Diagnosing Hashimoto’s Thyroiditis: Ultrasound, Exams, And Blood Tests

Hashimoto’s thyroiditis (or Hashimoto’s disease) is an autoimmune disorder that affects the thyroid gland. In this condition, the immune system starts attacking thyroid cells, and the gland stops producing enough hormones for the body. This causes hypothyroidism.

Diagnosing Hashimoto’s thyroiditis early can help you get the symptoms under control and avoid health complications. If you notice signs of hypothyroidism, contact your primary care physician. They will perform a variety of tests to make a diagnosis.

What is Hashimoto’s thyroiditis? 

In the early 20th century, a Japanese medical scientist, Hakaru Hashimoto, discovered a common autoimmune disorder, later named Hashimoto’s thyroiditis. This condition is the most common cause of hypothyroidism¹ in areas where people’s diets contain the necessary amount of iodine.

Hashimoto’s disease causes your immune system to confuse thyroid gland cells for hostile imposters. It starts attacking these thyroid cells with white blood cells. As the number of white cells inside the thyroid builds up, the organ begins to malfunction, which affects hormone production.

When the thyroid gland stops producing enough thyroid hormones (T3 and T4), you may experience unpleasant symptoms that include:

• Fatigue, daytime sleepiness, and loss of energy

• Low tolerance of cold temperatures

• Slow heart rate

• Muscle and joint pain and stiffness

• Depression and anxiety

• Constipation

• Reduced sweating

• Unexplained weight gain

• Brittle nails, dry and scaly skin, and hair loss

• Fertility and menstrual problems

• Low libido

• Goiter (enlarged thyroid gland)

Thyroid hormones are responsible for regulating your metabolism, heartbeat, and body temperature. When your thyroid gland is underactive, the cells and organs in your body start slowing down. This affects your quality of life and can lead to severe complications.

If you are experiencing any of the above symptoms of Hashimoto’s thyroiditis, schedule an appointment with your primary care physician.

What causes Hashimoto’s thyroiditis? 

The underlying cause of Hashimoto’s disease is currently unknown. Scientists believe it might be a combination of family history and genetic factors, existing conditions, certain infections, and environmental factors.

Some people are more likely to develop this disease than others. The common risk factors include:

• Age – The older you are, the more likely you are to develop Hashimoto’s disease. For women, the onset is often between 30 and 50 years of age. For men, it’s between 40 and 60.

• Gender – Women are 4 to 10 times² more likely to develop Hashimoto’s thyroiditis than men. In fact, women are at higher risk of both autoimmune disorders and thyroid problems.

• Family history – If a member of your immediate family has Hashimoto’s thyroiditis, you are nine times more likely³ to develop it than someone with no genetic history. Scientists are working on singling out the exact genes responsible for the disease.

• Radiation – Studies show⁴ the link between radiation exposure and autoimmune thyroid diseases. The exact dose that causes the condition to develop is currently unknown.

• Autoimmune conditions – If you already have an autoimmune condition (type 1 diabetes, rheumatoid arthritis, celiac disease, lupus, vitiligo, etc.), you are more likely to develop Hashimoto’s disease.

• Medications – Exposure to certain medicines that affect the immune system increases your chance of thyroiditis. About 15% of people taking alemtuzumab⁵ for multiple sclerosis may develop the condition, as well as some taking alpha-interferon therapy.

Once you develop Hashimoto’s thyroiditis, you may not experience symptoms for years. However, knowing that you have this issue can help you catch the underactive thyroid in its early stages and monitor your symptoms.

How do doctors diagnose Hashimoto’s thyroiditis?

Diagnosing Hashimoto’s thyroiditis is usually simple, especially if you have symptoms of hypothyroidism. The primary care physician is likely to order necessary tests and then refer you to an endocrinologist, a specialist in hormone-related conditions.

Physical exam 

In certain thyroid conditions, the gland itself will often become enlarged, and this is called goiter. Since goiter is a common complication of hypothyroidism caused by Hashimoto’s disease, your doctor will examine your neck, where your thyroid gland is located.

You can check for goiter at home by doing a simple self-exam:

• Stand in front of a mirror

• Look up at the ceiling to extend your neck

• Look and feel for bumps or enlargements in your neck as you swallow

A self-exam can help reveal a goiter, which is a sign that your thyroid gland is enlarged. However, you would still need a doctor to confirm it and diagnose the underlying condition.

Blood tests

Several blood tests can uncover Hashimoto’s thyroiditis:

• Anti-thyroid antibody tests – These are tests for autoantibodies that attack your own tissues. The most common lab tests for diagnosing this condition are the thyroid peroxidase (TPO) antibody test and the anti-thyroglobulin antibody test. High levels of these antibodies will indicate that you probably have Hashimoto’s disease.

• Thyroxine (Free T4) level – T4 is a thyroid hormone. If you develop hypothyroidism due to Hashimoto’s disease, the level of this hormone in your blood is likely to be low.

• Thyroid-stimulating hormone (TSH) level – Your pituitary gland is responsible for stimulating the thyroid to produce hormones. When the thyroid is underactive, the pituitary gland detects low T3 and T4 levels and starts making more TSH to stimulate thyroid hormone production. High levels of TSH can point to hypothyroidism.

If you have mild Hashimoto’s thyroiditis, blood tests may not be able to detect it. If these tests come back negative, it could also mean that you have another condition with similar symptoms.

Ultrasound

Ultrasound is another method used for diagnosing thyroid abnormalities. Sound waves are fed into a computer to offer a high-resolution image of your thyroid gland with no radiation. It is usually not necessary to diagnose thyroiditis but may be ordered if the gland is enlarged or if nodules are felt during the physical exam.

This method can help the doctor diagnose changes in the thyroid gland, including its size and the type and number of any nodules that might be present. Ultrasound can also help rule out other causes of an enlarged thyroid.

An ultrasound is painless and usually takes 30 minutes or less. You don’t have to do anything specific to prepare for it. Upon arriving for your test, you may be asked to put on a gown. You will then lay down on an exam table, and the technician will place some gel on your neck. Next, they will roll a transducer over the area. You may feel a little pressure, but no pain. They will proceed to check the thyroid gland and the areas surrounding it.

During the ultrasound, the technician can evaluate the blood flow to the thyroid gland to predict any further enlargement. An ultrasound will also show the background tissue of the gland and any nodules. This can indicate whether the growth may be cancerous and any need for further tests like a biopsy.

Can you diagnose Hashimoto’s thyroiditis without symptoms?

People who have Hashimoto’s thyroiditis rarely see the doctor if they aren’t experiencing symptoms. This condition can progress slowly over the years without causing any discomfort. However, once the thyroid gland is damaged to the point that it stops producing sufficient hormones, you will experience symptoms.

Even without symptoms, you may discover that you have hypothyroidism when you have screening lab tests done for your yearly physical. Once that is determined, thyroiditis will be confirmed with further lab tests, such as ATA and anti-thyroglobulin antibody levels. Your doctor may run these tests if:

• You have been diagnosed with hypothyroidism

• You have other autoimmune diseases

• You are at a high risk of developing Hashimoto’s thyroiditis

How do you treat Hashimoto’s thyroiditis?

If Hashimoto’s thyroiditis leads to thyroid damage and hypothyroidism, your doctor will recommend suitable treatment. 

Medication

In the majority of cases, the condition can be managed by taking synthetic thyroid hormone replacement therapy.

These hormones come in pill form, and the dose will depend on your age and any other medical problems. You should take them at the same time every day.

Some people need to start with a lower dose, which is adjusted upward until they achieve normal TSH levels. It may take a few months of monitoring with repeat blood tests to determine the correct dosage. It can take some time for symptoms to improve. Most people will need to continue this medication for life.

Surgery 

In some cases, your doctor may recommend thyroid surgery. This usually happens when a goiter interferes with your quality of life by affecting your voice or breathing. Thyroid gland removal can also reduce the number of antibodies⁶ and alleviate your symptoms when they are not improved with medication.

After the surgery, you would still need to continue with hormone replacement therapy.

Complications of untreated Hashimoto’s disease

If you don’t treat Hashimoto’s disease, you may develop complications, including:

• Goiter – If your thyroid gland becomes too big, it may cause problems with breathing and swallowing.

• Heart problems – Improper metabolism can affect your heart and lead to various conditions, including heart disease and congestive heart failure.

• Mental health issues – Hypothyroidism could cause depression and anxiety that get worse over time.

• Myxedema – This is a term for advanced hypothyroidism when the body’s systems start to shut down. While rare, a myxedema crisis is a medical emergency. If untreated, it could lead to coma.

Additionally, both men and women may experience low libido. Women may also have problems getting pregnant. If pregnancy occurs, problems like miscarriage, low birth weight, and birth defects are possible.

The lowdown

Hashimoto’s thyroiditis is an autoimmune disorder that affects your thyroid gland. When antibodies start attacking thyroid cells, the gland stops producing enough thyroid hormones. Eventually, this leads to hypothyroidism. If left untreated, it can reduce your quality of life and cause serious complications.

A doctor can diagnose Hashimoto’s thyroiditis with the help of a physical exam, blood tests, and ultrasound. If the condition is present, it will be treated with hormone replacement medication. Hashimoto’s can usually be managed over time so that you can expect to return to a normal, active lifestyle.