-15 pounds of weight gain.

Both conditions present with similar symptoms, but not to the same degree.

Below is a graph which shows the symptoms of subclinical hypothyroid patients compared to normal euthyroid patients.

It's easy to see that patients with subclinical hypothyroidism present with almost ALL of the symptoms of hypothyroidism when compared to "healthy" adults. 

subclinical hypothyroid symptoms

I've included a list of the symptoms of subclinical hypothyroidism below:

  • Weight gain (usually only 5-15 pounds)
  • Fatigue (not crushing fatigue, but low energy throughout the day or reliance upon caffeine for energy)
  • Cold hands and cold feet
  • Inability to lose weight or difficulty losing weight (especially if you were able to lose weight in the past)
  • Dry hair or a history of alopecia (usually not overt hair loss)
  • Decreased memory
  • Dry skin or other skin changes
  • Swelling in the neck, hoarseness or presence of a goiter
  • Constipation or other GI related issues (usually mild constipation)

You can compare the symptoms of subclinical hypothyroidism to the overt symptoms of hypothyroidism here

Reasons to Treat Subclinical Hypothyroidism

Now that you understand what subclinical hypothyroidism is and how to properly diagnose it, let's talk about why you should be treating it. 

I understand that many of you probably want to treat your condition but receive push back from your doctor. 

If you fall into that category then you may want to seek out an alternative physician who is more willing to work with you. 

Let's jump in: 

#1. Subclinical Hypothyroidism is still on the Hypothyroidism Spectrum

The first and probably most important reason to treat subclinical hypothyroidism is that it is on the hypothyroidism spectrum.

You can really consider subclinical hypothyroidism as just a mild form of hypothyroidism and therefore it should be treated in a similar way.

high TSH and hypothyroidism

What's important here is that patients who have subclinical hypothyroidism suffer from the symptoms of hypothyroidism and, as a result, suffer with a low quality of life.

This means that if you've been told you have subclinical hypothyroidism you stand to benefit tremendously from thyroid hormone replacement. 

At the very least, you should do some digging to see WHY you developed the condition in the first place.


Because abnormalities in thyroid function stem from some root cause, and if you can identify and treat that cause you can reverse the condition before it progresses to overt hypothyroidism.

#2. You may have Autoimmune Thyroiditis and not know it

I mentioned previously that it's important to find the CAUSE of your subclinical hypothyroidism. 

Well, one of the most common causes of decreased thyroid function in the US is autoimmune thyroiditis.

In fact, up to 70-90% (depending on which studies you look at) implicate autoimmune thyroiditis like Hashimoto's as the primary cause of hypothyroidism in developed countries.

Hashimotos thyroiditis with high TPO antibodies

Why is this important?

Well, for several reasons:

It turns out that mild inflammation and autoimmunity in your thyroid gland may eventually lead to irreversible damage and complete reliance upon thyroid medication.

Beyond that, and more importantly, is that you may be able to stop the inflammation (or at least slow it down) and prevent further damage.

Most physicians don't even check thyroid antibodies, even in the presence of hypothyroid symptoms, which means it's up to you to ask for these tests.

They are very standard tests, and you shouldn't get push back for asking for them.

You can find more information about thyroid antibody testing here and how to treat it here

#3. Impaired thyroid function causes dyslipidemia

Another very important reason to treat subclinical hypothyroidism is because of its effects on lipid regulation in the body.

Even slightly low amounts of thyroid hormone can contribute to changes in cholesterol levels leading to dyslipidemia and hyperlipidemia.

Those names are just fancy ways to describe high cholesterol that leads to an increased risk of heart attack and stroke.

subclinical hypothyroidism and cholesterol levels

Most physicians forget the important connection between thyroid hormone and cholesterol regulation in the liver.

Studies have shown that subclinical hypothyroidism (4) leads to higher levels of LDL-C and triglyceride levels in the serum. 

This same study showed that TSH levels between 2-4 uU/ml in patients with elevated antibody levels (showing signs of autoimmune thyroiditis) also have abnormal cholesterol levels.


Your thyroid influences so much more than just your energy levels, it's also very important in regulating other factors in your body such as metabolism and cholesterol levels. 

Which brings us to point #4...

#4. Low thyroid makes weight loss very difficult

It's rare nowadays for me to find someone who is NOT interested in weight loss. 

You probably know that low thyroid contributes to weight gain, but what you may not have realized is that low thyroid also contributes to weight loss resistance.

What does this mean for you?

It means that patients with subclinical hypothyroidism are not only at a higher risk for weight gain, but it will also be more difficult to lose that weight if they try.

Most patients who have subclinical hypothyroidism relate to the fact that they USED to be able to lose weight but haven't been able to lose weight recently - even by using old strategies.

Association between TSH and weight gain

This should tip you off that something is off in your body.

Remember that weight gain is the product of hormone imbalances in your body and thyroid hormone is heavily involved in regulating your metabolism and thus your weight. 

You can read more about how low thyroid contributes to weight gain here.

#5. You can feel like your old self again

One thing I've noticed from patients is that they know when they are "off" or when they just don't feel like their "old self". 

This phenomenon is especially true of patients with hypothyroidism (either diagnosed or suspected). 

Your thyroid is involved in multiple biochemical functions in your body and helps regulate your mood, metabolism, GI function, energy levels and so much more. 

Even small changes to thyroid function may result in the symptoms we discussed above. 

Many patients take their complaints to their Doctors only to be dismissed or given an anti-depressant. 

If the cause of your symptoms is related to thyroid status then no amount of anti-depressant will be able to help. 

So, lastly, this is probably the most important reason to consider getting treatment for subclinical hypothyroidism. 

Is Subclinical Hypothyroidism Reversible?

While subclinical hypothyroidism represents a problem in your body and in your hormones, it also represents the opportunity to catch a problem before it snowballs out of control. 

For this reason, it's very important to get the diagnosis early so that you can seek out and find the problem.

One question you might be asking yourself is this:

Can I improve my thyroid function?

And the answer is almost always yes, to some degree.

Because most physicians aren't really willing to prescribe thyroid hormone for this condition (some will) that leaves you with the ability to take matters into your own hands and take some steps to improve your thyroid function. 

Treating Subclinical Hypothyroidism Naturally

If you've recently been diagnosed with subclinical hypothyroidism and want to be active and aggressive about your condition I recommend starting with these tips:

*Note you may ultimately need physician help to get proper treatment, but you can start here.

#1. Address basic nutrient deficiencies in your body.

You can easily evaluate for basic vitamin deficiencies like B12, Vitamin D3, Folic acid, and omega 3 fatty acids. 

In addition, many patients have existing deficiencies of nutrients like zinc and selenium.

Simply checking for and replacing (if you are deficient) can often time dramatically reduce symptoms. 

#2. Check to see if your impaired thyroid status is due to Hashimoto's or autoimmune thyroiditis. 

Finding out your subclinical hypothyroidism is caused by an autoimmune disease can be stressful but it also represents another treatment option for you. 

If you know you fall into this category make sure you make changes to your diet, you can read more outlined in this post.

And take further steps to help reduce your antibody level which will, in turn, increase your thyroid function. 

#3. Check for and reduce systemic inflammation in your body. 

Inflammation causes reduced thyroid function and can lead to other hormone imbalances that lead to weight gain. 

You can check for inflammation by assessing your serum ESR, CRP and ferritin levels (all easy tests to ask your Doctor for).

If you find inflammation present you can treat with Fish oil or other anti-inflammatory supplements.

#4. Consider iodine replacement therapy.

Iodine is required for proper thyroid hormone production and if your diet isn't high in iodinated salt or seafood then chances are you may have suboptimal levels. 

In some patients, taking iodine is enough to completely reverse and normalize thyroid status.

Supplementing with iodine doesn't have to be tricky, in this post I explain exactly what to consider and how to do it.

#5. Take steps to boost T4 to T3 conversion to maximize existing thyroid hormone function. 

Even if your Doctor isn't willing to work with you or give you thyroid hormone there are special steps that you can take to naturally improve your existing thyroid function. 

You can do this by increasing T4 to T3 conversion which creates more of the active and free thyroid hormone in your body. 

You can find 8 steps to naturally increase free T3 levels in this guide

Back to you 

Remember that subclinical hypothyroidism is and should be considered a treatable condition on the hypothyroid spectrum. 

Failure to treat this condition, or failure to dig deeper as to the root cause, may result in overt hypothyroidism later in your life. 

For this reason, I recommend that you treat this condition aggressively and that you get further and more advanced testing to figure out what is happening in your body. 

If you've been diagnosed (or if you suspect you have) subclinical hypothyroidism I want to hear from you.

What steps have you taken to treat your condition?

Is your physician willing to work with you and put you on thyroid hormone?

Leave your comments or questions below!

References (Click to Expand)

why you should treat subclinical hypothyroidism

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

43 thoughts on “5 Reasons to Treat Subclinical Hypothyroidism + 5 Treatment Tips”

  1. Thank you so much for this article. I have a TSH of 6.9 and have antibodies in the 300’s. My T3s and T4s, B12 are in range. I am not on medication. The only symptom I have is a 20 pound weight gain. I am afraid of taking medication and developing symptoms. My doctor said that I need to consider Synthroid. Is it important that I take meds even if I am feeling fine? I’d rather avoid them if possible.

    • Hi Pat,

      I would dig deeper into why you are gaining weight, because chances are high it is probably not related to thyroid function (provided your doctor knows what he/she is looking for). If you are asymptomatic and your cholesterol is fine, then I wouldn’t necessarily pull the trigger on taking medication – though you will need to discuss this with your physician because I can’t make recommendations specific to your situation.

  2. Thanks for the information. Its late at night and I will read more in depth tomorrow. It sounds like me. I haven’t been happy with the endocrinologists I’ve seen. One told me the sensitivity to cold and environment has nothing to do with my thyroid and I wasn’t hypothyroid since my numbers weren’t high enough. But they are above the norm. While I don’t have the weight issue I Have other issues. Plus it runs in my family.

    • Hi Susan,

      With your symptoms it would be worth further evaluation with a comprehensive thyroid panel + sex hormone panel.

      • Thanks again for all the info. I have an appointment set up with integrative endocrinologist. While I have to wait a few weeks for my appointment, in just a short telephone conversation I can tell that she gets it. Will let you know what happens.

  3. Glucose, Serum no fasting 127 mg/dL
    TSH, Ultra- sensitive, Serum 2.3 20 uIU/mL
    T4,Free(direct) 1.41 NG/dL
    Thyroglobulin Antibody <1.0 IU/mL
    Thyroid Peroxidase (Tpo) Ab 11 IU/mL
    Cholesterol, Total 298 mg/dL
    T3, Free, Serum or Plasma 2.4 pg/mL

    Platelets. 409 x10e3/uL
    Thyroid Peroxidase (Tpo) Ab 11 IU/mL

    Hi, dr. CHILDS, thank you very much for your great informations. My MD did lab test after I was persistent. I have all symptoms of of thyroid problem. My MD told me my test is negative. I do not believe she is correct. Am I right? Thank you very much. I also have SIBO.

  4. Hi,

    7 years ago I was feeling very sluggish and my hair was not growing and breaking.
    I was seen by an endroconologist and she did a number of tests. My Tsh was 2.7 but my antobodies were normal. She said we could try a small dose of synthroid to see.
    Fast forward 7 years to today, I am taking .75 synthroid and gained 15 pounds since even though I am a runner and mother of 4 children and never had a problem with weight at all. My hair became very thin since taking synthroid and weight loss is impossible.

    Looking back when this all started I was extremely low in ferritin and basically feel that was the cause of all my symptoms, I want to wean myself off synthroid but everytime I do I find it so hard as my body has become used to it.
    Can you help me find a way to wean off this medication so I can test my levels again ? My GP was surprised I WAS ever given synthroid as he said my levels were always fine.
    PLEASE HELP !!!!

    • Hi Catherine,

      It’s fairly easy to wean off the medication with your GP if you wanted, you would just incrementally reduce the dosage much like any other medication. I wouldn’t recommend that course of action without a deeper look into your other hormones and nutrients, however. Synthroid may be part of the problem for you, but it probably isn’t even the biggest problem or only problem.

      • Hello Dr Childs,

        My TSH is 3.4 and my t4 free level is 10. I am now back on Synthroid after stopping for almost 2 years. Can Synthroid cause weight gain ? I have had my reverse T3 verified and according to my doctor I am converting properly.

  5. One month ago I was officially diagnosed with Hashimoto’s Thyroiditis. My doctor actually did the TPO test and my level was 118, but my TSH was 0.73 so she decided that I should not take any hormone replacement. I have always been anemic and for the last 3 years I have been severely vitamin D deficient, and now I am vitamin B12 deficient. All the endocrinologist wants me to do is take more vitamins…Biotin and to stop taking my birth control, DEPOV shot. I am still gaining weight (even though I am on a prescription diet pill and go to the gym 3 to 4 times a week). I break out in blisters on my lips, mouth, nose and even in my hair, whenever something is going wrong in my body. This has been happening ever since I had Rheumatic Fever when I was 13. I have had shingles twice and I am not even 50 years old yet. In the last 6 months, I have had numerous infections, sinusitis, bronchitis, strep throat…etc. This last month I haven’t been sick except the blisters. I have a standing order for Valtrex which works sometimes and sometimes not at all. My hair is still falling out, I loose my train of thought frequently and I am not healing very well. I am not a diabetic, my blood sugar levels are “normal”. I am very frustrated.
    12 years ago I was having “thyroid storms” and had the radioactive iodine uptake test which the specialist told me showed that I had all the normal levels of thyroid hormone except the one that makes the rest of them circulate throughout the body so I was building up hormone and then getting a massive rush of hormone that was causing the storms. He told me he didn’t know what was wrong, but that my thyroid was dying and I should just wait for it to die. Since then, I lost 100 pounds through a low carb diet and strength training exercise. I worked hard to lose the weight. I felt better and the storms stopped happening.
    Now I am back to barely having energy to get up and go to work (I’m a teacher). Thank Goodness school is out for the summer, but I need some answers. I am so tired of doctors telling me to wait and see.
    My current doctor wants to wait until August to run more blood test and if the node on the left side has gotten bigger, we will do an ultrasound in August, too. My next appointment isn’t until November! I can’t handle this wait and see kind of medicine. What can or should I be doing?

  6. 2/3 forms of T2 are biologically active. They directly stimulate mitochondria. Over a decade of italian rat studies, and bodybuilder usage confirm this.

    • Hi Bob,

      Great point, when it comes to physiologic control I am always interested in how much something is helping. So when we talk about thyroid hormones stimulating mitochondria it’s important to understand if that effect is a 1% boost or a 100% boost. In both instances the mitochondria are being stimulated, but one results in physiologic difference and improvement.

      • Its not 1% https://link.springer.com/article/10.1007/s10863-016-9686-4 . And we should all wonder why the original researchers who studied these substances 60 years ago just didnt swallow some of them to prove to themselves they weren’t inactive(or maybe synthetic T4 was just toooo profitable, despite being provably inferior to desiccated thyroid). Body builders use them and can raise their temperature a few degrees(can be bought over the counter) Whats more impressive is that both T3 and T2 stimulate insects energy rates even if those insects don’t produce those hormones(is it really more of a catalyst than a hormone?). T3 generally acts like juvenile hormone III https://www.ncbi.nlm.nih.gov/pubmed/?term=insects+diiodothyronine

        • Hi Bo,

          Sorry, I wasn’t suggesting that it was 1% as I haven’t seen the data, I was just using that to illustrate the concept. I’ll have to look into these studies further, but it seems interesting at first glance – thanks for sharing. I can say from clinical experience that not everyone responds to NDT, but an equal proportion of people don’t really respond to T3 either. On the flip side T3 (and/or NDT) can be absolutely life changing for other people.

          While T2 certainly has value, I wonder how much value it has to those with inadequate T4/T3 levels vs those with presumably normal thyroid status (body builders). If you have any experience please feel free to share.

  7. On 6/21/16 I had triple bypass surgery, after which I went into atrial fibrillation and was treated with IV Amiodarone. Oral Amiodarone was prescribed when I was discharged from hospital. The same day I was discharged, I went into a fib again at home and had to be readmitted to hospital. The cardiologist took me off Amiodarone and put me on a low dose of generic Synthroid to treat subclinical hypothyroidism. She suggested that the Amiodarone may have had a role in causing this condition. When I went to my follow up appointment with my internist, he re-tested me and expressed his vehement disagreement with the decision to start me on Synthroid. At that time (7/25/16) my TSH was 9.2 and T4 free was 1.1. He basically said it is a best medical practice not to treat subclinical hypothyroidism and that I should be retested in 6 months or so, ostensibly to see if the condition had progressed to clinical hypothyroidism. In March 2017 my TSH was 8.97 and T4 free was 0.9, which is at the very bottom of the normal range. Again, he said no treatment was warranted, even though I was having symptoms of extreme lethargy and some of the other symptoms associated with an underactive thyroid. Fast forward to July 2017, when I again went in to see my internist regarding my continuing fatigue/lethargy symptoms. We changed some of my meds that he thought could be causing drowsiness. He did not think I needed to be retested for thyroid issues, but was not against doing it if I insisted. I did not insist, but am now thinking that I should have, as I continue to have the same troublesome symptoms. What do you think?

  8. Hi Dr Childs.
    I have been having subclinical hypothyroidism for nearly 4 yrs now. It started off as subclinical hyperthyroidism which was followed by hypo-. Initially my TSH was only mildly elevated n t3 t4 were normal. So my doctor advised no treatment. I didn’t have any symptoms that time. over the years I’ve put on weight. around 10 kilos I guess. I always was an anxious person since a child. But it used to not bother me so much. now since a couple of months I started losing a lot of hair (so much that I kinda have small bald pathces). I get non specific fevers (all tests negative) once in 3-4 months..which was attributed to stress by my doctor. My Hb has reduced to 9. I’ve been having severe lethargy for a year now, associated with chronic fatigue, muscle aches n all. I know all these symptoms point to thyroid dysfunction, but I didn’t pay much heed to them (even though my TSH has risen to 7) until my sleep and mood started deteriorating since 1 & half months. I feel very low sometimes and easily irritated or agitated. Extremely labile emotionally! I always used to be an over thinker..but now it has tripled..to say the least. Sometimes I just cannot control my thoughts. Trivial things irritate me..which didn’t before. My anxiety has increased a lot. My mood is so affected that I actually consulted a psycho therapist! I don’t get good quality sleep at night which directly affects my mood. And these symptoms become unbearable during PMS! Since I was told that subclinical hypothyroidism doesn’t need treatment, I thought my symptoms suggested a psychiatric disorder, which freaked me out even more! But after reading your article I began to wonder if all these have any relation to my thyroid. I need to know whether I should go ahead with thyroid evaluation or to a psychiatrist. Please help me doc!

  9. Hi there! I’ve been diagnosed with PCOS in 2012 and was recently diagnosed with Subclinical Hypothyroidism in 2017.
    I already had symptoms of hypothyroidism when I was on PCOS medication (it wasn’t caused by medication as such but I was feeling more symptoms coming up) and it deteriorated (fainting spells, lethargy) in the beginning of 2017. I was tested for TSH/T4 and it showed that my TSH has been consistently increasing but the gynaecologist could not treat me. I’m not sure if my new appointment to the endocrinologist might help if they ask me to get off my PCOS medication. Would both conditions be clashing each other?

  10. Hello Dr Westin, My name is Romina and I am so happy to have discovered your website!There is so much awesome information and it so well explained that it would be great if not only the people who have issues whith their Thyroid, but also other Doctors, could read it to find out the correct way to treat their patients. I have a 6 year old daughter who has ADHD, but I can see that she doesn’t have a lot of energy, and I have also noticed that she has a bulky thyroid (goiter?). For that and other reasons I have asked her pediatrician to perform a few tests to check my daughter’s thyroid. She did, and although she didn’t order all the tests that I requested, the ones that came back were enough to see that something seems to be wrong (to my view, not hers). From what I see I think that my daughter could have subclinical hypothyroidism (his father has hashimoto) and I told that to her pediatrician and she told me that is normal that TSH changes while the kids are growing, and with those values nobody will treat my daughter until the values show that she really has hypothyroidism (so I have to wait until her body destroy her thyroid?). I’m not really interested in give her any conventional medicine, but if I should to give her any, this would be NDT. Could you please help me with my daughter, I know that the Dr didn’t order the TPO that is crucial to verify if she could have hashimoto (the autoinmune diseases runs in my family, my mother suffered from diabetes and rheumatoid arthritis). I’ve been researching about hypothyroidism for a while and about treatment with NDT, and so many things more, to help my husband to have a better quality of life, and now I’m very worried about my daughter’s health, and afraid that if I don’t do something about it now, this issue could become worse in the future. Would you tell me please what lab test should I ask her pediatrician to perform and what kind of treatment would you apply if she were your daughter?. I really hope to receive an answer from you and I’ll appreciate it a lot! Hope to hear from you soon, thanks!!!

  11. I’m sorry Dr, I forgot to put the lab results.
    tsh: 6.71
    Free T4: 1.2
    free T3: 3.5 Thyroglobulin Antibodies:1
    thyroglobulin: 14.5


  12. Dear Dr

    I am 76 yrs and have had Adrenal Burnout for 7 yrs. My TSH is 8.8 P ESR 87…..( I have had a bilateral knee replacement 21 mnths ago ) Immature Granulytes is H 1.10 Parathyroid 85( I have had 1 removed at age 63…with the tumour ( carsinoid Syndrome)Calcium 2.49 All my parathyroid are situated on top of my thyroid. I am taking 2 Tabs of natural L TYROSINE… I am running on chronic cortisol levels due to many yrs of stress which is due to a mitochondrial shortfall which is also in my family of 5 children and the father which has passed away at 63 due to alcoholism.. I have been on NAD co enzyme for 13 yrs under quidance of my mentor Theo Verwey Clinical Psychologist.. at the moment my Lactate Glucose Levels cellular ATP count is 38 and should bea minimum of 100 I have increased the NAD according to the calculator prescription. I have had MRI brain showed I am Brain aged 4O My appearance about 60 and SCIO count age 64….I have never smoked or drank and do a health life style and diet with lots of fresh products and no junk food. I have now Autonomic Neuropathy in my hands due to the high Thyroid TSH count. I have managed ot regulate the pain leve for 10/10 to 2/10 with fish oil lecithin and flax seed oilo.. however there is a problem with my blood and the scio shows I have started 2% leukemia… do you have any further advice for me. I am trying to control my cortisol levels but have an extremely challenging family and as the mitochondrial shortfall present in all of them with different excessive behaviour spectrums life has not been easy,,, My serotonin level is 18 currently and I have retired at the coast in S.A. and am trying to rest as much as I can but SCIO scan shows I am into Cushings… Any suggestions or advice will help.

  13. Hi Westin,

    My TSH is 4.17, so I’m going to get the other tests ASAP. Is this subclinical and can be reversed to normal or am I too far gone to restore thyroid health without drugs? Should I start the drugs or try to save it naturally? I don’t want to start them and become reliant but then I don’t want to get worse!


  14. What if the Hashimoto’s and slightly hypothyroid person easier lose than gain weight ( TSH is around borderline of official medicine reference range ~ 5 ) and is on the other side of the weight spectrum and want to gain some weight in a healthy and natural way instead of losing it? The idea is to start the diet changes like elimination diet for example, but before that, it would be wise to gain some weight as a precautionary measure – how to achieve that goal?

  15. I am confused about why my doc has me on thyroid meds. I have no symptoms at all. 5’7” and 125 lbs my whole life and I am 63! Always eat organic and no junk foods. No fatigue or depression or anything. I feel great! But he said my TSH at 5.5 is too high when he ran lab tests as an overall checkup. I REALLY don’t want to take meds I do not need.

    Any advice is appreciated.

  16. Thank you for writing this. I have been having terrible trouble as of recently and none of the doctors I have seen will listen. I have a family history of hypothyroidism so I recognize the symptoms but there’s some weird ones in there too. I had a doctor in 2014 who ran appropriate tests and my T4 free came back high several times, but only slightly and my TSH levels have only once been below 2 since then (while I was on Metformin). In 2014 I was sent to and endo who didn’t rub the same tests and completely dropped the ball but didn’t find out until recently. At the time I had dropped 40 lbs over 6 months for no reason, and then started to gain steadily. I have not stopped gaining since. My TSH has been steadily climbing and is now at 3.86 as of May this year while I was on Metformin. I recently got off Metformin for liver issues but my symptoms didn’t go away. The liver issues have cleared up and still no relief.

    I also have a diagnosis of PCOS (hence the metformin), as well as Vitamin D and Vitamin B12 deficiencies.

    I am 33 and weigh 200 lbs, but I work out 5 days a week, eat a 1900 calorie diet and eat as organic and gmo free as possible. I have massive food allergies which keep my diet limited to begin with. I was an althete in high school and college and maintain an active life style. This weight gain is absurd! I take a multitude of supplements to compensate for my poor nutritional options, and my research has led me to find that some of these medications can lower TSH readings. Is this true? None of the doctors I’ve seen seem concerned.

    Lately I can barely stay awake and my brain fog is horrible. I have been so irrationally crabby and mean too. I also can’t keep my blood glucose above 100, even 90 can be a struggle sometimes. My BP is pretty low too, 101/69 was my lowest reading before I stopped tracking a couples weeks back. And my body temp has been consistently in the 96 and 97’s which is not normal for me. I also feel nauseated and get hot and cold flashes. I’m almost always hot but the cold is new. I’m so lost and have completely lost faith in the medical communityThank you for writing this. I have been having terrible trouble as of recently and none of the doctors I have seen will listen. I have a family history of hypothyroidism so I recognize the symptoms but there’s some weird ones in there too. I had a doctor who ran appropriate tests and my T4 free came back high several times, but only slightly and my TSH levels have only once been below 2 since then (while I was on Metformin). At the time I had dropped 40 lbs over 6 months for no reason, and then started to gain steadily. I have not stopped gaining since, that was in 2014. My TSH has been steadily climbing and is now at 3.86 as of May this year while I was on Metformin. I recently got off Metformin for liver issues but my symptoms didn’t go away.

    I also have a diagnosis of PCOS (hence the metformin), as well as Vitamin D and Vitamin B12 deficiencies.

    I am 33 and weigh 200 lbs, but I work out 5 days a week, eat a 1900 calorie diet and eat as organic and gmo free as possible. I have massive food allergies which keep my diet limited to begin with. I was an althete in high school and college and weight lifted in my 20’s. This weight gain is absurd! I take a multitude of supplements to compensate for my poor nutritional options, and my research has led me to find that all of these medications can lower TSH readings. Is this true? None of the doctors I’ve seen seem concerned.

    Lately I can barely stay awake and my brain fog is horrible. I also can’t keep my blood glucose above 100, even 90 can be a struggle sometimes. My BP is pretty low too, 101/69 was my lowest reading before I stopped tracking a couples weeks back. And my body temp has been consistently in the 96 and 97’s which is not normal for me. I also feel nauseated and get hot and cold flashes. I’m almost always hot but the cold is new. I’m so lost and have completely lost faith in the medical community. Any thing at this point is helpful.

    Thank you for your time.

    • Hi Shannon,

      Thanks for sharing your story and I’m sorry to hear about your struggles. You’ll find that your experience is not much different from many others on this site. The single best thing that you can do is to find a Doctor that can help you manage your condition. You will most likely have to seek outside of the conventional/insurance model in order to find help, however. I would recommend you check out this post which will help guide you to find the right type of doctor: https://www.restartmed.com/thyroid-doctor/

  17. Hello,

    I do not have my exact numbers in front of my, but my TSH was near 5 with FT3 and FT4 both in range, though near the upper limit. I do not have antibodies. I have symptoms such as fatigue, cold sensitivities, hair loss, and dry skin. Both my mother and sister are hypothyroid. My question is, is it possible that I have subclinical hypothyroid? Or, does it not make sense that this is causing my symptoms?

    Thank you!

    • Hi Ali,

      It’s very possible to have subclinical hypothyroidism, especially in the setting of the symptoms you describe here and an elevated TSH. Some doctors would even diagnose that as hypothyroidism if they are using the tighter TSH reference range of 2.5.

  18. I am a psychiatric nurse practitioner working on an inpatient unit. I suspect a moderate number of pts we see have subclinical hypothyroidism ( and are treated with antidepressants). BECAUSE of your amazing website, I am screening more pts for this, however, I have received push back from the hospital in regards to testing. They will not allow Free T3 or Reverse T3, and recommend I refer these folks to have this done on an outpatient basis. My question is this: the hospital does have a “thyroid panel” which includes a TSH,T3 uptake, T4, and T7. I am assuming these are not useful, as they are not mentioned in your blog that I can find. Do you have feedback on these particular labs? I am trying to be proactive, and make some positive changes within my organization to better serve our patients. I am able to order the above panel, or a Free T4— and that is all. So I have been ordering TSH and Free T4 and going from there, but I am frustrated– as that does not give us the full picture. I would appreciate any thoughts you have and thank you so much for your mission to educate the masses!!

    • Hi B Griffin,

      Glad to hear you are trying to help!

      Unfortunately, those tests (especially T3 uptake and T7) have very little clinical utility. You will find that inpatient lab testing will be limited because they are trying to be profitable by only running tests which they can run in house. Reverse T3 and free T3 often require specialty testing which means they have to send them out which may reduce profits.

      They are readily available at common lab companies such as Quest Diagnostics and LabCorp, however, so they shouldn’t be difficult to get as an outpatient.

      Profits and algorithms tend to take the place of 1-on-1 patient care which may help explain the abysmal outcomes that we are now dealing with in medicine and around the nation.

    • To B Griffin PMHNP, thanks for trying to change things and help people. We need more people like you.

      Hope you are doing well

  19. This article has helped me greatly. I’ve been googling “mild hypothyroidism” to no avail. My aunt is a nurse and told me “Subclinical hypothyroidism is nothing to worry about.” I didn’t believe that and I found this article. A few months ago I had extreme anxiety about a sore I found on my tongue. It turns out I was subconsciously chewing on it which makes me wonder if I might have an auto-immune (Hashimoto) condition but haven’t had blood work confirm that yet. My TSH is 4.8, the doctor said it’s nothing and sent me on my way. I have a scalloped tongue-doctors, nurse, ENT said it’s nothing. I developed a sore in my neck that very mildly hurt when I swallowed/yawned that lasted for months and now seems to be subsiding. My scalloped tongue remains. I’ll be returning to my GP for a total thyroid/inflammation panel prepared from this website and other sources. I’m going to change my diet in the meantime. I know somethings off and I’d put money on Subclinical hypothyroid. I’m going to aggressively seek to minimize and or hopefully eliminate overt hypo. Thanks a ton!

    • Hi Mike,

      No problem! Google has been suppressing some information such as that found on this blog because it is not in line with conventional thinking. You will find, however, that this information is still very relevant and applies to many people. Be sure you ask for a complete thyroid panel including antibody levels.

  20. Hi Dr. Childs, I have had symptoms of hypothyroidism for about a year (slight weight gain, sluggishness, brain fog, among others), so I pushed my GP for thyroid testing in April. My doc said TSH was high but they wanted to test again in 3 mos to confirm. Now it’s even higher- I have TSH 7.1, T4 free 0.94, and TPO antibodies 75. They said this suggests subclinical hypothyroidism (duh!). I have food sensitivities too and am wondering if you think the high antibody numbers suggest Hashimoto’s? My doc wants to give me levothyroxine and call it a day.

  21. Hello Doctor,

    I have subclinical hypothyroidism with TSH 7.5 with no antibodies and my Free t4 is 1.0 and T3 is 98. I never had thyroid issues in my life, but suddenly out of nowhere I started losing hair(diffuse hair loss all over my scalp) mainly at crown with less hair growth. Then I went to doctor and he took my thyroid test as I don’t have a family history of hair loss and (I have a long and healthy hair until 6 months ago). then my hair fall started and other symptoms like tiredness, flank pain sometimes and change in bowel movements. Right now, the doctor gave me levothyroxine 25mcg every day. how much time will it take to recover from subclinical hypothyroidism and hair recovery? Can you please let me know your views?

  22. Hi Dr. Childs,

    I was diagnosed with Subclinical hypothyroidism a few years ago. My TSH during my last test about 6 months ago was 3.5; Free T3=3.1; Free T4=1.2; Reverse T3=19. I haven’t taken any medicine just various herbs but my main symptom is sleep issues. I would really appreciate any guidance. Thank You!

  23. Hello my
    THS is 6.19 and has been over 4 for the past two years.
    My free T4 and free T3 levels are in range. And my T3 are low. I haven’t gotten the antibodies testing done yet. I’ve been trying many natural things for all my systems I’ve had the past two years. Unfortunely I continue to get worse. I really don’t want to have to get on meds for the rest of my life, and would love some advice and counsel.

    Thank you!
    Christine pillette

  24. Hi Dr. Childs,

    Thanks for your blog! Am a pre-menopausal woman and concerned that one side effect of going levothyroxine life-long (as you and my current doctor advocate), is that eventually our body stops producing enough thyroid hormones of its own. Am more inclined on an alternative model of treating this with a functional medicine practitioner. What are your thoughts on this?

    I seem to fit the picture of subclinical hypothyroidism with a mild goiter and clinical levels of 5.0 TSH for close to 2 decades. My previous doctors have agreed to leave it alone and keep monitoring. My bp, cholesterol, blood sugar levels have continued to stay normal and stable till date, with no mood swings or cold/heat intolerance issues (or any other symptoms as mentioned in your article).

    2 months ago, I avidly hiked at Rocky Mountain (including 14.5K altitude hikes). This was my first time at high altitudes for a 10-day trip. It was when coming back that I registered terrible fatigue (that lasted all day long), brain fog, hair fall…and ended up taking 2 days extra time off work. I also didn’t realize that my goiter had gradually swollen up (since we trekked in snow). Scheduled my annual exam right after, which is when my lab work showed 7.84 TSH (and no other thyroid tests were done). I also didn’t realize until very recently that my decision to go salt-free from age of 12 years onwards for 2 decades, meant that I could be having a silent iodine deficiency (hence the mild goiter). Also that high altitudes can and do disrupt thyroid functioning.

    Requested my new doc (previous one recently retired)to do a follow-up thyroid panel (T3,T4,TSH,TPO,iodine) some 6-8 weeks later, before starting meds. My fatigue, brain fog symptoms cleared on its own in 2 weeks. Started taking multivitamins, B12, folic acid and gradually started with iodized salt in my diet. I try to cut down my stress levels at work and prioritize a good night’s sleep daily. That alone, improved my symptoms and visible goiter levels drastically. My hair fall has slowed down by 65% and am seeing new baby hair growth. Currently, I can easily jog 4-6 miles each morning (decided to train for a half-marathon) and feel more alert, active for the past 4 weeks or so.

    Based on your article, am keen on looking into the micronutrient deficiencies (the selenium(30mcg), zinc(10mg), iodine (75mcg) levels on my daily multivitamins are quite low ~35-50% RDA) using an alternative medicine approach. I also am thinking of adding a Vitamin D3 supplement.

    My main concern is that my doctor has decided to put me on levothyroxine unless my TSH drops to 2.0, (which is realistically quite unlikely in my case to get there in a few weeks’ timeframe). She makes me feel powerless. Please advise.

  25. Hi Dr. Childs,

    Thanks, this is helpful! Just one last question: Am thinking to go with a functional medicine practitioner who is an expert on thyroid diseases vs a family care practitioner. That way, I can be more vigilant of my diet, lifestyle habits as well as how my meds are helping heal my thyroid. Your thoughts?


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