Q: I often feel tired and, after some routine tests, found out I have subclinical hypothyroidism. I’m 50, a bit overweight and have a busy, full-time job. The GP will monitor my thyroid function and says I don’t need treatment, but I’m wondering if I would feel better with a top-up of thyroxine?
Hypothyroidism is when the thyroid gland in your neck is underactive, leaving you unable to produce enough thyroid hormones. this can lead to the metabolism slowing. people often don’t notice the changes. these can be varied and vague: you may become sensitive to the cold, suffer from tiredness, dry skin, thinning hair, weight gain, constipation and muscle aches. It can slow thinking, speech and movements, as well as cause brain fog, reduced libido and low mood.
An underactive thyroid is diagnosed by examination and a blood test showing low thyroxine levels, along with raised thyroid stimulating hormone (TSH), which tells your thyroid that it needs to produce more thyroxine.
However, subclinical hypothyroidism – the condition you have – is common and affects up to 20 per cent of adults. It means that you have a slightly raised TSH level of between four and ten milliunits per litre of blood (mlu/l), even though your actual thyroxine levels remain within normal limits. We have increasingly been giving people in this group thyroxine tablets – but is this benefiting them? Or are we just adding more tablets, risking unnecessary side-effects and possible overtreatment? Taking medicine can be a nuisance. so if you are prescribed thyroxine alongside products containing iron or calcium, they must be taken four hours apart. And regular blood tests are required to monitor thyroxine levels.
Reassuringly, in around two thirds of people like you, TSH levels return to normal without any treatment. there is also variation – women and people of Caucasian origin tend to have higher levels, which also rise naturally with age, stress and other illness.
A recent review in the British Medical Journal states that ‘for adults with subclinical hypothyroidism, thyroid hormones demonstrate no clinically relevant benefits for quality of life or symptoms and may have little or no effect on cardiovascular events or mortality’.
Your doctor has probably arranged another blood test to look for thyroid antibodies. If it’s positive, you will need to be monitored, as over time these antibodies can attack your thyroid, reducing your ability to produce thyroxine. If your TSH creeps above ten mlu/l, your doctor is likely to recommend regular thyroxine treatment.
For now, regular monitoring is likely to be the best strategy. If symptoms remain troublesome, you may see if you feel better on treatment. In the meantime, you could have another chat with your doctor about your tiredness. For more information, visit btf-thyroid.org
The therapy that’s music to our ears
The music therapy charity Nordoff Robbins helps change the lives of thousands of people, many of whom live in challenging circumstances – in particular, children or adults living with conditions such as learning difficulties, mental health issues or autism.
Music therapy allows for expression and interaction, which for some people may not be easy in words.
I am keen to highlight the work of Nordoff Robbins, since the son of good friends of ours – who was diagnosed with autism at a young age – was encouraged through the charity’s support.
Being acutely sensitive to noise – the sound of someone closing a door a street away could send him into a state of hysteria – he could choose the sounds he made, and the instruments. the calming regularity of the beat gave him security and reassurance – and this in turn led to his love of music. the social interaction has also helped him in other areas of his life. See nordoff-robbins.org.uk/what-is-music-therapy.