Painful Hashimoto’s Thyroiditis: What You Need to Know

Hashimoto's thyroiditis is the most common cause of hypothyroidism. Hypothyroidism occurs when the thyroid gland does not produce an adequate level of hormones and is therefore underactive. This can result in uncomfortable symptoms and disruptions of many of the body's internal systems.

Most people who suffer from Hashimoto's thyroiditis don't experience painful symptoms. However, there is a rare variant of Hashimoto's disease that can cause pain near the thyroid gland in the neck. Therefore, it's important to understand the symptoms of this disorder and possible treatment for it.

What is Hashimoto's thyroiditis?

Hashimoto's thyroiditis (also called Hashimoto's disease) is an organ-specific autoimmune disorder that causes people to develop thyroid antigens. These antigens trigger the body's own immune system to attack its thyroid gland. 

Your thyroid is a butterfly-shaped gland that sits in your neck. As part of your endocrine system, the thyroid produces critical hormones that your cells use to process proteins, carbohydrates, sugars, and critical vitamins and minerals. 

In those with Hashimoto's thyroiditis, the thyroid gland is slowly scarred and damaged by the immune system. This causes it to produce fewer hormones, leading to a condition called hypothyroidism (or "underactive" thyroid).

Variants of Hashimoto's thyroiditis

There are multiple variants of Hashimoto's disease. They are diagnosed based on the underlying cause or how the thyroid tissue appears under a microscope. 

This article will focus on the painful variant: 

• Painful variant: While extremely rare, multiple cases of painful Hashimoto's disease have been reported in the literature.¹ Typically, this variant causes extreme neck pain in the area of the thyroid. 

Most cases of painful Hashimoto's thyroiditis are treated with surgical intervention. However, a few areas of research have noted a complete reduction in pain after starting thyroid hormone replacement therapy.

Most people with Hashimoto's disease are not assigned a specific variant. Typically, variant information is used to detect rare presentations of Hashimoto's thyroiditis.

What are the symptoms of Hashimoto's disease?

Since Hashimoto's disease is heterogeneous in nature, it can present with multiple symptoms.

Common symptoms of Hashimoto's thyroiditis include:

• Fatigue, tiredness, or sluggishness

• Increased appetite

• Weight gain

• Sensitivity to temperatures (particularly heat)

• Low pulse rate (also called bradycardia)

• Brittle nails

• Thinning hair

• Constipation

• Fertility issues

• Menstrual irregularities

• Muscle aches and weakness

• Joint pain or stiffness

• An enlarged tongue (also called macroglossia)

• Depression

• Memory problems

Rarely, Hashimoto's disease can also cause pain in the area of the thyroid.

How to manage uncomfortable Hashimoto's thyroiditis symptoms

Most people who have Hashimoto's disease do not experience any pain related to their disorder. However, certain symptoms of Hashimoto's disease, such as menstrual irregularities, macroglossia (enlarged tongue), constipation, or diarrhea, can cause some level of discomfort.

This pain can be treated using a combination of lifestyle changes, over-the-counter medications, prescription medications, and possible surgery.

How to manage Hashimoto's disease constipation discomfort

Some people with Hashimoto's disease experience chronic constipation, which can cause discomfort and pain in the bowels. Most people can manage their constipation through lifestyle changes. 

Generally, this involves changing your diet to include more fiber, exercising more regularly, and taking fiber supplements. However, some people may need laxatives to help them pass particularly hard and painful stools.

There are a wide variety of laxatives that can be used to soften stool and make it easier to pass. These include:

• Osmotic laxatives: These types of laxatives attract water inside of the colon to stimulate your bowels. There are multiple osmotic agents used to create over-the-counter (OTC) laxatives, including polyethylene glycol 3350 (Miralax, GaviLAX, Clearlax, etc.), magnesium hydroxide (Phillips' Milk of Magnesia, etc.), and lactulose (Kristalose, Enulose, Generlac, etc.)

• Emollient laxatives (stool softeners): These types of laxatives help your stool absorb more water and fat, making them easier to pass. You can find both docusate calcium and docusate sodium (Colace, Surfak, DDS, etc.) at many drug stores and supermarkets.

• Lubricant laxatives: These types of laxatives work by coating the stool in a slippery substance to help it move through your bowels. Mineral oil is an example of a lubricant laxative, and you can find it over-the-counter.

• Stimulant laxatives: Laxatives like sennosides (Ex-Lax, Senokot, etc.) and bisacodyl (Dulcolax, Correctol, etc.) help the colon contract and move, which can loosen stool and cause bowel movements.

• Prescription laxatives: There are various laxatives that are available as a prescription, and these are generally more potent than OTC forms. Common types includelactulose (Cholac), lactitol (Pizensy), prucalopride (Motegrity), plecantide (Trulance), methylnaltrexone (Relistor), lubiprostone (Amitiza), linaclotide (Linzess), naloxegol (Movantik), and naldemedine (Symproic).

If you are struggling with constipation-related pain due to Hashimoto's, please contact your healthcare provider to discuss your options.

How to manage Hashimoto's disease-related menstrual pain

Hashimoto's disease can cause menstrual irregularities that may increase the frequency or severity of menstruation. For some, this may cause painful cramps. Generally, menstrual cramping can be successfully managed with over-the-counter pain reliever medications such as acetaminophen (Tylenol) and NSAIDs (Aspirin, Advil, etc.) 

However, some people may need more potent pain medication that requires a prescription. If you are suffering from menstrual pain related to Hashimoto's disease, you should contact your healthcare provider to discuss your options.

How to manage Hashimoto's disease macroglossia pain

Very rarely, Hashimoto's thyroiditis can cause your tongue to enlarge — known as macroglossia. This may cause pain either directly or through accidental biting. 

Many people with macroglossia are treated with orthodontic surgery. Certain medications such as corticosteroids may help reduce swelling temporarily. In rare cases, doctors may prescribe pain relief medication to help alleviate painful symptoms.

How to manage pain associated with painful Hashimoto's disease

In very rare cases, people develop painful Hashimoto's disease — a variant of Hashimoto's thyroiditis associated with thyroid pain. If you develop painful Hashimoto's disease, your doctor may treat you with pain medications or surgery. Many people immediately find relief when they begin synthetic thyroid hormone replacement therapy.

How is Hashimoto's disease diagnosed?

A wide variety of symptoms can lead healthcare providers to suspect Hashimoto's thyroiditis. However, you will need to undergo either a blood test or imaging test (sometimes both) to confirm your diagnosis. 

Most healthcare providers will also give you a full physical exam and ask for your medical history. If you are suspected of having Hashimoto's thyroiditis, you can expect to undergo one (or both) of the following tests.

Blood tests used to diagnose Hashimoto's thyroiditis

There are two types of blood tests — thyroid antigen test and thyroid function test — that are used to detect thyroid disorders like Hashimoto's thyroiditis. These tests measure the levels of certain hormones and antibodies, including:

• T3 and T4: Both T3 and T4 are called "thyroid hormones." T3 is used by every cell in your body to process critical nutrients, and T4 is an inactive form of T3 that circulates in your bloodstream to be quickly converted to T3 when needed. Low levels of T3 or T4 are common complications of Hashimoto's disease.

• Thyroid-stimulating hormones (TSH): While TSH isn't a hormone itself, it does help transport and regulate hormones throughout your bloodstream. High levels of TSH often indicate hypothyroidism.

• Thyroid antibodies: Different types of thyroid antibodies (e.g., TG, TSI, TPO, etc.) can indicate Hashimoto's disease.

Imaging tests used to diagnose Hashimoto's thyroiditis

Hashimoto's disease is sometimes diagnosed via imaging tests. These tests look for physical changes in your thyroid. 

Typically, imaging tests are used to rule out malignant causes of hypothyroidism. But they cannot diagnose Hashimoto's disease by themselves. You may need a combination of blood and imaging tests to successfully diagnose Hashimoto's thyroiditis.

Commonly performed imaging tests include:

• Thyroid scans: These scans require you to ingest a tracer (radioactive iodine). A few hours later, you will undergo a scan that uses gamma rays to detect abnormalities in your thyroid. Tumors have trouble absorbing iodine, and they appear darker on the scan. Most people get thyroid scans to rule out malignancies or nodules — not to diagnose Hashimoto's thyroiditis directly.

• Ultrasounds: These common imaging tests use a simple monitor and water-soluble gel to quickly get a scan of your neck. Ultrasounds require no preparation. An ultrasound can help determine if your thyroid has shrunk or is scarred due to thyroid antigens in the blood.

Is there a cure for Hashimoto's disease?

No, there is currently no cure for Hashimoto's thyroiditis. Luckily, there are fantastic treatments available for those with Hashimoto's disease, including synthetic hormones (levothyroxine sodium) that replicate human thyroid hormones. 

Rarely, you may need surgery to treat Hashimoto's thyroiditis. People diagnosed with Hashimoto's disease are expected to have a normal life expectancy.

When to see your healthcare provider

You should consult with your healthcare provider if you experience any symptoms of Hashimoto's disease. While these symptoms are shared with many other common illnesses, diseases, and benign disorders, it's important to keep an honest and open line of communication with your healthcare provider.

Often, those with Hashimoto's thyroiditis go through multiple treatments before being properly diagnosed.

The lowdown

Hashimoto's thyroiditis is an autoimmune disorder characterized by an underactive thyroid. Those with Hashimoto's disease do not produce enough thyroid hormones and will likely need to take thyroid hormone replacement therapy.

Some symptoms may cause pain that can be effectively managed by over-the-counter or prescription medications. 

Though rarely, people develop a variant of Hashimoto's thyroiditis referred to as "painful Hashimoto's thyroiditis." This variant of Hashimoto's disease can be effectively treated with hormone replacement therapy, simple pain relief, or, in rare cases, surgery. 

Most people with Hashimoto's thyroiditis are diagnosed by a blood test. If you suspect you have Hashimoto's disease, you should contact your healthcare team for treatment-related details and information.