Hashimoto's disease is an autoimmune disorder that affects the thyroid gland. An autoimmune disorder is an illness that is caused by your body's immune system attacking healthy tissue.
Hashimoto's disease is also commonly referred to as Hashimoto's thyroiditis, chronic lymphocytic thyroiditis, and chronic autoimmune thyroiditis.
In the case of Hashimoto's disease, the immune system works against the thyroid gland, which causes it to stop producing an adequate amount of thyroid hormones.
The disease is the leading cause of hypothyroidism after the age of 6, also known as an underactive thyroid. However, on rare occasions, it can lead to a hyperactive thyroid.
Anyone can develop Hashimoto's disease, but it is most common among middle-aged women.
Hypothyroidism occurs when your thyroid gland doesn't produce enough hormones to support the normal functions of other systems in your body.
Hypothyroidism can develop in people for a variety of reasons but, in the case of Hashimoto's disease, it occurs because your immune system is attacking your thyroid; this causes a large number of white blood cells and various antibodies to pool inside the thyroid, blocking vital receptors and decreasing the production of thyroid hormones.
Untreated hypothyroidism may go unnoticed in its earliest stages, but will eventually lead to symptoms that can range from mild to severe, including weight gain, fatigue, joint pain, and cognitive and psychiatric disorders.
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:
Muscle pain or tenderness
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.
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:
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.
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.
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.
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.
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.
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.
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.
An ultrasound of the thyroid gland can be completed to examine the shape and size of the gland.
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:
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
A combination of genetics and environmental factors
Vitamin D deficiency²
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
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.
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.
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:
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:
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.
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.
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.
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