Everything You Need to Know About Hashimoto’s Disease

Hashimoto's disease (HD), also called Hashimoto's autoimmune thyroiditis, is an autoimmune disease that damages and enlargens the thyroid gland. The damage lowers the level of hormones it can produce, leading to hypothyroidism (low thyroid activity).

The thyroid is a butterfly-shaped gland at the front of your neck. It makes hormones that control your metabolism, which is how your body uses energy. Thyroid hormones influence nearly every organ in your body.

This article discusses Hashimoto's disease symptoms, causes, diagnosis, and treatment options.

Hashimoto’s Disease Symptoms

Hashimoto’s disease can cause various symptoms. You may not experience all of them, and you may experience different symptoms at different times. It’s possible to have Hashimoto’s thyroiditis and not know you’re sick.

Thyroid-Related Symptoms

HD is a type of hypothyroidism and shares its symptoms. These include:

• Fatigue or weakness
• Weight gain
• A puffy face
• Impaired cold tolerance
• Joint and muscle pain
• Constipation
• Dry, thinning hair and dry skin
• Decreased sweating
• Heavy or irregular menstrual periods
• Female fertility problems
• Depression
• Slow heart rate

HD can also cause a goiter, which is an enlarged thyroid gland. It is caused by inflammation and is not cancerous. A goiter can cause:

• A visible bulge in the front of your neck
• The feeling that something is stuck in your throat
• Problems with breathing, speaking, or swallowing

Hashitoxicosis

In some people, early Hashimoto’s disease makes the thyroid gland temporarily release too much thyroid hormone into the bloodstream (thyrotoxicosis). This is a response to the immune system’s attack called hashitoxicosis. Symptoms can include:

• Impaired heat tolerance
• Rapid heart rate
• Sweating
• Unintended weight loss
• Tremors
• Anxiety

Eventually, the thyroid will produce less hormone, and the symptoms will change.

Autoimmune Disease–Related Symptoms

An overactive immune system causes specific symptoms. You may experience:

• Low-grade fever that may be sporadic
• Dizziness
• Difficulty concentrating
• Skin rashes
• Digestive issues
• Feeling unwell

Symptoms of autoimmunity tend to flare up from time to time rather than being constant.

What Causes Hashimoto’s Disease?

Medical professionals are unsure what causes autoimmune diseases, including Hashimoto’s. However, they believe several things can play a role, such as:

• A genetic predisposition
• Certain viruses, including hepatitis C
• Some medications used to treat bipolar disorder and other mental health problems
• Heart medicines containing iodine

Risk Factors

Your risk of having HD is higher if you:

• Were assigned female at birth
• Are between 40 and 60 years old
• Have a family history of HD
• Were pregnant or gave birth in the past 6 months
• Have had a previous thyroid problem, such as a goiter
• Have had thyroid surgery
• Have had radiation treatment to the neck or chest

Having another autoimmune disease also increases your risk of Hashimoto’s, especially:

• Celiac disease
• Lupus
• Rheumatoid arthritis
• Sjögren’s syndrome
• Type 1 diabetes

While the risk of HD increases with age, anyone, including children, can develop it.

Associated Endocrine Disorders

Hashimoto’s is often seen alongside other endocrine (hormonal) and metabolic conditions. These include:

• Polycystic ovary syndrome (PCOS): A hormonal imbalance that can lead to infertility
• Turner syndrome: Involves short stature and early loss of ovarian function
• Type 1 diabetes: When the pancreas makes little or no insulin, affecting blood-sugar levels

Having HD and PCOS may impact female fertility and increase your risk of heart disease and cancer.

Hashimoto’s Disease Diagnosis: What Tests Are Used?

If your healthcare provider suspects you have Hashimoto’s disease, they’ll use the following methods to test for the condition:

• Consider your symptoms
• Perform a physical exam to check for a goiter
• Order thyroid hormone blood tests
• Order thyroid antibody blood tests

If the diagnosis isn’t certain, your provider may order an ultrasound of your thyroid to measure its size and look for features of HD as well as other possible causes of your symptoms, such as thyroid nodules (small lumps).

Can You Detect Hashimoto’s Disease Early?

It is possible to diagnose HD early on. This is most common in people with a strong family history of thyroid disease. In an early diagnosis, an antibody test may be positive while thyroid hormone levels are normal and symptoms have yet to develop.

Hashimoto’s Disease Treatment

Hashimoto's disease treatment may include:

• Levothyroxine: Synthetic form of the thyroid hormone thyroxine (T4), the most common treatment and often the only one that's needed
• Liothyronine: Synthetic form of the thyroid hormone triiodothyronine (T3) that's used when levothyroxine doesn't eliminate symptoms
• Surgery: When a goiter causes pain or problems with breathing, swallowing, or speaking

When you start thyroid medication, your healthcare provider will monitor you closely to ensure you're at the correct dosage. Your dosage may be changed several times. You might also need to increase your dosage over time or if you become pregnant.

Supplements and Herbal Remedies

You shouldn’t try to self-treat a thyroid disease with supplements or herbs. Proper treatment takes frequent monitoring with blood tests and a qualified healthcare provider to interpret them.

However, some supplements may help counter common vitamin and mineral deficiencies in people with HD. Your healthcare provider can do blood tests to see whether you have any deficiencies. Common supplements and herbal remedies for people with HD include:

• Vitamin B-12
• Zinc
• Selenium
• Iodine
• Ashwagandha

Other Alternative Treatments

Alternative treatments that may help you manage your HD include acupuncture, which may increase thyroid hormone levels, and yoga and guided meditation to relieve stress, as stress may increase HD symptoms. Discuss all treatments with your healthcare provider before you attempt them.

Hashimoto’s Disease Diet

Your diet can have a big impact on your thyroid health and help you manage HD. 

Goitrogens

A group of foods called goitrogens can interfere with how much hormone your thyroid makes. A problematic chemical is present in raw forms of these foods, but cooking them breaks down the chemical and makes them safe.

Some common goitrogenic foods include:

• Broccoli
• Cabbage
• Cauliflower
• Kale
• Lima beans
• Sorghum
• Sweet potato
• Turnips

If you’re iodine deficient, soy may also act as a goitrogen.

Iodine

Your body uses iodine to produce thyroid hormones. When you have HD or other autoimmune diseases, though, high levels of iodine can worsen hypothyroidism.

Iodine-containing foods include:

• Fish, seafood, and seaweed
• Dairy products
• Eggs

If you’re pregnant, getting the right amount of iodine is important. Your healthcare provider can help you determine how much iodine you need.

Complications of Hashimoto’s Disease

If HD isn’t treated, it can lead to serious complications. These include:

• Heart problems
• Slowed mental function
• Loss of sexual desire
• Congenital disabilities 
• Myxedema coma (altered mental state, inability to maintain a normal body temperature, and multiple organs slowing down)
• Thyroid cancer (rare)

Living With Hashimoto’s Disease

Low thyroid hormone levels can lead to mental and emotional disorders. These can include:

• Anxiety
• Depression
• Difficulty concentrating
• Irritability
• Memory problems
• Mood swings

Speak to a healthcare provider about these symptoms. It may indicate that your thyroid-replacement hormone dosage is too low or too high. You may also benefit from mental health counseling, support groups (locally and online), and exercise. Hashimoto’s can take a toll on your social life. Let your provider know how they can help you manage your illness.

If your HD causes sexual dysfunction, discuss it with your partner(s). Make sure they know it’s not a problem with them but with your health. A healthcare provider may be able to help you find ways to overcome your sexual dysfunction.

Outlook

Hashimoto’s disease is a lifelong illness, and the prognosis for most people is good. HD can stay stable for many years, with no necessary increase in medication or management strategies. It’s easily treatable with long-established medications and doesn’t shorten your life expectancy. The earlier Hashimoto’s disease is diagnosed, the better your long-term outlook is. Talk to a healthcare provider if you have symptoms that may suggest a thyroid problem.