Nine years ago, Maressa Brown, now 36, was working out regularly, eating clean—and gaining weight. Then she started feeling fatigued, mentally foggy, and constantly chilly. Her periods, which typically had been regular, stopped. The combination of symptoms made her suspect that her thyroid might not be functioning as it should, so she headed to an endocrinologist (a doctor specializing in treating hormone and endocrine disorders) to get hers checked. The doctor tested her TSH (thyroid-stimulating hormone released by the pituitary gland), which is the main way to check for thyroid issues. He said her results—over 4 mIU/L—were normal and she didn’t need to be treated.
“It didn’t make sense,” Maressa says. “I was having all of these symptoms, but he was telling me there wasn’t anything wrong.”After two months, she didn’t feel any better, so she saw a holistic OB/GYN, who looked at her test results and said her TSH was too high. Working with the OB/GYN and a naturopathic doctor, she started treatment. Almost immediately her periods came back and her symptoms improved.
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How Common Are Thyroid Issues?
The debate about when to treat thyroid issues has been going on for decades. More than 12 percent of Americans (and roughly 16 million women) develop issues with their thyroid, which produces hormones regulating body functions like metabolism. About 1 percent of Americans will have hyperthyroidism, when the thyroid produces too much TSH, leading to symptoms like weight loss, insomnia, and an irregular heartbeat. More common—affecting about 5 out of every 100 people—is hypothyroidism, when the thyroid gland doesn’t produce enough hormones, so the pituitary gland produces more TSH (hence a high TSH number) to stimulate the thyroid.
What Are the Symptoms, and How Are They Treated?
In either case, medications can normalize thyroid hormone levels. For an underactive thyroid, synthetic thyroid hormones are given to replace what the body isn’t producing; for overactive, medications stop the thyroid from pumping out excess hormones. And then there are women like Maressa, whose TSH levels are within the range of what experts say is normal but who still experience symptoms. This “subclinical hypothyroidism” may affect up to 10 percent of women. A normal TSH ranges from about 0.4 to 4. Some physicians treat a 2; others hold off until 10, says Martin Surks, M.D., an endocrinologist at Montefiore Health System in New York City. This past spring a panel of experts weighed in, advising that medication shouldn’t be given to adults with a mildly underactive thyroid—anything under 10. The reason? The majority of research suggests there’s little benefit in doing so.
Doctors started squabbling about borderline low thyroid—generally a TSH between 4.5 and 10—in 2004. An article in The Journal of the American Medical Association noted there was no solid evidence that treating borderline cases helped people feel better. Around the same time, the National Academy of Medicine and the U.S. Preventive Services Task Force released similar guidelines. So why does controversy linger? The data at the heart of the papers showing whether or not treatment helps is “a bit of a mess,” says Surks, who coauthored the JAMA paper. The studies were small, and researchers didn’t factor in things like age. “TSH levels tend to increase as people get older, and generally this isn’t harmful,” says David Cooper, M.D., director of the thyroid clinic at Johns Hopkins Hospital.
Adding to the confusion, symptoms of an underactive thyroid can also be caused by many other disorders, explains Elizabeth Pearce, M.D., president of the American Thyroid Association and professor of medicine at Boston University School of Medicine. Women with normal thyroid function may also have some hypothyroid symptoms. Another factor in deciding whether to prescribe meds is warding off other health issues. Some doctors treat to prevent cardiovascular problems, but the research about that is mixed, and a too-high dose of levothyroxine (thyroid hormone replacement) can slightly increase the risk of an erratic heartbeat, known as arrhythmia, and bone loss.
With so much debate among doctors, the best approach for patients with a TSH under 10 may be to watch and wait. If you’re having symptoms and your doctor says your TSH levels are only mildly elevated, experts suggest testing your levels again in three to six months and checking T4 levels (T4 is the primary hormone that helps regulate your body functions). The exception is women who are pregnant or thinking about having a baby; hypothyroidism is linked to higher rates of miscarriage and preterm births. If you’re having symptoms and your numbers are mildly elevated, it’s reasonable to try medication.
When Will My Thyroid Problems Symptoms Subside?
Treating a thyroid condition can take time. Some people start to feel better within a few weeks, but it can be six months for symptoms to fully resolve, Pearce says. And the dosage often has to be adjusted. If your thyroid hormone levels are off, there is good news. Although people who take medication may have to remain on it for life, a recent study found that more than half of people with borderline hypothyroidism were able to come off the meds without their TSH levels (or symptoms) increasing. "There’s no harm in a six-month trial of a low dose,” Pearce says.
If the meds don’t help, it might feel disheartening, but now your doctor knows to dig into other causes, Pearce says. The trial was still a step toward feeling better.