Hashimoto's disease (also called Hashimoto's thyroiditis) is an autoimmune disorder. It tells your immune system to treat the thyroid gland as a threat and attack it with antibodies.
Eventually, thyroid cells sustain severe damage, and the gland stops producing sufficient hormones. This leads to hypothyroidism.
While there isn't a cure for Hashimoto's thyroiditis yet, it's possible to counter the effects of hypothyroidism with hormone replacement therapy.
Let's take a closer look at what Hashimoto's disease does to your body and what you can do about it.
Researchers are studying thousands of new treatments and you could be a part of finding a cure while accessing the newest treatments for Hashimoto's disease.
Hashimoto's thyroiditis is currently the most prevalent¹ autoimmune disorder and the most frequent cause of hypothyroidism.
Named after a Japanese doctor who discovered the condition in 1912, Hashimoto's disease affects 1%–2% of people in the US².
When the immune system starts attacking the thyroid gland, its population of white blood cells increases and eventually damages the organ. The damaged thyroid then stops producing sufficient thyroid hormones (T3 and T4), causing hypothyroidism.
These hormones are responsible for:
Regulating your metabolism
Controlling how your muscles contract
Affecting how the brain matures (in children)
Regulating heartbeat and body temperature
Every cell in your body is affected by thyroid hormones. As Hashimoto's disease progresses, your body stops working properly.
Hashimoto's disease vs. hyperthyroidism
As we’ve seen, Hashimoto's thyroiditis is an autoimmune disease that causes hypothyroidism. Hyperthyroidism is the opposite, occurring when your thyroid gland starts producing too many hormones.
Like hypothyroidism, hyperthyroidism affects the metabolism and causes the body to suffer. The standard treatment is anti-thyroid drugs.
Hashimoto's thyroiditis may not cause any symptoms for the first year or two. The first sign of the disease is often an enlarged thyroid gland, known as a ‘goiter.’
The thyroid gland is located in the front of your neck and, when healthy, is about two inches long. It sits unnoticed under your Adam's apple. When Hashimoto's disease progresses, it causes the gland to swell and become prominent.
Other symptoms of Hashimoto's thyroiditis are due to the lack of thyroid hormones:
Pain, weakness, and stiffness of muscles
Memory problems and clouded thinking
Irregular menstrual cycle
Problems with getting pregnant
Hair loss and brittle nails
These symptoms of Hashimoto's thyroiditis may also signal other medical conditions, so it's important to contact a doctor to discuss your symptoms. In fact, your symptoms are likely to get worse. But it's possible to keep this condition under control and improve your quality of life.
When to see a doctor
You need to see a doctor if you notice that your thyroid gland is growing. The main signs of goiter include swelling in the lower part of your neck, hoarse voice, and tightness around the throat.
Any of the symptoms listed above also warrant a doctor's consultation. Schedule an appointment with your primary care physician. They will likely order blood tests, do a physical examination, and refer you to an otolaryngologist (ear, nose, and throat doctor) or endocrinologist.
The exact cause of Hashimoto's thyroiditis is yet to be discovered. However, some factors may play a role in developing this condition:
Certain viruses³ (hepatitis, coxsackie, human parvovirus B19, cytomegalovirus, and herpes)
Some researchers believe that the combination of the above factors may be responsible for the development of Hashimoto's thyroiditis.
Although anyone can develop Hashimoto's disease, some people are more likely to develop the condition than others.
The risk factors for developing Hashimoto’s disease include:
Women are 10 to 15 times more likely⁴ to get Hashimoto's thyroiditis than men. Generally, autoimmune conditions tend to be more frequent in women than men.
Existing autoimmune conditions
You are more likely to develop Hashimoto's disease if you already have an autoimmune condition such as:
Regardless of gender, the likelihood of developing Hashimoto's disease increases with age. The peak age of onset for females is between 30 and 50, and for men, it's usually 10 to 15 years later.
While most cases are discovered in patients between 30 and 60 years of age, it has been known to occur in younger people.
You are more likely to develop Hashimoto's thyroiditis if it runs in your family. However, scientists are yet to find the exact gene that increases the risk of developing this condition.
Some researchers believe that the genes responsible for Hashimoto's disease may be part of the HLA (human leukocyte antigen) complex⁵. These genes help your immune system understand the difference between your body’s proteins and invaders like viruses and bacteria.
Exposure to radiation
High doses of radiation (external or internal) can trigger Hashimoto's disease, and people exposed to excessive levels of environmental radiation are at risk.
While more research is needed, studies⁶ on patients who undergo external beam radiation therapy (EBRT) show that radiation may cause hypothyroidism.
Excessive iodine consumption
Iodine is essential for producing thyroid hormones, but excessive consumption may lead to several thyroid diseases, including hypothyroidism.
The majority of people can handle excess iodine well. However, if you are at risk of developing Hashimoto's disease, excessive consumption could be a trigger for developing the condition.
Since most iodine comes from food and supplements, it's possible to control the intake of iodine by being careful of how much you consume in your diet. If you are at risk of developing Hashimoto's disease and hypothyroidism, consider speaking to your doctor about diet adjustments.
To diagnose Hashimoto's disease, your doctor will conduct a physical examination to check if you have an enlarged thyroid. They will also:
Order blood tests
To determine if Hashimoto's disease is causing your symptoms, the doctor will request some standard blood tests to measure the levels of:
Antibodies: If your immune system produces too many antibodies, it could be a sign of an autoimmune disease. People with Hashimoto's disease usually produce antibodies to thyroid peroxidase (a protein that helps thyroid hormone production).
Thyroid-stimulating hormone: If levels are high, it means the pituitary gland is trying to compensate for the low levels of thyroid hormones
Free thyroxine (T-4): Low levels of T-4 reflect low thyroid hormone production
The doctor may also request other antibody blood tests.
Do an ultrasound
If you don't have the thyroid-stimulating hormone in your blood, but the doctor still suspects Hashimoto's disease, they may do an ultrasound.
The ultrasound will help determine the size of your thyroid gland and check for related problems such as nodules.
Hashimoto's disease without hypothyroidism
More often than not, people see the doctor about Hashimoto's disease when they start experiencing symptoms of hypothyroidism. However, in rare cases, your healthcare provider may discover a high number of antibodies to thyroid peroxidase incidentally when investigating for other illnesses.
It's important to remember that Hashimoto's disease doesn't always progress into hypothyroidism. High levels of antibodies simply mean that you need to monitor your health closely to catch the onset of underactive thyroid in a timely manner.
While there isn't yet a cure for Hashimoto's disease, your doctor will suggest treatment for hypothyroidism.
Thyroid replacement hormones
This oral medication is a synthetic thyroid hormone. By taking the drug regularly, you prevent hypothyroidism and its effects on your body. It may take a while to find the right dosage to control your symptoms.
Your doctor will monitor the thyroid function with blood tests to determine which dose of the drug is most effective at controlling hypothyroidism. Unpleasant symptoms will start to subside once you are on the correct dosage.
It's important not to expect the medication to work instantly. It could take two to six months until you start feeling better. Your doctor may need to adjust the dosage several times during this period.
People who have Hashimoto's disease are likely to need thyroid hormone replacement therapy for the rest of their lives.
In some cases, removing the thyroid gland may be necessary to improve your quality of life. Your doctor may recommend this surgery if the symptoms of Hashimoto's thyroiditis are caused by excessive antibody production rather than the decrease in thyroid hormones.
A 2019 study⁷ demonstrated that thyroid surgery in patients with high antibody levels was highly successful. The antibody levels returned to normal, and the quality of life improved significantly.
The doctor may also suggest surgery to remove a goiter.
Complementary alternative medicine
While this type of medicine can't be used to treat Hashimoto's disease, it can supplement your main medication to relieve the symptoms.
You can also improve your condition by adopting a healthier lifestyle:
Diet: Speak to your doctor about removing goitrogens (broccoli, cauliflower, kale, and cabbage) from your diet. Goitrogens interfere with the activity of your thyroid gland and promote the growth of thyroid tissue. You may also want to consider removing gluten from your diet. Some studies⁸ show that a gluten-free diet can reduce the number of thyroid antibodies.
Exercise: Regular exercise can help you deal with symptoms of hypothyroidism such as fatigue, sleepiness, and depression. However, extensive exercise may need to be postponed until the hormone replacement therapy is helping to control your symptoms.
Additionally, stress can make some symptoms of Hashimoto's disease worse and decrease your quality of life. While your doctor chooses the right dosage of your medication, practice stress-management techniques.
Goiter: Besides being aesthetically unappealing, a goiter could affect your voice and cause difficulty breathing and swallowing. To counter the symptoms, you would likely need surgery that removes your thyroid gland (or part of it).
Heart conditions: Low thyroid hormone levels could lead to serious heart issues, including an enlarged heart, irregular heart rate, heart valve problems (mitral valve prolapse), and congestive heart failure
Mental health problems: Improper thyroid function can lead to depression⁹ and anxiety. The longer you leave the problem untreated, the worse mental health issues may become.
Sexual dysfunction: Low levels of thyroid hormones coupled with unpleasant symptoms of Hashimoto's disease can decrease libido in women and cause erectile dysfunction in men
Fertility and pregnancy problems: Hypothyroidism can lead to infertility, miscarriage, low birth weight, and major congenital disabilities¹⁰
In rare cases, people with untreated hypothyroidism caused by Hashimoto's disease could develop myxedema. This serious condition requires immediate medical attention, or it can be fatal.
Symptoms of myxedema include:
Dry, pale skin
Swelling in the face, legs, or tongue
Hypothermia (low body temperature)
Hypotension (low blood pressure)
The earlier Hashimoto's disease is diagnosed and treated, the less likely you are to suffer from serious complications. In most cases, hormone replacement therapy can alleviate many of the symptoms of hypothyroidism and allow you to lead a normal life.
Hashimoto's thyroiditis is an autoimmune condition that causes your body to attack healthy thyroid-gland tissue. Once the attack progresses, the thyroid gland stops producing enough hormones, leading to hypothyroidism.
While scientists are yet to find a cure for Hashimoto's disease, treatments for hypothyroidism are readily available. By contacting your doctor as soon as you experience the first symptoms of this condition, you can improve your quality of life within weeks.
Hashimoto thyroiditis: Frequency | MedlinePlus
Hashimoto thyroiditis: Causes | MedlinePlus
Hypothyroidism | American Thyroid Association
Hashimoto's disease | NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Hashimoto thyroiditis | Radiopaedia
Thyroid hormone replacement therapy | Johns Hopkins Medicine
Thyroid surgery | American Thyroid Association
Complementary and alternative medicine in thyroid disease (CAM) | American Thyroid Association