Treating Hashimoto's Thyroiditis With Normal TSH

New Research Says It Can Help

Blood Sample Tube in Hand
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Many thyroid patients wonder if having Hashimoto's thyroiditis -- with otherwise normal reference range results for thyroid blood test levels -- should be treated.

Many endocrinologists believe that having elevated Thyroid Peroxidase Antibodies (TPOAb) is not enough reason for treatment, as long as the blood tests are otherwise "normal."

Still, many patients who have TSH, Free T4 and Free T3 levels that fall within the reference range can experience a range of hypothyroidism symptoms -- including fatigue, weight gain, brain fog, depression, swelling, joint and muscle aches and pains, hair loss, and other problems, as a result of their underlying autoimmune thyroid disease.


The conventional view of Hashimoto's disease is thought to depend on the thyroid blood test results. If the TSH shows overt hypothyroidism -- often defined as levels above 10.0 - then most conventional physicians believe treatment is recommended. 

In those patients who are considered "subclinical" -- with elevated TSH that does not exceed 10.0 - some conventional doctors recommend treatment, but others recommend a "watch and wait" approach.

This watch and wait approach is often recommended -- even when patients have significantly elevated thyroid antibodies, and numerous symptoms, including goiter (an enlarged thyroid gland.)  

Complicating this controversial situation is the fact that research has shown that in those patients with elevated TPOAb, treatment with thyroid hormone replacement medication can actually reduce the antibodies, prevent progression to overt hypothyroidism, and help alleviate symptoms in a significant percentage of patients.

In one study of patients who had Hashimoto's disease, but whose TSH thyroid levels were normal (referred to as "euthyroid"), one group of patients received levothyroxine (LT4) treatment, and the other group did not receive treatment.

After 15 months, the treated group had major changes in their thyroid test levels, including significantly increased Free Thyroxine (Free T4) levels, significantly decreased TSH levels, and a reduction in both anti-thyroglobulin antibody (TgAb) and TPOAb.

The actual size of the thyroid also decreased in the treated group, while those not receiving treatment had an increase in the size of their thyroid.

The researchers reported that although levothyroxine treatment is "mandatory in hypothyroid autoimmune thyroiditis patients, the LT4 treatment which is shown to inhibit autoimmune process in animal models is still controversial in euthyroid Hashimoto's disease patients where the disease has not destroyed the thyroid gland enough to cause hypothyroidism."

They found, however, that LT4 treatment at doses keeping TSH at low-normal levels appears to be effective not only in decreasing the antibody levels but also in the goiter size, which could ultimately prevent progression to overt autoimmune hypothyroidism.

What Can Patients Do?

It's important to recognize that this is a controversial issue, and doctors view the issue in different ways. If you are found to have elevated TPOAb with symptoms, but you are denied treatment by a conventional doctor or endocrinologist because you have levels in the reference range, you should consider consulting with an integrative physician who specializes in autoimmunity, and/or thyroid and hormone balance. These physicians are more likely to consider the bigger picture, and are more willing to treat "subclinical" hypothyroidism, or to prescribe thyroid hormone replacement medications to address elevated antibodies and autoimmune Hashimoto's disease.



Source: Duygu Yazgan Aksoy, et. al. "Effects of Prophylactic Thyroid Hormone Replacement in Euthyroid Hashimoto's Thyroiditis" Endocr J (Japan) Vol. 52: 337-343, (2005).

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