How Do I Know If I Have Hashimoto’s Disease?

Hashimoto's disease (or Hashimoto's thyroiditis) affects as many as one in 50 in the United States. Most of these are women. Hashimoto's disease is the leading cause of hypothyroidism. Here, you'll learn all you need to know about this condition and when you should see a doctor about your symptoms.

What is Hashimoto's disease?

Hashimoto's disease is an autoimmune condition where your body's immune system attacks your thyroid gland. Your thyroid gland produces hormones that regulate several important body functions, including:

• Heart rate

• Body temperature

• Growth and development

• Weight

• Menstrual cycle

Hashimoto's disease is a type of chronic inflammation that can cause thyroid damage and decrease your thyroid's ability to make hormones.

Symptoms of Hashimoto's disease

Hashimoto's thyroiditis progresses gradually over the years. It's possible to have the disease and not notice. Eventually, thyroid hormone production decline can lead to any of the following:

• Increased sleepiness

• Sluggishness and fatigue

• Dry skin

• Increased sensitivity to cold

• Hair loss

• Constipation

• Joint pain and stiffness

• Muscle weakness, aches, stiffness, and tenderness

• Depression

• Brittle nails

• Issues with concentration and memory

• Excessive or irregular menstrual bleeding

• Enlargement of the tongue

• Goiter (swelling of the thyroid)

• A swollen or puffy face

Most people receive a Hashimoto's disease diagnosis after experiencing typical hypothyroidism symptoms. Some receive a diagnosis on a routine screening without experiencing symptoms or after a family member develops the condition.

Your doctor will diagnose you based on blood tests that measure your thyroid-stimulating hormone (TSH) and thyroid hormone levels. Your doctor may order a thyroid peroxidase antibody (TPO) test. This tests for thyroid autoantibodies, which indicates Hashimoto's disease.

Different antibodies, such as the anti-Tg (anti-thyroglobulin) and the anti-TPO antibodies, are detectable in people with Hashimoto’s. 85-90% of people with Hashimoto's disease¹ have anti-TPO antibodies, and 60-80% have anti-Tg antibodies.

Doctors don’t always test to determine the root cause of hypothyroidism. As Hashimoto's thyroiditis and hypothyroidism treatment are the same, Hashimoto’s is frequently undiagnosed. It’s the most common cause of hypothyroidism, so you likely have it if you receive a hypothyroidism diagnosis. 

Difference between Hashimoto's and hypothyroidism symptoms

Hashimoto's disease and hypothyroidism are used interchangeably sometimes, but they're different. Even so, Hashimoto’s symptoms look the same as other types of hypothyroidism, and they can be general and vague.

In hypothyroidism, there is an issue with your thyroid gland. In Hashimoto's disease, there is an issue with your immune system.

You'll likely receive a positive anti-TPO antibodies test if you have Hashimoto's disease, but you don't necessarily have hypothyroidism. Even though Hashimoto's can cause hypothyroidism, it's not the only cause.

What causes Hashimoto's thyroiditis?

Hashimoto's thyroiditis is an autoimmune disorder. This is where your immune system starts attacking the tissues and organs of your body, mistaking healthy cells for harmful ones. If you have Hashimoto's disease, lymphocytes (white blood cells) accumulate irregularly in your thyroid, damaging it.

These lymphocytes produce immune system proteins (antibodies) that attack thyroid cells and destroy them. When there are too many damaged or dead thyroid cells, your thyroid can't create enough hormones to regulate your body's functions. This decrease in thyroid hormones causes the symptoms of Hashimoto's disease. However, some individuals with thyroid antibodies don't experience symptoms or have hypothyroidism.

Various things can cause a flare-up (sudden worsening of symptoms) of Hashimoto's disease. They can include:

Certain nutrients

Certain minerals and nutrients can affect individuals with Hashimoto's disease. They include:

• Iodine: Iodine is vital for thyroid function, and you should ensure your diet has a sufficient amount of it.

• Selenium: Selenium is essential for your thyroid, and a selenium deficiency can affect the function of your thyroid². However, you don't usually need to supplement as you can get enough selenium in your diet.

• Zinc: A zinc deficiency has links with hypothyroidism. A study³ showed thyroid hormone levels improved in individuals with a goiter after taking a zinc supplement.

• Vitamins: Scientists have observed vitamin B12 and vitamin D deficiencies⁴ in individuals with Hashimoto's disease. You'll want to ensure you're getting enough of these vitamins. 

Medications and supplements

Certain supplements and medications can interfere with thyroid medicine. When this occurs, you may not get the right dosage of your medication (levothyroxine), leading to a flare-up.

Consult with your doctor if you take or plan on taking any of these supplements or medications:

• Antacids

• Iron or calcium supplements

• Sucralfate (ulcer medication)

• Estrogens (i.e., those used in hormone replacement therapy or contraceptive pills)

• Rifampicin (antibiotic)

• Certain cholesterol-lowering medications (i.e., colestipol or cholestyramine)

• Seizure medications, such as carbamazepine or phenytoin

Stress

Everyone experiences stress now and then. But stress can affect the immune system⁵ and possibly aggravate autoimmune disorders such as Graves' disease.

Graves' disease causes an overactive thyroid, while Hashimoto's thyroiditis causes an underactive thyroid. Stress won't result in a thyroid condition by itself, but it can make it worse.

Chronic stress slows your body's metabolism down, affecting your thyroid. When the function of your thyroid slows while you're stressed, your thyroxine (T4) and triiodothyronine (T3) hormone levels fall.

Various things can cause stress, including:

• Physical stresses, such as an injury, an illness, or surgery

• Emotional stresses, such as those linked with work, relationships, or your health

• Life changes, which include things like menopause or pregnancy

What puts you at risk of Hashimoto's disease?

Things that may increase your risk of Hashimoto's disease include:

Being middle-aged

Most cases of Hashimoto's thyroiditis occur between the ages of 40 and 60. It can also affect younger people.

Being a woman

Women are around seven times more likely to develop Hashimoto’s disease. It sometimes develops during pregnancy.

Autoimmune diseases

These conditions increase your risk. Some examples include Type 1 diabetes and rheumatoid arthritis. Hashimoto’s also places you at a greater risk for another autoimmune disease.

Heredity

Hashimoto’s disease often runs in families, but scientists haven’t found the gene that carries it.

Treatments for Hashimoto's thyroiditis

Most people with Hashimoto's thyroiditis take medication if they develop hypothyroidism. If you're experiencing mild hypothyroidism (also known as subclinical hypothyroidism), you may not require treatment. Your doctor will likely perform routine TSH (thyroid-stimulating hormone) testing to monitor your thyroid hormone levels.

T4 hormone replacement therapy

Hypothyroidism linked with Hashimoto's thyroiditis is treated with levothyroxine. The synthetic hormone acts like the naturally produced T4 hormone in your thyroid.

The treatment goal is to restore and maintain sufficient T4 hormone levels and improve symptoms. You'll need to stay on levothyroxine for life.

Monitoring the dosage

Your doctor will determine the correct dose of levothyroxine by considering your:

• Weight

• Age

• Other medical conditions

• Current thyroid production

• Any other factors

They'll retest your TSH levels six to eight weeks later⁶ and adjust your dose if necessary.

Once your doctor finds the best dosage for you, you’ll continue taking this medication once daily. You'll require follow-up tests annually or any time after the doctor changes your dose to monitor your TSH levels.

Certain types of food and supplements can affect how your body absorbs levothyroxine.  Examples are soy, espresso coffee, grapefruit juice, and multivitamins containing iron or calcium. Taking levothyroxine on an empty stomach can stop this from happening. You may need to take your medication in the morning before you eat anything (about 30 to 60 minutes before). You can discuss this and other things concerning your prescription with your doctor.

Complications and prognosis

Complications of Hashimoto's disease

The primary Hashimoto's complication is an increased risk of developing another autoimmune condition, such as:

• Type 1 diabetes

• Addison's disease

• Rheumatoid arthritis

• Lupus

• Graves’ disease

It can also raise your risk of developing thyroid lymphoma (a type of thyroid cancer), although this is rare.

If you leave hypothyroidism due to Hashimoto's disease untreated, it can result in several health complications⁷, including:

• Depression

• Heart problems

• Slowed mental functioning

• Congenital disabilities

• Loss of libido (sexual desire)

• Myxedema coma (a life-threatening, rare condition characterized by drowsiness, lethargy, and unconsciousness)

• High cholesterol

• Hypertension

• Heart failure and heart disease

Hashimoto's thyroiditis prognosis

While there isn't a cure for Hashimoto’s, highly effective treatments can make it manageable.

When to see a doctor about your symptoms

Symptoms and signs of Hashimoto's thyroiditis vary widely and aren't specific to the condition. Since the symptoms can come from various other disorders, see your doctor as soon as possible.

If you're currently taking levothyroxine and you experience a Hashimoto's flare-up, make an appointment with your doctor. They will test your thyroid hormone levels to ensure you're getting the right levothyroxine dosage.

Sometimes you may be on the right levothyroxine dose but still, experience symptoms. In these cases, something else could be causing your symptoms, and your doctor will try to find out what that is.

Seek immediate medical attention if you have hypothyroidism and develop:

• Myxedema coma symptoms (drowsiness, lethargy, and unconsciousness)

• Fever

• Difficulty breathing

• Changes in mental status or behavior

• Increased foot and hand swelling

The lowdown

You can’t prevent Hashimoto's disease from occurring, but it is a manageable condition. If you’re suffering from any symptoms, see your doctor for a proper diagnosis.

Your doctor will give you a physical examination and ask about your medical history. You'll also have blood work done to measure your TSH levels. If your test results are abnormal, your doctor might order thyroid hormone and thyroid autoantibody tests. If you have an underactive thyroid, medication can help. Your doctor will figure out the best treatment plan for you.