What Is Hashimoto’s Disease?

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Hashimoto’s disease is the most common type of thyroid disease in the United States and worldwide. Researchers believe incidence is at 3.5 per 1,000 in women per year and 0.8 per 1,000 in men per year.

Twin studies have shown Hashimoto’s is quite common in twins, as genetics play a central role in the development of this condition.

What Is Hashimoto’s Disease?
Verywell / Emily Roberts

Hashimoto’s Disease Symptoms

Hashimoto’s comes in two different types—thyroiditis with goiter and hypothyroidism.

With a goiter, the thyroid becomes inflamed and enlarged to the point that a person develops a goiter, appearing as a visible bulge in the front of the neck. The goiter may be painful over time and without treatment, it may interfere with swallowing and breathing, and causes changes to the voice.

Hypothyroidism impairs the thyroid’s ability to produce enough thyroid hormone. And without enough thyroid hormone, the body cannot function correctly.

It quite possible for someone to have Hashimoto’s for a number of years and not know because they are not experiencing symptoms. When it does cause symptoms, they may include: 

  • Weight gain
  • Fatigue
  • Cold sensitivity
  • Concentration troubles
  • Dry skin, hair and nails and thinning hair
  • Stomach troubles, especially constipation
  • Drowsiness
  • Joint and muscle pain and stiffness
  • Heavy menstrual flow
  • Depression
  • Puffiness in face and eyes
  • Slow heartbeat
  • Problems with getting pregnant

Anyone who is experiencing one or more of these symptoms for many weeks should talk to their doctor about getting their thyroid levels checked and/or determine a cause for symptoms.

Causes

Because Hashimoto’s disease is an autoimmune disease, it causes white blood cells and certain antibodies to attack the thyroid. Scientists don’t know why this happens but believe genetics play a role. Other risk factors include:

  • Autoimmune diseases: Having at least one autoimmune disease, such as Graves’ disease, lupus, celiac disease, or type 1 diabetes.
  • Age: The risk for Hashimoto’s increases with age and the highest risk is after age 50.
  • Ethnicity: Caucasians have the highest risk for developing Hashimoto’s over other races.
  • Gender: Women have a much higher risk for Hashimoto’s than do males. Pregnancy and menopause might be to blame.
  • Medications: Certain medications, especially those containing iodine, may increase a person’s risk for Hashimoto’s disease.
  • Smoking: Smoking increases the risk for thyroid diseases, especially Hashimoto’s. Certain chemicals in cigarette smoking are harmful to the thyroid.

Diagnosis

A doctor may suspect Hashimoto’s if a person experiences some of the symptoms associated with the condition. Blood work can check a person’s thyroid-stimulating hormone (TSH) levels. TSH levels are highest when thyroid hormone activity is low because the body is working harder to produce more thyroid hormone.

Additional blood work may help to confirm a diagnosis, including testing for antibodies and other thyroid hormones. If a person does not have antibodies in their blood, it is unlikely they have Hashimoto's. An ultrasound in someone with the disease will show thyroid tissue that looks very uneven (heterogenous), as well as pseudonodules (tissue that resembles nodules but is not a nodule per se)

Treatment

Most people with Hashimoto’s will need medication. However, if a person’s thyroid is still functioning normally, a "watch-and-wait" approach is taken.   

One of the most common medications prescribed for people whose thyroid isn’t producing enough hormone is Levothyroxine. This medication is a synthetic hormone that mimics thyroxine, the missing hormone. Levothyroxine medication has few side effects and most people who take it will need to for their entire lives.

Any side effects of Levothyroxine tend to be mild and usually go away within a few days or a couple of weeks. If side effects are severe or don’t go away, it is a good idea to talk to a doctor.

The goal of treatment is to return thyroid hormone levels back to normal, so symptoms disappear. Hormone levels will be monitored with blood work and medications will be adjusted as needed. 

It is important to tell your doctor about all the medications and supplements you are taking, as some medications and supplements affect the body’s ability to absorb the drug. Moreover, certain foods may affect absorption, so it is important to discuss with a doctor the best ways to incorporate thyroid medications into your diet.

Complications

Hashimoto’s increases a person’s risk for a number of autoimmune diseases. And because of this increased risk, it is a good idea to talk to a doctor about managing risks. Management may include periodic testing to assist with early treatment. 

Hashimoto’s disease may increase the risk for a rare type of thyroid cancer called thyroid lymphoma. Thyroid lymphoma is a sudden and severe enlargement of the thyroid gland that happens over a few days or weeks. It is not a normal goiter or thyroid nodules. If found early, it is treatable and curable. 

A Word From Verywell

Hashimoto’s disease is a lifelong condition with no cure. And while there is no way to prevent the condition, it is very treatable and the sooner a person is diagnosed, the sooner they can start treatment. 

The prognosis for someone with Hashimoto’s is usually good with the right treatment. Getting thyroid hormone levels back to normal will reverse symptoms. 

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Article Sources
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  2. National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto's Disease. Sept 1, 2017.

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  4. Harvard Health Publishing. The lowdown on thyroid slowdown. Harvard Health. Mar 19, 2019.

  5. MedlinePlus. Levothyroxine: MedlinePlus Drug Information. Feb 15, 2019.

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Additional Reading
  • Cleveland Clinic. Hashimoto’s Disease. Updated October 23, 2017.

  • Eleftheriou P, Kynigopoulos S, Giovou A. Prevalence of Anti-Neu5Gc Antibodies in Patients with Hypothyroidism. Biomed Res Int. 2014; 2014: 963230. DOI: 10.1155/2014/963230.

  • Mayo Clinic. Hashimoto’s Disease. Published March 3, 2018.

  • Medline Plus. Levothyroxine. Updated July 15, 2017.

  • Mincer DL, Jialal I. Hashimoto Thyroiditis. Updated October 27, 2018.

  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Hashimoto’s Disease. Updated September 2017.

  • Office of Women’s Health. Hashimoto’s Disease. Updated October 18, 2018.

  • Sawicka-Gutaj N, Gutaj P, Sowiński J, et. al. Influence of cigarette smoking on thyroid gland--an update. Endokrynol Pol. 2014;65(1):54-62. DOI: 10.5603/EP.2014.0008.