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The Silent Thyroid Epidemic

The Silent Thyroid Epidemic

Perhaps you are one of the millions of Americans who have one or more signs and symptoms of low thyroid such as fatigue, weight gain, dry skin, poor memory and focus, and depression. Yet your doctor runs a basic thyroid test and tells you that all is well. Things just do not seem to add up. There is a good chance you do have a thyroid problem…but just not what your doctor thinks.

I have found in my 26 years of practice and research that the frequency of thyroid disease in America is closer to 25% of the American population! And there are so many signs and symptoms that suggest possible hypothyroidism:

  • Decreased appetite
  • Sleep problems
  • Muscle pain, joint pain, weakness in the extremities
  • Emotional lability
  • Constipation
  • Menstrual disturbances, impaired fertility
  • Decreased perspiration
  • Paresthesia and nerve entrapment syndromes
  • Blurred vision
  • Decreased hearing
  • Fullness in the throat, hoarseness
  • Slowed speech and movements
  • Jaundice
  • Pallor
  • Coarse, brittle, straw-like hair
  • Loss of axillary hair, pubic hair, or a combination
  • Dull facial expression
  • Coarse facial features
  • Periorbital puffiness
  • Macroglossia
  • Goiter (simple or nodular)
  • Decreased systolic blood pressure and increased diastolic blood pressure
  • Bradycardia
  • Pericardial effusion
  • Abdominal distention, ascites (uncommon)
  • Hypothermia (only in severe hypothyroid states)
  • Nonpitting edema (myxedema)
  • Pitting edema of lower extremities
  • Hyporeflexia with delayed relaxation, ataxia, or both

Remember that your thyroid gland produces thyroid hormones, which are the main hormonal drivers of your cell metabolism and the burning of calories.

Do You Have Subclinical Hypothyroidism?

Many people have what is called subclinical hypothyroidism. This is a condition where one does not have overt or easily recognizable hypothyroid (low thyroid) on a lab test…unless you are trained like me in detecting subtle imbalances that cause huge health problems. Doctors need to understand that a patient’s signs and symptoms are just as vital as lab testing. If you have several hypothyroid signs and symptoms, then you probably do have a thyroid imbalance.

According to the Endocrine Society, subclinical hypothyroidism is more prevalent than typical hypothyroidism (based on regular lab testing). Subclinical hypothyroidism is referred to in conventional medicine as when the TSH (message from the brain telling the thyroid to produce more or less thyroid hormone) is mildly elevated, but the circulating thyroid hormones (T4 and T3) are normal. The TSH is usually less than 10mIU/L but above the reference range of 5.5 mIU/L. People with subclinical hypothyroidism have a high rate of progression to overt hypothyroidism

Holistic Thyroid Ranges

However, holistic doctors, such as myself, use tighter reference ranges. Also, we pay close attention to a patient’s signs and symptoms. One may have “normal” thyroid lab values but have problems with their thyroid activity. In my opinion, this would fall into the category of subclinical hypothyroidism. One of the explanations for this is that we can only measure the blood level of thyroid hormones. We do not measure thyroid activity inside the cell, which is the most critical level. This is why a person’s signs and symptoms may be indicative of subclinical hypothyroidism even though the blood work does not identify a problem. The typical doctor in America does not consider this fact and disregards the patient’s symptoms.

Now getting back to thyroid hormone lab testing, it is likely your doctor tests TSH hormone. The higher the number, the more hypothyroid you are (it may seem confusing, but it is the opposite of what some think initially, the higher the TSH, the more messaging from your brain (pituitary gland) telling your thyroid to produce more hormone).

The National Academy of Clinical Biochemists suggests that TSH levels should be lower than 2.5 mU/L as this is what is found in more than 95% of normal individuals There are several other tests you will want to check. This includes the actual hormones that have activity in your cells, which include Free T3 and Free T4. Out of these two, it is the Free T3, which is the most powerful in terms of potency. I also test reverse T3, since an elevated level blocks the active Free T3. And it is always important to check thyroid antibodies since autoimmune thyroid disease known as Hashimoto’s Thyroiditis is by far the most common cause of hypothyroidism.

Following is a summary of thyroid tests I order with patients:

TSH (Thyroid Stimulating Hormone)

Typical range is 0.3-0.5 to 5.5 mU/L

Optimal  range is 0.5 to 2.5 U/L

Free T3

Typical range is 2.4 to 4.2 pg/mL

Optimal  range is 3.0 to 3.8 pg/mL

Reverse T3 (rT3)

Typical range is 9.2−24.1 ng/dL

Optimal range is mid-range

Thyroid antibodies (thyroid peroxidase, thyroglobulin)

Levels should be lower than the range given by the laboratory

Important Note 1: Biotin supplementation may alter thyroid function tests and should be avoided for two days before blood is drawn.

Important Note 2: If you are on thyroid medication, it is best to be consistent on the time of day when you have your blood drawn. It is usually recommended to have testing done first thing in the morning (fasting not required) before taking thyroid medication or supplements, or 4 hours or longer after taking drugs or supplements.

Take Action

If you have signs or symptoms of subclinical hypothyroidism or have suboptimal thyroid lab testing, then work with a holistic doctor to achieve thyroid balance. At the Stengler Center For Integrative Medicine, we help patients with subclinical hypothyroidism on a daily basis.

Coming soon in Dr. Stengler’s News and Breakthroughs: Foods and supplements that improve thyroid function as well as the effective use of natural thyroid hormones.


Fatourechi, Vahab. “Subclinical Hypothyroidism: An Update For Primary Care Physicians.” Mayo Clinic Proceedings 84, no. 1 (2009): 65-71.

“Thyroid Function Tests | American Thyroid Association.” American Thyroid Association, Last modified 2019.

Wartofsky, Leonard, and Richard A Dickey. “The Evidence For A Narrower Thyrotropin Reference Range Is Compelling”. The Journal Of Clinical Endocrinology & Metabolism 90, no. 9 (2005): 5483-5488. doi:10.1210/jc.2005-0455.