Everything You Need To Know About Hashimoto’s Thyroiditis And Its Diagnosis

Hashimoto's thyroiditis is the most common cause of hyperthyroidism in the US.¹ It is mostly hereditary but can be treated.

Many symptoms of the condition can be frustrating and overwhelming, so it's best to identify it early so you can start treatment.

This article will discuss the facts you need to know about Hashimoto's to help you understand your diagnosis better. 

What is Hashimoto's thyroiditis?

Hashimoto's thyroiditis, or Hashimoto's disease, is an autoimmune disease that attacks the thyroid gland. It's often associated with hypothyroidism, affecting more than 10 million people in the US.²

The disorder can damage or destroy healthy thyroid tissue, resulting in an underactive thyroid gland.

Symptoms

The most common symptoms of Hashimoto's thyroiditis include:

• Loss of appetite or weight loss

• Swollen thyroid

• Fatigue or chronic fatigue

• Headache or migraine

• Difficulty concentrating

• Depression

• Anxiety

• Excessive sweating (for example, night sweats)

• Sensitivity to cold temperatures or overreaction to heat in the weather (hypothermia)

• Muscle weakness

• Mental fogginess

• Ringing in the ears (tinnitus)

• Abdominal pain, nausea, vomiting, and/or diarrhea

• Irregular periods³

• Dry skin, hair, and nails

• Itching and/or hives

• Shortness of breath (dyspnea)

• Sudden weight gain

• Joint pain and/or swelling

• A decreased sex drive in men, or low libido in women (psychosexual problems)

• Bloating/constipation

• Fertility issues

When to see a doctor about your symptoms

Book an appointment with your physician if you notice any of the following:

• If you feel your symptoms have become more pronounced or if other signs are developing

• If you experience a worsening of symptoms, but nothing has changed from when your condition was first diagnosed

• If you visited a doctor in the past but did not find anything conclusive, you still have symptoms, and they have not gone away.

• If you are experiencing symptoms that are on par with thyroid disorders

• If you feel your condition has worsened over the years, even if it has not gotten worse since initially being diagnosed

• If your doctor's previous tests for an autoimmune disorder did not confirm the diagnosis of Hashimoto's thyroiditis

• If you experience an increase in the severity, frequency, or duration of any symptom listed above (e.g., if the menstrual cycle is less than expected or more painful or difficult to predict in previously regular women)

• If you are under- or overweight (greater than 15 pounds (7kg) difference between your ideal weight and your current weight). This may be due to Symptomatic Hyperthyroidism or even a genuine thyroid problem.

How is Hashimoto's thyroiditis diagnosed?

The diagnosis of Hashimoto's disease is often challenging. Patients tend to have several symptoms that can affect multiple systems, making it difficult to pinpoint the most indicative of the disease.

However, if you have some of the persistent symptoms listed above, it's best to see a doctor.

How to prepare for your appointment

To diagnose the illness correctly, below is a list of requirements needed for the process to be successful:

1. Make a list of symptoms and prioritize those that are worrying you

List all the potential causes of your symptoms that the doctor may need to rule out. For example, have you recently changed medications? Has your weight gone up or down? Are you experiencing a new symptom you've never had before? Be as detailed as possible.

2. Seek professional advice

Take notes in your appointment to help you ask questions and remember important information. Make sure to write your questions down and ask whether or not they are related to the condition or if they can help further the diagnosis in any way.

The following are some examples of what to ask:

• Have you been suffering from this symptom since you were diagnosed?

• Have you had a fever, headache, cough, or any other symptom that isn't on this list?

• Have you seen any other doctors recently for other health concerns?

• When did the symptoms begin, if it was recent or several years ago?

3. Bring your medications

Don't forget to bring your medications and written prescriptions since you don't want the doctor to diagnose you for something unrelated to your symptoms.

Bring a list of your previous prescription bottles, vitamins, over-the-counter medications, herbal remedies, and any other medication you are currently taking.

4. Keep your medical records handy

Try to bring along your previous medical care history and records. These records will help your doctor find a possible cause or any new symptoms that arise post-treatment. Most doctors will ask you to bring along this information, but be sure to ask if you should ahead of time if they don't.

5. You may want to bring a family member or a close friend to your appointment

While this is optional, you may want to bring along a family member or close friend to your appointment. They may help you remember vital points/questions for your doctor or assist you in taking down notes based on the doctor's remarks.

6. Request for an interpreter should you need one

Most doctors will have a free interpreter available, but you can also request this by mentioning it in your consultation. Interpreters help gather information, as you will be communicating in another language. If you need an interpreter, mention it when you see your doctor or call them a week in advance.

7. Wear comfortable clothes

Ensure you wear clothes that will keep you comfortable throughout your appointment. Your doctor may even ask you to disrobe and change your clothes if they feel it is necessary. It is also a good idea to avoid wearing makeup and jewelry.

What would a doctor want to know?

If you've been diagnosed with Hashimoto’s thyroiditis, your doctor may ask for a few things before they can give you medication.

Your current health status

A doctor will want to know your current health status, and they may ask about how you have been recently or could go more in-depth, such as when you last got sick or started experiencing symptoms. They will also want to know if you have any other conditions requiring special care.

Your social/family history

Doctors will be interested in knowing about your family members and their health history. They may want to ask you if there are any common health conditions among your family members.

Your past medical history

A doctor will want to know about your past health history, including surgeries, illnesses, injuries, and treatment plans you have undergone. You may also be asked for the dates, frequency, and length of time they occurred.

Medications, medical conditions, and allergies that may put you at risk for complications

They will also want to know about the medications you are currently taking, the description and possible side effects of the drugs, and any allergies you may have.

Medications that will help you recover

A doctor will ask you about the amount of pain and discomfort you are experiencing, the type of pain medication you are taking, and the dosage. This information will help them determine if they should prescribe any additional or new medication or ask you to continue with your current medications.

What are the tests for Hashimoto's thyroiditis?

Several tests will be conducted based on the degree to which your thyroiditis is present and how it has affected your body.

Thyroid scan

Your doctor will conduct an ultrasound on your thyroid gland to determine if any nodules (abnormal growths) need treatment.

Thyroid function tests

Your doctor will conduct several blood tests such as thyroid-stimulating hormone (TSH), anti-thyroid antibodies, and free T4 tests. This will help them determine if there is a problem with your thyroid function.

Free T4 test

A free T4 level is the number of thyroid hormones in your blood that can be converted into active thyroid hormones. This amount must be normal to avoid hypothyroidism (low TSH and high T4).

High levels of free T4 indicate a problem with the production of the hormone or abnormal metabolism. Low levels of free T4 suggest a problem with the metabolism or conversion of an inactive hormone to an active hormone. A T4 blood test is also beneficial because most of the T4 in your body is attached to a protein (thyroxine-binding globulin).

TSH test

This test is performed to determine the levels of thyroid hormones and the sensitivity of the thyroid gland. The test is also effective in checking for hypothyroidism caused by Hashimoto's disease.

Anti-thyroid antibodies test

This test is conducted to determine if there are problems with your immune system linked to thyroid disease. This test also examines your thyroid gland to detect the presence and levels of antibodies produced by the immune system when it mistakenly attacks. The antibodies subjected to such tests include thyroglobulin antibody, or TgAIAB (thyroid-specific immunoglobulins), thyroid peroxidase antibody, or TPOAb (Thyroid Peroxidase Antibodies).

Is there a self-test?

If you have or think you have a thyroid problem, below are the American Association of Clinical Endocrinologists (ACCE) recommended ways to check for the possibility of enlargements or nodules.

1. Stand in front of a wall or handheld mirror.

2. Get a glass of water.

3. Tip your head back towards the ceiling while maintaining eye contact with your thyroid.

4. Take a sip of the water and gently swallow it.

5. While swallowing, watch your thyroid movements. Are you able to see bulges or enlargements?

6. If you are not sure, take another sip of water and swallow. You can repeat it as many times as needed. Be careful not to confuse your thyroid with your Adam's apple.

Upon detecting any abnormalities, ensure you book an appointment with your doctor for proper diagnosis.

What to expect after the diagnosis?

The first step after a diagnosis is to understand what the results mean. The most common question people ask is whether they have Hashimoto's or not. Also, note that this disease can present in many ways, depending on several factors.

If your doctor has diagnosed you with Hashimoto’s thyroiditis, they will refer you to an expert in Hashimoto's, such as an endocrinologist. They will take you through the whole process, from diagnosis to treatment and aftercare.

Treatments

Treating Hashimoto’s thyroiditis is based on the severity of the condition. If you have moderate symptoms, you will only require regular TSH tests to monitor thyroid hormone levels and medications to control the symptoms.

However, if you have severe symptoms, you will require a combination of medications to manage the condition and surgery to remove the dead or damaged thyroid.

The most common treatment for Hashimoto’s is through T-4 hormone replacement therapy. The treatment involves taking a synthetic hormone known as levothyroxine (Levothroid, Levoxyl, Unithroid, Synthroid, Levothroid, and others), similar to the T-4 hormone produced by your thyroid gland.

T-4 therapy is not a cure for Hashimoto's, and it can only help manage the symptoms and slow down the progression of the disease. The treatment usually goes on throughout the person’s life.

Possible complications of Hashimoto's

If left untreated, Hashimoto’s thyroiditis can lead to the following complications:

• Thyroid cancer

• Depression

• Myxedema coma

• Damage to the heart and/or lungs (congestive heart failure and pulmonary fibrosis, and cancer)

• Sexual and reproductive dysfunction (low libido in women and inability to ovulate)

• Poor pregnancy outcomes such as miscarriages

How serious is Hashimoto’s thyroiditis?

The condition manifests in different ways and levels of severity, depending on the number of symptoms you have. The good news is that you can live with Hashimoto's thyroiditis with proper treatment and support.

The lowdown

Hashimoto's is a chronic condition that can be managed but not cured. Thyroid hormones play an essential role in the body, and if your thyroid gland does not produce enough, it can lead to all the symptoms mentioned in the article.

If you or someone you know has any of these symptoms, ensure you book an appointment with a doctor as soon as possible to get diagnosed and start treatment.