In this article, we explore what SCH really is, when to investigate further, and which patients may benefit from treatment (according to research), even when thyroid hormones appear “normal.” For a consultation with Dr. Radhika Kamat, the leading naturopathic practitioner in Singapore, please get in touch. She helps patients in person at her practice, and around the world online. Contact Feeling tired, foggy, or struggling to lose weight, yet your thyroid test says you’re “normal”? You might be dealing with something called subclinical hypothyroidism (SCH). This is a milder form of thyroid dysfunction that often doesn’t show up clearly on standard blood tests. But even so, it can still leave you feeling unwell. What is Subclinical Hypothyroidism? Subclinical hypothyroidism happens when your brain is working harder to get your thyroid to function; your TSH (thyroid-stimulating hormone) is high, but your actual thyroid hormones (T3 and T4) are still in the normal range. It’s like your body is saying: “Hey thyroid, I need more from you!’, but the thyroid isn’t quite responding yet. Common Symptoms of SCH Even though your thyroid hormones are technically “normal,” you might still feel off. Common symptoms include: Fatigue or low energy Weight gain or trouble losing weight Brain fog or memory issues Hair thinning or dry skin Mood changes like anxiety or depression Irregular periods or fertility issues Cold hands and feet Does this sound familiar? How Is Subclinical Hypothyroidism Diagnosed? Subclinical hypothyroidism is usually found when: TSH is between 4 and 10 (mild or Grade 1) TSH is above 10, but thyroid hormones are still okay (more advanced, or Grade 2) To confirm it’s not a temporary change, it has to be retested in 2–3 months. It is also important to check for thyroid antibodies (TPO) to see if your immune system is affecting your thyroid—a sign of an autoimmune condition like Hashimoto’s thyroiditis. Before Blaming the Thyroid… SCH symptoms often overlap with other common health issues. It’s important to rule out other causes like: Low iron Poor sleep or sleep apnea Anxiety or depression Chronic fatigue or fibromyalgia Treating the thyroid won’t help if one of these is the real issue. Special Case: Pregnancy & Fertility If you’re trying to get pregnant or are in early pregnancy, thyroid function is especially important. In this case: TSH should be below 2.5, especially if thyroid antibodies are present. If TSH is higher, treatment with thyroid hormone is usually recommended to reduce the risk of miscarriage. What Does the Research Say Regarding Thyroid Medication? In most cases, medication is not recommended right away for SCH, especially if you’re not having strong symptoms. Recent research shows that: Thyroid medication (like levothyroxine) doesn’t usually improve symptoms in mild SCH. It doesn’t lower the risk of heart problems. In older adults, it can actually cause more harm than good. But in certain cases, like TSH over 10, pregnancy, migraines, or heart issues, treatment might help. Natural Ways to Support Thyroid Health Many people with SCH can feel better with a more holistic approach: ✔️Nutrient Support with Right Dosages Here are some common examples although the list is not exclusive. Iron: Essential for thyroid hormone production. Vitamin D: Low levels may make SCH worse. Selenium, zinc, inositol and B12: Often helpful, especially in autoimmune thyroid issues. ✔️ Herbs & Lifestyle Adaptogenic herbs like ashwagandha and rhodiola may support overall hormone balance and energy. Stress management, better sleep, and anti-inflammatory foods can all support your thyroid naturally. Our Approach At our clinic, we take a whole-body view. We look at your nutrition, stress, hormones, immune system, and lifestyle to understand what’s really going on, rather than simply looking at your TSH. We focus on: Digging deeper with full thyroid panels Personalized nutrition and supplement plans Helping you feel better, naturally and safely Ready to Get to the Root of Your Symptoms? If you’re feeling off, but your thyroid labs are “normal,” you might be in the subclinical zone. Your body could be asking for support. Book a functional thyroid appointment, and let’s work together on finding a solution. Functional medicine in Singapore has helped many people heal naturally and effectively. References: A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism doi: 10.1016/s0002-9343(02)01022-7 A Comparative Study of Iron Status in Subclinical Hypothyroid and Euthyroid Subjects in a Tertiary Care Hospital doi: 10.7759/cureus.52007 Cardiovascular and bone health outcomes in older people with subclinical hypothyroidism treated with levothyroxine: a systematic review and meta-analysis doi: 10.1186/s13643-024-02548-7 Chronic anemia and thyroid function doi: 10.23750/abm.v88i1.6048 Comparison of Five Different Criteria for Diagnosis of Subclinical Hypothyroidism in a Large-Scale Chinese Population doi: 10.3389/fendo.2022.820414 Determinants for Thyroid Hormone Replacement Therapy in Subclinical Hypothyroidism: A Multicenter Electronic Health Records-Based Study doi: 10.1089/thy.2023.0062 Effects of Levothyroxine Treatment on Fertility and Pregnancy Outcomes in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials doi: 10.1089/thy.2023.0546 Incidence and Determinants of Spontaneous Normalization of Subclinical Hypothyroidism in Older Adults doi: 10.1210/clinem/dgad623 Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. Sharma AK, Basu I, Singh S.Journal of Alternative and Complementary Medicine (New York, N.Y.). 2018;24(3):243-248. doi:10.1089/acm.2017.0183.
