Why Waiting Makes You Sicker – The Shocking Truth About Subclinical Hypothyroidism

Foreign. Today is a solo episode, and it's been a while since we've hung out, just you and I. So I'm excited about it. And we are talking about a topic that I am incredibly, incredibly passionate about, and it is subclinical hypothyroidism. Doesn't sound interesting. Y' all bear with me, because this episode is going to blow your mind. Let's talk first about what subclinical hypothyroidism even is and why I feel so strongly about it. So the definition of subclinical hypothyroidism is an elevated TSH with a normal T4. Okay, so think of that as your body is working harder to produce hormones, but you're still able to make adequate amounts of your inactive thyroid hormone. And the reason this is a big deal right now is because this is a lot of the occurrences where people go in and you get labs drawn and you have all these thyroid symptoms, and your clinician says, you know, you've got this mild thing going on, but it's not bad enough to treat. Let's wait. We'll recheck it again next year. And you leave usually pretty disheartened, usually pretty frustrated because you feel horrible, but no one wants to do anything about it. And not only does that compromise your quality of life, it compromises so much more. Today we're going to talk about what else happens in the case of subclinical hypothyroidism, what medicine says about it, as well as my approach. So for the last several years, I really noticed it Starting in about 2018, 2019, medicine has begun to more and more further stratify people with all these different. In all these different ways, whether it's age, whether it's labs, whether it's continent, whatever it is, and say that we should not treat them, that we should delay treatment. And this really started in the world of subclinical hypothyroidism with two main studies. Ride this out with me, all because it's fascinating, and you won't honestly hear this Anywhere else. In 2004 and in 2019, two different studies were published that completely transformed thyroid care in America. And I think because of that, worldwide, what they found in these studies and this, how they were structured, is they took a bunch of people on medication, on love with Iraq, and determined if their quality of life scores improved, if their symptoms reduced with treatment. And what these studies determined was, look, people are really not getting better with treatment in all these different ways until they're severe. So until their TSH is over 10, nothing really changes in these quality of life scores. So let's not treat them with subclinical Hypothyroidism where their T4 is okay, but their TSH is elevated until their TSH is above 10. And so that is starting to spread in the traditional medical sector. And a lot of clinicians are now not treating people with subclinical hypothyroidism until their TSH is over 10. Some studies y' all advocate for holding treatment until TSH is over 20. So I don't know how high you've experienced your TSH being, but those people are disabled at that point, right? I even think above 10 you're borderline disabled. If not already can't function in your life, relationships work home. Well, there's a key flaw in the study design and the interpretation of this data. I'm going to give you a moment to think about what that might be. So if we are saying that because people are not getting better with treatment until they are profoundly severe, and therefore concluding that we shouldn't treat them until they are profoundly severe, we should probably ask ourselves if the problem isn't treating too early, treating when their TSH isn't crazy high. What if the problem is that the medication doesn't work for any percentage of people? But both of these studies that literally shifted the paradigm in thyroid started with the assumption that levothyroxine works and therefore when people take it, they should get symptomatic improvement, when in fact for a huge percentage of the population, levothyroxine will never work, it will never get the job done, and people will perpetually be symptomatic. So that doesn't mean we shouldn't treat them. And in fact it means perhaps, maybe we need to look at alternative treatment options and not put every single person with hypothyroidism on the same exact hormone based medication. Because that's levothyroxine, Synthroid, tyrosine, unitheroid, Levoxal, all of these medications are from the same hormone. It's an inactive hormone that so many people have difficulty activating. So they'll never get better. It doesn't matter how much Synthroid you're on, how much T percent you're on, if you can't convert that inactive crude oil hormone to gasoline, you're not going anywhere in your car. And that is what's plaguing our country with thyroid symptoms. And it's a shame, because even the most recent study, the one from 2019 has been cited over 350 times in other studies, meaning it's presumed to be valid. We are basing clinical paradigms, medical paradigms, on these two studies that are, in my opinion, completely invalid. So, long story short, my view of subclinical hypothyroidism is that it's hypothyroidism, it's overt hypothyroidism. It should be treated way earlier than a TSH of 10. In my opinion, if your TSH is over 2, you need treatment because you're symptomatic. But I want to go deeper than that in this conversation. I want to talk to you about long term health outcomes that are associated in research with subclinical hypothyroidism and let you see for yourself is it overt or is it truly subclinical and shouldn't be addressed. So I want to read to you different parts of our physiology and talk about how they're impacted specifically with subclinical hypothyroidism. And I want you guys to remember this is hypothyroidism that medicine doesn't want to treat. This is when they want to tell you you've got a little thyroid problem. It's not bad enough to treat, come back. So if you've heard that, if you know someone who's heard that, please share this episode with them because in my opinion, this is one of the biggest drivers of chronic disease in our country today that we can easily intervene with. So let's talk first about cardiovascular disease. Cardiovascular disease is what we all need to be concerned with. It kills more people. It actually kills one and a half times more people than all cancer combined every year. So I know we talk a lot about cancer. Naturally we're geared to be afraid of cancer. But y', all, cardiovascular disease is what comes for us and this is important. So A study in JAMA in 2010 with over 55,000 patients determined that people with subclinical hypothyroidism, or Sch, had a 68% higher risk of heart attack. 68%. They also had a 37% increase in cardiovascular death. That seems important. That seems like something that we should treat. Additionally, metabolic health, non alcoholic fatty liver disease. That's a big one. Okay. A huge percentage of the American population end up with this. 36% of non alcoholic fatty liver disease patients were hypothyroid, subclinical and regular with treatment. They were had fatty liver. So very, very significant. Subclinical hypothyroidism people have a two to three times higher odds of becoming insulin resistant. And insulin elevations are one of the key measures of our long term health outcomes. It can predict with very good accuracy what our future health picture looks like. So two to three times increased risk is not okay when it comes to brain health. Thyroid is so incredibly important, obviously for mood, for depression, for anxiety, for all of these things. But even low functioning thyroid, even people with treatment like T4 Levothyroxine based meds, the majority of people on those classes of medications still have persistently low T3 active thyroid hormone, or what I described a minute ago as your gasoline hormone. And free T3 correlates with a 1.8 times increase for dementia. So your risk for dementia is 1.8 times higher if you have low T3 subclinical hypothyroid patients though, y', all, if their TSH was over 10, they had a 3 times higher risk of dementia than people when they were compared to what's called euthyroid. Let's talk about some other important health outcomes when it comes to frailty, bone health, et cetera. So sch or subclinical people were found to have a 1.3 times higher risk of osteoporosis as compared to euthyroid. Women over 50, both were women over 50. Additionally low T3, right. That your gasoline hormone is linked to 1.6 times higher odds of frailty, which we know very much is linked to health outcomes. How good our lifespan, our health span, all the things, which is why we emphasize building muscle so much and prevention of osteoporosis, osteopenia. And then, you know, there's the concept of the human cost of ignoring subclinical hypothyroidism. I mean, why are we doing that? Thyroid hormones, thyroid medications are cheap, labs are readily available, it's safe, it's effective. I think we should be asking ourselves why? Why are we working so hard to treat less people, which in the end result is leading to increases in obesity, insulin resistance, cancer, frailty, dementia, Alzheimer's, neurodegenerative conditions. And I didn't even touch on all the pieces here today. We just talked about some big rocks. But here is the message. We need to be treating more people for thyroid because thyroid is the root cause of so much of our chronic disease burden in our country today. We need to stop the direction of heading towards always free, further and further stratifying people into different groups and removing them. The treatment category, if you're elderly, if you're overweight whatever it is, we need to be treating every single person with subclinical hypothyroidism. If we know that even mild thyroid dysfunction in the realm of subclinical hypothyroidism increases your chance of heart disease by 68% and your chance of dying of a heart attack by 37%, then those are good implications to tell us clearly. Let's not wait. So then is the cost of the human experience, right? I was 27 when my life was completely derailed, most recently with my thyroid condition and I was spending 16 hours a day in bed. I would easily be on disability by now. I would have missed out on all if I could have still gotten pregnant. I would have missed out on the joys of motherhood, of being able to not just survive to raise my children, but actually take joy, spend time with them, do things, go outside. And I think so many mothers right now are robbed of that, that sacred opportunity that doesn't really come back later. We can't go back to those early years that happen to coincide when so many women are struggling deeply in the throes of hypothyroidism. So we also don't want long term health outcomes of diabetes, high cholesterol, all of these things. If we can simply fix the thyroid. When I was 27 2, I had high cholesterol. The doctor wouldn't change my thyroid medication from Synthroid or adjust it, but they would put me on Lipitor. I mean, thankfully I declined that, but still, you know, I find the opposite of what the studies in 2004 and 2019 stated. I find, look, if someone's TSH is over 1.8, they improve with treatment. Now we only use combination treatment, we only use T4 with T3 or T3 alone, et cetera. So people always get some form of active thyroid hormone. But our success rate is absolutely different than the studies show. Our people do feel better. Their quality of life measures significantly improve. Their life completely changes. So again, that points to the fact that it's not that we shouldn't treat people until their TSH is over 10. We need to be asking the hard question is, is levothyroxine working? Should it actually be the standard of care? Because I think until we rethink that, until we start to look at people as individuals that need individualized treatment for therapies, medications, doses, approaches, we are going to not only have a country filled with millions of women who are robbed of the joy and quality of their life, we are going to further and further contribute to the long term health outcomes that destroy lifespan. Healthspan but also it is an incredible, incredible economic burden to our country that we could shift in a powerful way and change the trajectory of, of the health of our nation and the economy of our nation.