Can Hashimoto’s Disease Be Reversed?

Hashimoto's disease is a genetic autoimmune disorder that causes an underactive thyroid gland. Put simply, it causes your body to make antibodies that attack your thyroid gland, damaging it so it doesn't make enough hormones. It is the most common form of hypothyroidism.

Rarely, Hashimoto’s disease causes an overactive thyroid gland, or in some cases, an overactive thyroid gland initially, followed later by an underactive one. It can also cause a goiter (swelling of the thyroid gland).

What are the risk factors for Hashimoto's disease? 

The risk factors for Hashimoto's disease are:

• Having a relative with Hashimoto's disease

• Being female (Hashimoto’s disease is 4–10 times more common in women)

• Being 30–50 years of age, as Hashimoto's disease usually first shows symptoms in this age range

• Having another autoimmune disorder such as celiac disease or type 1 diabetes

• Hepatitis C infection

What are the symptoms of Hashimoto's disease?

Symptoms are similar to those of other forms of hypothyroidism and only develop after you have had the condition for a while. They include:

• Reduced tolerance to cold temperatures 

• Weight gain

• Fatigue

• Joint and muscle pain

• Constipation

• Dry skin

• Dry, thinning hair

• Heavy or irregular menstrual periods

• Reduced fertility

• Slowed heart rate

• Brain fog, which can resemble dementia

• Depression or irritability

• A goiter (swelling of the thyroid gland)

Different people may get different symptoms depending on how their body reacts to it. If untreated, hypothyroidism can lead to an increased risk of heart disease.

How is Hashimoto's disease diagnosed?

Your doctor will take a complete medical history and ask about your symptoms. They may feel your neck to check for a goiter. However, the diagnosis is usually confirmed with blood tests. Your doctor will test for:

• High levels of TSH (thyroid-stimulating hormone). This is the most reliable way to detect hypothyroidism. Low levels of TSH indicate an overactive thyroid. When your thyroid doesn't produce enough hormones, your pituitary gland tries to ‘wake it up’ by producing more TSH.

• Low levels of thyroxine (T4) and triiodothyronine (T3), the hormones produced by the thyroid gland

• Thyroid peroxidase antibodies (TPO), a key indicator of Hashimoto's disease (as opposed to other causes of thyroiditis)

Hashimoto's thyroiditis is, thankfully, a manageable condition.

Is Hashimoto's disease curable?

Unfortunately, there is no cure for Hashimoto's disease and no way to reverse the damage done to your thyroid gland, but it is a manageable condition. While there are promising studies into ways to cure Hashimoto’s disease in the future (such as with stem cell therapy), currently, Hashimoto's disease can only be managed, not cured.

Does Hashimoto's disease always lead to hypothyroidism?

Not always. In rare cases, people with Hashimoto's disease may remain asymptomatic. Sometimes the disease can lead to the thyroid becoming overactive (hyperthyroidism), which is also easily detectable with blood tests.

Additionally, some people with Hashimoto's disease never develop clinical hypothyroidism despite having high levels of anti-thyroid antibodies. The clinical condition may be triggered by stressors such as age or pregnancy.

Can hypothyroidism be cured?

No, but you can lead a normal life with treatment. With some forms of thyroiditis, your thyroid will recover and return to normal. However, with Hashimoto's disease, the damage to the thyroid gland is ongoing, so no ‘remission’ is possible.

There are currently no treatments that can heal a damaged thyroid or cause it to increase its production of hormones.

Can Hashimoto's disease be prevented?

There is no known way to prevent Hashimoto's thyroiditis. The primary cause of the condition is genetic, and if you are born with the risk factors, you are likely to develop Hashimoto's disease. There are no known lifestyle changes that can slow the development of Hashimoto's disease. However, eating a healthy diet and getting regular exercise are recommended to improve your overall health.

If you have a family history of Hashimoto's disease or an underactive thyroid, you should talk to your doctor about getting your thyroid levels checked every year during your routine physical examination. This can allow the disease to be caught early before it causes any damage to your thyroid gland and your body in general.

How is Hashimoto's disease treated?

Hashimoto's disease can't be cured or reversed. However, it can be treated and managed so that you have few or no symptoms and can lead a normal life.

If you aren't showing signs of hypothyroidism, your doctor will most likely just check your thyroid levels regularly. This may allow you to spot a problem before you develop symptoms. 

Some people with Hashimoto's disease never develop actual hypothyroidism (and some people with hypothyroidism don't have Hashimoto's disease).

If you do have hypothyroidism with symptoms, your doctor will most likely prescribe medication.

Medication

The most common treatment for hypothyroidism is levothyroxine. This is chemically identical to thyroxine (T4) and is taken orally once daily. Traditionally a pill, it's also available as a liquid or soft gel for people who find swallowing pills difficult. 

The medication should be taken at the same time every day on an empty stomach. Many doctors recommend taking it when you get up, 30–60 minutes before breakfast, but you can adjust this schedule to one that works for you.

If you are on levothyroxine, don’t take it too close to consuming coffee, soy products, and calcium or iron supplements. If you miss a dose, take it as soon as you realize, unless you are close to your next dose, in which case you should skip the missed dose.

Levothyroxine overdose is commonly asymptomatic but can result in various symptoms, including chest pain, irregular heartbeat, diarrhea, fever, headache, irritability, and seizures. If you get symptoms after taking too much levothyroxine, seek immediate medical help as, in rare cases, it can cause fatal heart problems.

Because levothyroxine is identical to thyroxine, it has few side effects, which can include:

• Headaches

• Nausea

• Diarrhea

• Changes in weight

• Changes in appetite

• Changes in the menstrual cycle

• Increased sensitivity to heat

• Hair loss

• Joint pain

• Leg cramps

• Fever

It often takes a few adjustments to get the dosage right. You will typically get a blood test after six weeks and then after six months to check the dosage is working for you. After you and your doctor have found the right dosage, you will have a blood test every 6 to 12 months, as your natural thyroid hormone levels can fluctuate. If your thyroid symptoms return, you should speak to your doctor, who might need to check your medication dose.

If you become pregnant, you should talk to your doctor because your medication dose will most likely need to be increased to compensate for the extra strain on your thyroid caused by the baby. Levothyroxine will not harm your unborn baby.

While levothyroxine is the standard treatment, there is an alternative medication – desiccated thyroid extract (usually under the brand name Armour Thyroid). There is little difference between the treatments, but in a small study, some people felt better on desiccated thyroid extract.¹ The extract is seldom recommended as a first-line treatment for hypothyroidism but might be used if you react to levothyroxine.

Typically, you will take levothyroxine for the rest of your life. For some other forms of thyroiditis, you may be able to stop taking this medication after a certain period. 

To establish whether it's safe to stop, your doctor will typically reduce your dose and see if symptoms return or if your TSH levels go up. However, you will remain on this medication for the rest of your life in most cases.

It may help to set a reminder to take your medication at the same time each day as your body has a good reservoir of thyroxine, and you will not be able to tell from symptoms alone that you have missed a dose.

Diet 

Typically, there are no dietary recommendations for Hashimoto's disease because, for most people with Hashimoto's disease, dietary interventions are of limited value. It is worth talking to a nutritionist if you still have symptoms while on medication or are otherwise concerned for your health. 

One common recommendation is to avoid seaweed and iodine supplements, as iodine can make hypothyroidism worse in some people. Consider switching to salt made without iodine and/or reducing your salt consumption.

Some people also find they feel better on the Mediterranean diet, which builds meals around whole grains, beans, and vegetables, includes fish at least twice a week, fruit for dessert, and uses olive oil in place of butter where possible.

Lifestyle changes

While exercise has no direct effect on thyroid levels, it can improve your overall health and energy levels. Exercise intolerance can happen with untreated Hashimoto's, so your doctor may recommend not starting an exercise program until you have been on levothyroxine for a few weeks.

You should also try to reduce your stress and get plenty of sleep.

There are no other specific lifestyle changes recommended. The primary treatment for Hashimoto's disease is levothyroxine to normalize thyroid hormone levels.

If you still have bothersome symptoms after you have been on levothyroxine therapy for a while and are showing normal thyroid levels, talk to your doctor. Something else may be causing your symptoms.

Does Hashimoto's shorten your lifespan?

There is no evidence that treating Hashimoto's disease results in a shorter lifespan. However, untreated Hashimoto's disease can be associated with conditions, such as cardiovascular complications, that can shorten your life. 

Some people may have both Hashimoto's and another autoimmune disease, which can affect lifespan.

It is important to take your medication regularly and get your dosage checked as recommended by your doctor.

Can people with Hashimoto's disease safely get pregnant?

Low levels of thyroid hormones can cause fertility issues and pregnancy complications. Specifically, it increases your risk of:

• Anemia

• Miscarriage

• Preeclampsia

• Placental abruption

• Postpartum bleeding

It can also harm your baby and result in stillbirth, premature birth, low birth weight, and birth defects. Your baby may also develop thyroid problems. It is best not to try and get pregnant until the medication has stabilized your thyroid hormone levels.

Your thyroid hormone levels should be checked frequently during pregnancy as it is normal to have to increase your levothyroxine dosage to help support your baby. Once you have given birth, your dosage will be adjusted or reduced.It is completely safe to breastfeed while taking levothyroxine. Because levothyroxine mimics a natural hormone, even though small amounts can be expressed in breast milk, it will not harm your baby. You should continue to take your medication as prescribed throughout the breastfeeding period.

The lowdown

Hashimoto’s disease is an incurable autoimmune disease, but it is a manageable condition that most people live well with. 

Most people with Hashimoto's disease live a normal lifespan and have a good quality of life. Talk to your doctor if your thyroid levels are normal and you still have symptoms, as it could indicate another condition.