Symptoms of Hashimoto's Disease

Common and Uncommon Signs of Autoimmune Hypothyroidism

When discussing the symptoms of Hashimoto's disease (Hashimoto's thyroiditis), most are usually referring to the clinical symptoms of low thyroid function—fatigue, sensitivity to cold, hair loss, constipation, and others. Though Hashimoto's impairs the thyroid gland's ability to produce hormones that the body needs to maintain normal metabolism (the conversion of oxygen and calories into energy), it isn't until the associated inflammation of the thyroid gland—known as chronic lymphocytic thyroiditis—causes hypothyroidism that symptoms are usually detected.

symptoms of hashimoto's disease
Illustration by Emily Roberts, Verywell

Frequent Symptoms

Though most people with Hashimoto's have no obvious symptoms at the early stages of the disease, some may experience mild swelling at the front of the throat (goiter) caused by the direct inflammation of the gland.

Hashimoto's disease typically worsens slowly over many years and causes progressive damage to the thyroid gland, leading to an associative decline in thyroid hormone output.

While some people use the terms Hashimoto's disease and hypothyroidism synonymously, Hashimoto's is more aptly characterized as the most common of the disorder that can produce hypothyroidism.

Hashimoto's and hypothyroidism symptoms are the same.

The most common include:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Pale and dry skin
  • A puffy face
  • Brittle nails
  • Hair loss (alopecia)
  • Enlargement of the tongue
  • Unexplained weight gain despite no change in your diet
  • Muscle aches (myalgia)
  • Joint pain (arthralgia)
  • Muscle weakness
  • Heavy menstrual bleeding (menorrhagia)
  • Irregular menstruation (oligomenorrhea)
  • Depression
  • Lapses in memory ("brain fog")
  • Low sex drive
  • Growth delay in children


As Hashimoto's disease progresses, it can cause permanent damage to the thyroid gland. In an effort to produce more thyroid hormone, the gland itself will start to enlarge, leading to the development of a goiter.

There are different types of goiter:

  • Diffuse, characterized by smooth and generalized swelling
  • Nodular, characterized by a lump
  • Multinodular (multiple lumps)
  • Retrosternal (extending backward toward the windpipe)

While smaller goiters may not require treatment, radioactive iodine (RAI) may be needed to reduce the size of larger ones. Retrosternal goiters occasionally require surgical removal if they interfere with breathing or swallowing.

The progressive dysregulation of metabolism and growing imbalances in hormonal output can begin to affect multiple organ systems, leading to a cascade of complications that extend well beyond the thyroid gland itself.


If thyroid hormone levels are too low, they can affect the hormonal mechanisms that regulate the menstrual cycle and trigger ovulation. This can lead to infertility, which can affect up to 50% of women with Hashimoto's, according to research published in the International Journal of Endocrinology.

Even with the proper treatment of hypothyroidism, there is no guarantee that fertility can be fully restored in women severely affected by Hashimoto's.

Heart Disorders

Even mild hypothyroidism can have a profound effect on heart health. The dysregulation of thyroid hormones can instigate increases in "bad" LDL (low-density lipoprotein) cholesterol, leading to the hardening of arteries (atherosclerosis) and increasing the risk of heart attacks and stroke.

Pericardial effusion, the buildup of fluid around the heart, can affect up to 30% percent of people who have hypothyroidism.

While most cases are mild, severe hypothyroidism can lead to a pericardial tamponade, a condition in which the heart is less able to pump blood. In some cases, it can lead to a potentially fatal drop in blood pressure.

Pregnancy Complications

Because maternal thyroid hormone is vital to fetal development, untreated hypothyroidism during pregnancy can lead to potentially serious complications for both the mother and baby.

According to research, untreated hypothyroidism nearly doubles the risk of premature birth and significantly increases the risk of low birth weight, premature rupture of membranes, fetal heartbeat irregularities, and fetal respiratory distress.

Even with subclinical hypothyroidism (in which there are no observable symptoms), pregnant women are at greater risk of preeclampsia, gestational diabetes, post-delivery hemorrhage, and postpartum depression than women without thyroid disease.

Hashimoto's Encephalopathy

Hashimoto's encephalopathy is a rare complication in which the swelling of the brain can cause profound and debilitating neurological symptoms. The condition only affects around two of every 100,000 people each year and usually between the ages of 41 and 44. Women are four times more affected than men.

Hashimoto's encephalopathy typically manifests in one of two ways:

  • A steady decline in cognitive function leading to tremors, sleepiness, confusion, hallucinations, dementia, and, in rare cases, coma
  • Seizures or sudden stroke-like attacks

Hashimoto's encephalopathy is usually treated with intravenous corticosteroid drugs like prednisone to quickly bring down the inflammation and swelling of the brain.


Myxedema is a severe form of hypothyroidism in which metabolism slows to a point where you can fall into a coma and potentially die. It is associated with untreated disease and can be recognized by characteristic changes in the skin and other organs, including:

  • Swollen and puffy skin
  • Drooping eyelids
  • Severe intolerance to cold
  • A drop in body temperature leading to hypothermia
  • Slowed breathing
  • Extreme exhaustion
  • Slowed movement
  • Confusion
  • Psychosis
  • Shock

Myxedema is considered a medical emergency requiring immediate medical assistance.

When to See a Doctor

As a largely "invisible" disease in the early stages, Hashimoto's is often first discovered during a routine exam when thyroid hormone levels are found to be abnormally low.

As Hashimoto's disease tends to run in families, it's a good idea to get tested if someone in your family has the disease.

Talk to your doctor if you begin to experience the classic signs of hypothyroidism, including persistent tiredness, facial puffiness, dry skin, hair loss, abnormal periods, and unexplained weight gain. Early diagnosis and treatment will improve your outcome.

Frequently Asked Questions

  • What does it feel like when you have a Hashimoto attack?

    Your hypothyroid symptoms will flare up, so you may feel tired and begin gaining weight or have other common symptoms of an underactive thyroid such as cognitive problems, sensitivity to cold, dry skin, constipation, and hair loss.

  • What are signs that you may be suffering from complications of Hashimoto disease?

    The most common signs include goiter, heart disease, depression, peripheral nerve disease, and infertility. Rarely, “brain fog,” increased sleepiness, or sudden seizures could be a sign of Hashimoto encephalopathy in which the brain swells and causes neurological problems. Chest pain and shortness of breath, meanwhile, could be a sign of cardiac tamponade, a rare and life-threatening heart condition caused by hypothyroidism.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American Thyroid Association. Hashimoto’s Thyroiditis (Lymphocytic Thyroiditis)

  3. Quintino-moro A, Zantut-wittmann DE, Tambascia M, Machado Hda C, Fernandes A. High Prevalence of Infertility among Women with Graves' Disease and Hashimoto's Thyroiditis. Int J Endocrinol. 2014;2014:982705. doi:10.1155/2014/982705

  4. Harvard Medical School. Thyroid hormone: How it affects your heart

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