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Thyroid health plays a pivotal role in regulating metabolism, energy levels and overall well-being.1 Among the spectrum of thyroid disorders, subclinical hypothyroidism often flies under the radar due to its subtle symptoms. However, its implications on weight management warrants closer attention. Taking a closer look into what subclinical hypothyroidism entails, its connection to weight loss challenges, the importance of appropriate testing, and how excipients in medications can influence thyroid hormone absorption can help many patients with this elusive condition.
Subclinical hypothyroidism (SCH) is a mild form of hypothyroidism where the thyroid gland doesn't produce enough thyroid hormones to meet the body's needs, but the deficiency isn't severe enough to cause overt symptoms. It's characterized primarily by elevated thyroid-stimulating hormone (TSH) levels, while free thyroxine (free T4) and free triiodothyronine (free T3) levels remain within the normal range but might not be what is considered optimal. When TSH is elevated, this indicates that the pituitary gland is sending out a stronger signal to the thyroid to produce more hormones.2 It is always important to look at a complete thyroid panel to obtain the full picture, such as looking at both the free T4 and free T3. T4 is a prohormone for T3, and the body converts it to T3 as it is needed. T3 is the hormone that actually interacts with the receptor and does the work, so to speak.3
Thyroid hormones are integral to regulating metabolism — the rate at which the body converts food into energy. Even subtle imbalances can influence weight management. When thyroid levels are lower, the metabolic rate is slowed as well as the patient typically is more fatigued. A sluggish metabolism can make weight loss more challenging. And a patient with low energy has a difficult time staying committed to an exercise regimen.
However, it's essential to note that the relationship between SCH and weight is complex. While overt hypothyroidism is more directly linked to weight gain, SCH's impact can vary among individuals. Some may experience weight fluctuations, while others may not notice significant changes.2
Accurate diagnosis is crucial for effective management of SCH, especially when addressing weight-related concerns. As previously mentioned, TSH, free T4 and free T3 are essential to be included in the thyroid panel. In addition to those components, it is also very beneficial to look at peroxidase antibodies (TPOAb). If these antibodies are elevated, it can indicate autoimmune thyroiditis, a common cause of SCH.4 In addition to antibodies, a lipid panel is essential since thyroid hormones can influence cholesterol metabolism. For some patients, an atypical rise in lipids is a sign that there could be thyroid dysfunction.5
The decision to treat SCH hinges on several factors, including TSH levels, presence of symptoms, age and underlying health conditions.2 It is also key to evaluate adrenal function before beginning thyroid supplementation. Adrenal insufficiency is actually a contraindication for thyroid replacement.6
When it comes to managing SCH, thyroid hormone replacement therapy, such as levothyroxine or Thyroid USP (Porcine), is commonly prescribed. However, the efficacy of these medications isn't solely dependent on the active ingredient. Excipients play a crucial role in the drug's absorption and effectiveness. Common excipients in thyroid medications include fillers such as lactose, microcrystalline cellulose and magnesium stearate. Excipients can influence how well the active hormone is absorbed in the gastrointestinal tract.7 For instance, certain fillers might bind to thyroid hormones, reducing their availability, while others, such as PCCA LoxOral®, can enhance dissolution, potentially leading to improved absorption.
Subclinical hypothyroidism is a nuanced condition that, despite its subtlety, can influence various aspects of health, including weight management. Recognizing its signs, understanding the importance of appropriate testing and being aware of how excipients affect medication absorption are vital steps in effective management. If a patient suspects thyroid imbalances or is facing challenges with weight management despite a healthy lifestyle, consulting with a healthcare professional for comprehensive evaluation and personalized treatment is essential. Pharmacists should empower patients with knowledge and help them take proactive steps towards optimal thyroid health and overall well-being.
These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care or encourage its abandonment.