How Does Hashimoto’s Thyroiditis Progress And What’s My Outlook?

Hashimoto's thyroiditis is the most common cause of underactive thyroid, affecting thousands of people around the world. It is not curable, but most people with it can live completely normal lives with treatment.

What is Hashimoto's thyroiditis?

If you have Hashimoto's thyroiditis, also called Hashimoto's disease or autoimmune thyroiditis, then your immune system is attacking cells in your thyroid gland. This results in your thyroid being unable to make enough of the hormones you need for normal function.

Thyroid hormones regulate different functions in your body, including metabolism, so this can lead to systemic symptoms - such as your body slowing down because it can't get enough energy.

Hashimoto's disease is primarily genetic, so you are more likely to suffer from the condition if someone in your family has suffered from it.

However, there are also some factors that increase the likelihood of developing Hashimoto’s.

Risk factors for Hashimoto's thyroiditis

Known risk factors for Hashimoto's thyroiditis include:

• Age (typically it presents between 30 and 50 years old)

• Female gender

• Family history

• Excessive iodine intake

• Radiation exposure

How is Hashimoto's disease diagnosed?

Hashimoto's disease generally manifests with symptoms of hypothyroidism, which vary from person to person, but can include:

• Weight gain

• Hair loss

• Depression

• Brain fog/mild cognitive impairment

• Fatigue

• Lack of tolerance for cold

• Dry skin

• Joint stiffness

• Constipation

• Irregular or heavy menstrual periods

• Slowed heart rate

• Thick or brittle nails

These symptoms can indicate a variety of other problems. The diagnosis of Hashimoto’s disease is usually based on your signs and symptoms and a number of blood tests.

Blood tests include thyroid-stimulating hormone (TSH) and free thyroxine (T4) level, which would reflect your overall thyroid function.

An elevated level of Thyroid Peroxidase Autoantibodies, which are the antibodies that attack the enzymes in your thyroid, means that you likely have Hashimoto’s disease.

However, the treatment for hypothyroidism is the same regardless of the cause.

How is Hashimoto's disease treated?

The go-to treatment for Hashimoto's disease is hormone replacement therapy with levothyroxine¹. This is chemically identical to natural thyroxine and thus typically has few or no side effects.

Levothyroxine is also the standard treatment for other forms of hypothyroidism.

Levothyroxine is taken orally every day and should be taken at the same time every day. Most doctors recommend taking it 30 to 60 minutes before breakfast, but the key factor is to take it at close to the same time.

If you miss a dose, you should take it when you notice unless it is close to the time for your next dose. You should not double up on doses, as this can cause symptoms of hyperthyroidism.

The medication is typically well-tolerated and is safe to take while pregnant or breastfeeding.

However, if you do become pregnant you should have your thyroid levels monitored. Sometimes the extra burden of the baby requires you to increase your dosage of levothyroxine to compensate.

There is no special diet necessary for Hashimoto's disease, although some people benefit from an autoimmune diet.

Medication is typically the only treatment recommended, although you should avoid eating soy products, calcium supplements, or foods high in calcium, and grapefruit close to your dose as it can interfere with absorption.

What are the stages of Hashimoto's disease?

Hashimoto's disease is a progressive disease that causes damage to your thyroid gland that eventually results in hypothyroidism. Some doctors consider there to be stages of Hashimoto's, which are:

Genetic predisposition

Hashimoto's thyroiditis is known to run in families and affects women more frequently than men.

Immune cell infiltration

This is when your immune system starts to create antibodies that attack the thyroid. At this point, some – but not all – people express antibodies in their blood. However, as this is not routinely checked for, Hashimoto's disease is typically missed at this stage.

Your doctor may order a test for the antibodies if you are over 30 and have a first-degree relative with Hashimoto's.

Subclinical hypothyroidism

The antibodies start to damage your thyroid, which will become underactive, though, you typically don't experience any symptoms.

Some people may start to experience very mild symptoms, including weight gain and fatigue. If you are being screened, then elevated TSH levels will start to show up.

It is important to get your thyroid levels checked if Hashimoto's thyroiditis runs in your family.

Overt hypothyroidism or full-blown disease

The majority of people with Hashimoto's are diagnosed at this stage and have to immediately go on hormone replacement therapy.

Unfortunately, routine thyroid screening for people at average risk is not cost-effective and, therefore, many cases are undiagnosed until they have symptoms.

The end-stage of Hashimoto's is when your thyroid has become so damaged that you no longer have enough thyroid hormones and have to go on medication.

Is Hashimoto's disease fatal?

With treatment, people with Hashimoto's disease can have a normal life expectancy. It is sometimes comorbid with other autoimmune disorders, which may cause different issues.

Untreated Hashimoto's disease can lead to damage to your heart, increasing your risk of heart disease.

In severe cases, it can lead to myxedema coma or crisis, which can be life-threatening. This is, however, rare.

Can Hashimoto's disease be cured?

There is no cure for Hashimoto's disease and the damage done to your thyroid gland cannot be reversed. However, Hashimoto's can easily be managed.

As long as you take your medication and have your hormone levels checked regularly, you can lead a completely normal life.

Typically, thyroid hormones are checked every few weeks until they become stable and your dosage has been established, then every six to twelve months thereafter. If you start getting symptoms, you should seek medical advice and have your levels checked again.

Living with Hashimoto's disease is not hard, but it is very important to take your medication to avoid further damage to the rest of your body.

The lowdown

Hashimoto's thyroiditis causes progressive damage to your thyroid and maintaining a healthy lifestyle can help the course of your condition.

With appropriate treatment, the outlook for Hashimoto's disease is good. Most people lead a normal life as long as they take their medication regularly.

The medication prescribed for Hashimoto's disease has few to no side effects as long as the dosage is properly monitored.

However, if you have a family history of Hashimoto's thyroiditis, it is worth talking to your doctor about tests that can potentially identify the disease before you develop hypothyroidism and help you avoid any unpleasant symptoms. In some cases, you can be put on thyroid medication before you begin to develop symptoms.