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Hypothyroidism: Treatment or Monitoring

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When your thyroid function is low, you may feel tired, weak, and depressed, and you may gain weight. Hypothyroidism is the term for too little production of thyroid hormone, while hyperthyroidism is the term for too much. Dr. Jesper Karmisholt and colleagues at Aahus University Hospital in Denmark provided a review of subclinical hypothyroidism, a mild form that is very common and sometimes temporary.

There are two standard blood tests for hypothyroidism: thyroid stimulating hormone (TSH) and thyroxine (T4). When thyroid function is too low, the TSH value is too high, because it is the body's signal to the thyroid to produce more metabolism regulating hormones, including T4. Karmisholt defined subclinical hypothyroidism as a condition with TSH above the normal range, but T4 in the normal range. Approximately 5 to 8 percent of patients with subclinical hypothyroidism progress per year to standard hypothyroidism, with both TSH and T4 out of range.

Patients with standard hypothyroidism are treated with replacement levothyroxine. Those with subclinical hypothyroidism may be monitored without treatment. “It has been, and still is, much debated whether the abnormality should be treated with levothyroxine (L-T4) or not,” Karmisholt reported.

Karmisholt recommended the following schedule for monitoring persistent subclinical hypothyroidism:

1. Evaluation of TSH, T4, and symptoms every 6 months for the first 2 years.
2. Evaluation every year after 2 years.
3. After 3 years, monitoring can be stopped for patients with no symptoms, goiter, or signs of autoimmune disease.
4. Monitoring should be restarted if the patient gets pregnant, develops hypothyroid symptoms, or presents for general health evaluation.

The National Institutes of Health's PubMed web site gives possible causes of hypothyroidism:

1. Autoimmune damage, also known as Hashimoto's thyroiditis.
2. Viral thyroiditis.
3. Sheehan syndrome, a condition that may occur in a woman who bleeds excessively during pregnancy or childbirth.
4. Congenital defects.
5. Treatment for hyperthyroidism, including radioactive iodine, surgery, and drugs.
6. Radiation treatment for neck cancers.
7. Drugs used to treat other conditions, including lithium (for bipolar disorder) and amiodarone (for heart ventricular arrhythmias).

Women have more hypothyroidism than men, and age greater than 50 years is also a risk factor. Karmisholt reported that the causes of subclinical hypothyroidism resemble the causes of standard hypothyroidism, with autoimmune thyroiditis as the most frequent.


1. PubMed Health. Hypothyroidism. Web. August 28, 2011.

2. Karmisholt J et al, “Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy”, European Journal of Endocrinology 2011; 164: 317-23. http://www.ncbi.nlm.nih.gov/pubmed/21208994

Reviewed August 31, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith

Add a Comment2 Comments

What about eating or not eating certain foods? W2W recommends foods like sea vegetables, nuts, and oysters. https://www.empowher.com/thyroid-hormones/content/thyroid-does-it-determine-colors-you-see#comment-96413 Anything else?

October 10, 2011 - 6:23pm

Some of the biggest problems when patients are dealing with possible hypothyroidism is:

1) the different ranges that have been considered acceptable for the TSH, whether it is the actual range itself that different medical communities use, or the fact that some people may feel hypothyroid with a TSH of 3 while others will not,

2) Recent published studies suggest that although a patient may have a normal TSH, they could still be suffering hypothyroidism if their thyroid antibodies are elevated,

3) Some patients, once diagnosed as hypothyroid, may do better on different medications than standard synthetic T4. Some people do well on the generic synthetic T4, and some patients do better on a combination T3/T4 desiccated thyroid medication.

For many years patients have been lead to believe that once their TSH has risen to a level totally outside of range, that one little pill once a day will resolve all hypothyroid symptoms. This is not true for all cases. If the hypothyroidism is caused by Hashimoto's Disease, (or Graves' Disease since once a patient is diagnosed as Graves' Disease the prime objective is to lower their thyroid function which in turn usually leaves them hypothyroid), there needs to be more understanding of the big picture of autoimmune disease. Any patient diagnosed with an autoimmune disease is more likely to develop another autoimmune disease, and patients need to understand this and develop ways to control their health as much possible.

I just wanted to let people keep these things in mind, as more and more research is showing how complex this disease truly can be

September 6, 2011 - 10:23am
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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