Hashimoto's Disease: What You Need To Know

For many people, Hashimoto's disease can progress slowly over time, often without the person realizing they have the disorder until years later. Hashimoto's disease may not present any noticeable symptoms in its very early stages.

The most common early symptoms that could be missed or misdiagnosed are fatigue, weight gain, dry skin, and sensitivity to cold.  Eventually, however, low thyroid hormone levels can lead to more serious symptoms, such as:

• Constipation

• Muscle weakness

• Muscle pain or tenderness

• Peripheral neuropathy

• Depression

• Memory loss

• Voice hoarseness 

• Sleep apnea

• Difficulty concentrating

• Puffy face

• Hair loss or thinning

• Enlarged thyroid gland (goiter)

• Joint stiffness or pain

• Changes to your menstrual cycle

If you experience one or more of these symptoms, don't hesitate to schedule an appointment with your doctor. Even though some of the symptoms of Hashimoto's disease could be viewed as minor or attributed to other lifestyle factors, seeking professional medical care sooner rather than later can prevent the disease from progressing and causing more serious symptoms.

Potential complications from Hashimoto's disease

Having the appropriate amount of thyroid hormones in your body is essential for its other systems to work properly. Because of this, untreated Hashimoto's disease and hypothyroidism can lead to serious complications, including:

Goiter

A goiter is another term for an enlarged thyroid. As Hashimoto's disease decreases the production of your hormones, the pituitary gland in your brain tries to encourage it to make more. As a result, your thyroid may develop a goiter. While goiters usually aren't painful, they can negatively impact the appearance of your neck and make it difficult to swallow and/or breathe.

Mental health concerns

Mental health issues are common among individuals with Hashimoto's disease, particularly depression.

Sexual and reproductive abnormalities

Hashimoto's disease can result in decreased libido, trouble ovulating, and irregular menstrual cycles in women. In men, Hashimoto's disease can result in reduced libido, a lower sperm count, and erectile dysfunction.

Cardiovascular problems

Hashimoto's disease can lead to poor heart health, irregular heartbeats, and an enlarged heart. It can also make you more likely to develop heart disease and heart failure as it causes high blood levels of LDL cholesterol.

Pregnancy complications

Untreated Hashimoto's disease can increase your likelihood of preeclampsia, miscarriage, stillbirth, or premature delivery. Babies born to women with untreated hypothyroidism are at a higher risk of experiencing low birth weight, congenital disabilities, and thyroid problems.

Papillary thyroid carcinoma

The risk for papillary thyroid carcinoma is increased in patients with Hashimoto thyroiditis.

Myxedema

Although uncommon, this condition can develop due to untreated hypothyroidism and is considered life-threatening. Symptoms of myxedema include skin thickening and swelling, swollen face and tongue, extreme lethargy, and low heart rate, this condition requires immediate medical attention.

How is Hashimoto's disease diagnosed?

Because the symptoms of Hashimoto's disease can also be attributed to many other medical conditions and lifestyle factors, it's important for your doctor to complete a thorough physical exam to determine whether you have Hashimoto's disease. Your doctor will likely review your medical history, perform a physical exam, and review your blood work in order to provide a diagnosis.

You can expect your healthcare provider to perform the following tests to determine if you have Hashimoto's disease:

T-3 and T-4 test

The main hormones that your thyroid produces are thyroxine (T4) and triiodothyronine (T3). If your blood work indicates that your hormone levels are low, this could be a sign that your thyroid isn't functioning properly.

TSH test

Your pituitary gland makes thyroid-stimulating hormone (TSH). When your pituitary gland senses low thyroid hormone in your blood, it increases TSH production to encourage thyroid hormone production. Because of this, high TSH levels are a sign of hypothyroidism.

Antibody test

Hashimoto's disease doesn't always cause hypothyroidism. Your doctor could have an antibody test performed to determine if it is. Typically, people with Hashimoto's disease will have thyroid peroxidase (TPO) in their blood, which could indicate that their immune system is, in fact, attacking their thyroid gland. However, some Hashimoto's cases may still show negative antibody tests.

Ultrasound

An ultrasound of the thyroid gland can be completed to examine the shape and size of the gland.

What are normal thyroid hormone levels?

When monitoring your thyroid hormone levels through blood tests, your healthcare provider will pay close attention to your TSH and T4, in particular. The normal range of these thyroid hormones are as follows:

• TSH: 0.5-5.0mlU/L

• Total T4: 0.5-12ug/dL

• Free T4: 0.8-1.8 ng/dl

• T3: 200-200 ng/dl

If you are pregnant, have a history of thyroid cancer or pituitary disease, or other medical conditions, your optimal thyroid hormone levels could vary slightly from these numbers.

The thyroid is a butterfly-shaped gland located in the front of your throat, below your Adam's apple. Your thyroid is responsible for producing hormones that help other functions of your body work properly, including your metabolism, heart rate, digestion, and mood.

When your thyroid releases too many or too few hormones, it's called thyroid disease. Thyroid disease can take many forms, including hypothyroidism, hyperthyroidism, thyroiditis, and Hashimoto's disease.

Much like other autoimmune disorders that involve the immune system treating healthy tissues in your body as if they were dangerous bacteria or another invader, no one knows exactly what causes Hashimoto's disease.

It's suspected that the following could contribute to Hashimoto's disease:

• Heredity: when compared to the general population, first-degree relatives of persons¹ with Hashimoto's disease have a nine-fold higher risk of developing the same condition

• Environmental factors, such as stress, radiation exposure, or viral infection

• Iodine-containing medications

• A combination of genetics and environmental factors

• Vitamin D deficiency²

Risk factors for developing Hashimoto's disease

While you can't prevent Hashimoto's disease, certain risk factors could indicate that you're more likely to develop this disorder, including:

• Gender: Women are more likely to develop it than men

• Age: While it can occur in anyone, it's more likely to occur in people who are middle-aged (30-50)

• Family history: If other people in your family have autoimmune disorders or thyroid conditions, you're more likely to also develop one

• Pregnancy: Hormonal and immune system changes during pregnancy can lead to Hashimoto's disease.

• Other autoimmune diseases: Conditions such as graves disease, lupus, type 1 diabetes, celiac disease, and rheumatoid arthritis put you at a higher risk of developing Hashimoto's disease

• Radiation exposure: Individuals exposed to high levels of radiation are more prone to Hashimoto's disease

If you are diagnosed with Hashimoto's disease, you will likely have to take synthetic thyroid hormone medication to combat your hypothyroid symptoms. If your symptoms are mild, your doctor may recommend monitoring your TSH through routine blood work without medication unless your TSH levels increase.

Synthetic thyroid hormone is called levothyroxine. Levothyroxine works as T4 would if it were naturally produced by your thyroid gland and then converts into T3.

Most people with hypothyroidism or Hashimoto's disease will have to take a form of synthetic thyroid hormone for the rest of their life. The purpose of this is to maintain a healthy amount of T4 in your body to perform normal bodily functions and reduce the symptoms of hypothyroidism.

Your doctor will create an individualized treatment plan based on the following:

• Your medical history, current medication conditions, and age

• The severity of your symptoms

• How well you've responded to medications or treatments in the past

• Any worsening of your condition over time

• Your preferences

Is thyroid surgery necessary to treat Hashimoto's disease?

Unless you are experiencing complications from another thyroid problem, such as cancer, having your thyroid removed isn't necessary to treat Hashimoto's disease and hypothyroidism. You can effectively manage the condition with medication and routine blood tests.

If you have a goiter that does not go away with medication or is causing problems, such as pain or difficulty breathing or swallowing, surgery may be necessary to remove it.

Maintaining the appropriate dosage of levothyroxine

Your doctor will prescribe a dosage of levothyroxine based on your weight, age, current TSH level, and other health factors. Six to eight weeks after your first dose, your healthcare provider will schedule blood work again to monitor your thyroid levels and adjust them if needed.

Once your doctor has found the appropriate dosage to maintain a healthy TSH level, you'll continue to take the recommended dosage once a day. You'll likely have blood work performed every 6-12 months to ensure that your levels are still within a safe, healthy range.

If you are pregnant, staying in close contact with your OB-GYN and endocrinologist is essential. You may need to have your levothyroxine dosage readjusted during pregnancy, along with more frequent blood tests performed. After you deliver your baby, you will likely be able to resume your normal medication dose. 

Promoting proper absorption of levothyroxine

What you eat can affect how your body absorbs levothyroxine, including certain foods, medications, and supplements. If you're currently taking other medications, supplements, or vitamins, be sure to let your healthcare provider know, including:

• Calcium 

• Iron

• Aluminum hydroxide (found in some antacids)

• Any psychotropic medication

• Heart medicines that contain iodine

To aid the proper absorption of levothyroxine, take it on an empty stomach at the same time every day. It is best to take it right after waking up in the morning. However, be sure to wait at least thirty minutes to one hour before eating or drinking any caffeinated drink as they can impact the absorption of levothyroxine. If you forget to take your daily dose of levothyroxine, resume your usual dosage the next day.

If you have been newly diagnosed with Hashimoto's disease, you may be wondering which healthcare providers can best help you treat your symptoms and manage your condition long-term. There are many doctors and specialists to choose from depending on the severity of your condition and other lifestyle factors, including:

Primary care physician (PCP)

If your family doctor is the one to diagnose you with Hashimoto's disease and/or hypothyroidism, they may also be the one to create your personalized treatment plan, monitor your symptoms, and prescribe medication as needed.

Endocrinologist

If your PCP doesn't feel comfortable monitoring your thyroid levels or your condition becomes difficult to maintain for any reason, they may refer you to an endocrinologist. Endocrinologists specialize in the diagnosis and treatment of the endocrine glands, including the thyroid gland. Endocrinologists are prepared to treat even the most complicated thyroid conditions and are up-to-date on the most recent, effective treatment options.

OB-GYN

If you are pregnant and have Hashimoto's disease, your OB-GYN may be able to adjust your medication accordingly to ensure that you and your baby stay healthy before and after delivery.

Psychiatrist

While a mental health professional may not be responsible for monitoring your thyroid levels or adjusting your levothyroxine dosage, they can help you manage your depression or other mental health concerns that can stem from Hashimoto's disease.

Before discussing your symptoms with your healthcare provider, it can be beneficial to prepare for your appointment. Keep these tips in mind to help your doctor's visit go as smoothly and productively as possible.

Before your appointment

• Identify what you'd like to accomplish at the appointment, including questions you'd like answered.

• Write down any symptoms you're experiencing, including those you think are unrelated to your thyroid, and when they began.

• Write down any questions you may have about your symptoms or treatment options.

During your appointment

• Write down any new diagnoses, medications, or treatment guidelines your doctor gives you.

• Ask about alternative treatment or medication options

• Ask why a particular test or medication is being given and about any potential side effects 

• Bring a friend or family with you to ask questions and listen closely to the doctor's instructions

After your appointment

• Follow your doctor's treatment instructions.

• Do not skip or stop taking your medication without permission from your doctor.

• Write down any side effects or new symptoms you experience

• Contact your doctor if your symptoms get worse, you develop new symptoms, or you become pregnant