Do I worry for Borderline or Subclinical Hypo-Hyper-thyroidism?

What are subclinical or borderline thyroid problems?

When the level of thyroid hormones (T3 and T4) are normal and there is a variation in the level of TSH, it is called as subclinical or borderline thyroid disorders i.e., with high TSH, it is called as subclinical hypothyroidism and low TSH called as subclinical hyperthyroidism.

You are not expected to have symptoms of low or high thyroid with these reports, so it is also called biochemical hypo- or hyperthyroidism, as the abnormality is in blood report.

Does subclinical hypothyroidism need to be treated?

There is an ongoing debate regarding the significance of Subclinical Hypothyroidism and the need for treatment. More awareness and frequent blood checking made subclinical hypothyroidism commoner.

The body always try to correct abnormality, so unless there is pressing reason we prefer to wait and see for some time with a repeated blood test.

Subclinical hypothyroidism needs to be treated in

Pregnant women
Women planning conception
Men taking treatment for infertility
People with elevated cholesterol levels
Cardiac abnormalities, heart failure
Depression

Does subclinical hyperthyroidism need treatment?

It is always better to do a retest of the thyroid functions after 3-4 weeks and then decide on the further course of action. If you are symptomatic it may be worthwhile to start on a small dose of anti-thyroid medication.

If there is failure to decrease the levothyroxine dose when TSH level is suppressed below the normal range which can occur without the free T4 level rising above normal.

This state is considered to represent subclinical hyperthyroidism and although formerly it was thought to be harmless, it is now believed to be associated with undesired effects on bone density(osteoporosis) and cardiac function and to be a possible cause of neuropsychologic symptoms and other mild manifestations of hyperthyroidism.

Is spontaneous recovery possible in subclinical thyroid disorders?

Yes, a person with both subclinical hypothyroidism and hyperthyroidism can spontaneously recover. This is why we prefer to wait and see for sometime before starting treatment.

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