Hashimoto's Symptoms and Complications

Common and Uncommon Signs of Autoimmune Hypothyroidism

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Hashimoto's symptoms aren't obvious in the early stages of the disease. People may live for years with Hashimoto's disease (Hashimoto's thyroiditis) before symptoms emerge that lead to a diagnosis.

These common symptoms include fatigue, sensitivity to cold, hair loss, and constipation. The symptoms are consistent with hypothyroidism, or low thyroid function. But even when Hashimoto's is already at work, symptoms go unnoticed until inflammation of the thyroid gland—known as chronic lymphocytic thyroiditis—advances.

This article explains what Hashimoto's feels like and its common symptoms and complications. It also discusses when the symptoms mean you should see a healthcare provider.

symptoms of hashimoto's disease

Verywell / Emily Roberts

Hashimoto's Symptoms

Hashimoto's symptoms in the the early stages may include fatigue and weight gain. This is because Hashimoto's disease affects the thyroid gland's ability to produce hormones that the body needs to maintain normal metabolism. It limits the ability to convert oxygen and calories into energy.

Though many people with Hashimoto's have no obvious symptoms in the early stages, 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 a decline in the production of key thyroid hormones.

Hashimoto's Symptoms vs. Hypothyroidism

Some people use the terms Hashimoto's disease and hypothyroidism synonymously, but there is a difference between hypothyroidism and Hashimoto's. Hashimoto's is more aptly characterized as the most common of the disorders that can produce hypothyroidism.

Hashimoto's and hypothyroidism don't exactly mean the same thing, because there are other kinds of low thyroid-function conditions. The symptoms, however, 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

Who's at Risk for Hashimoto's Disease?

Hashimoto's disease affects both biological males and females with many of the same symptoms. However, it affects females seven to 10 times more often than males. Most cases emerge in people between 40 and 60 years old. It's also more common in people with other autoimmune disorders, including type 1 diabetes.

Hashimoto's Complications

Hashimoto's symptoms don't always appear immediately but as the 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)

Goiter Treatment

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 metabolic disruptions and hormonal imbalances can begin to affect multiple organ systems, leading to a cascade of complications that extend well beyond the thyroid gland itself.

Infertility

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 females with Hashimoto's.

Even with the proper treatment of hypothyroidism, there is no guarantee that fertility can be fully restored in females 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 a pregnant person's thyroid hormones are vital to fetal development, untreated hypothyroidism during pregnancy can lead to potentially serious complications for both the parent and child.

According to research, untreated hypothyroidism significantly increases the risk of:

  • Low birth weight
  • Premature rupture of membranes
  • Fetal heartbeat irregularities
  • Fetal respiratory distress

With these complications is a greatly increased risk of premature birth, between two and four times that of typical pregnancies.

Hashimoto's in Pregnancy

Even with subclinical hypothyroidism (in which there are no observable symptoms), pregnant people are at greater risk of preeclampsia, gestational diabetes, post-delivery hemorrhage, and postpartum depression than those 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. Females are affected four times more often than males.

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

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 or dropping lids.

Other symptoms of myxedema include:

  • Severe intolerance to cold
  • A drop in body temperature leading to hypothermia
  • Slowed breathing
  • Hypotension (low blood pressure)
  • Bradycardia (slow heart rate)
  • Slowed movement and delayed reflexes
  • Mental confusion
  • Shock

Myxedema is considered a medical emergency requiring immediate medical assistance.

When to See a Healthcare Provider

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 healthcare provider 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. Other common symptoms of an underactive thyroid include cognitive problems, sensitivity to cold, dry skin, constipation, and hair loss.

  • What are signs of complications of Hashimoto's disease?

    A goiter often develops, alongside conditions including heart disease, depression, peripheral nerve disease, and infertility. Rarely, “brain fog,” increased sleepiness, or sudden seizures could be a sign of Hashimoto encephalopathy. Chest pain and shortness of breath could be a sign of cardiac tamponade.

  • How do you determine if you have Hashimoto's disease?

    A diagnosis typically is made on the basis of thyroid hormone tests. A thyroid ultrasound also may be used to provide images, especially if your blood tests appear normal but your healthcare provider still suspects Hashimoto's disease.

9 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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