Hashimoto's Can Cause Symptoms Even When TSH Is Normal

This autoimmune disease can still lower quality of life when bloodwork is normal

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If you have symptoms of hypothyroidism, such as fatigue, constipation, anxiety, irritability, dry hair, and difficulty concentrating, but your doctor already checked your TSH and it's normal, you may still have thyroid disease. Hashimoto's thyroiditis, an autoimmune thyroid condition and the most common cause of underactive thyroid in the U.S., is only diagnosable by running a blood test to check for thyroid antibodies—but many doctors don't run this test when a patient first complains of low thyroid symptoms.

Often, thyroid symptoms occur once Hashimoto's thyroiditis has developed into full-blown hypothyroidism, which takes several years, but research clearly shows that Hashimoto's thyroiditis can begin substantially reducing the quality of life, even before the TSH level changes.

When Thyroid Levels Are Normal—But Hashimoto's Still Causes Symptoms

Research published in the journal Thyroid in 2011 showed that women with higher levels of anti-thyroid peroxidase (TPO) antibodies had a significantly higher number of symptoms compared to women with lower antibodies. Low thyroid symptoms such as chronic fatigue and dry hair, and even early miscarriage, were associated with higher TPO antibodies.

The article concluded that hypothyroidism is only one factor that contributes to symptoms of Hashimoto's thyroiditis.

Charles H. Emerson, MD, Editor-in-Chief of the journal Thyroid, said: "This study raises important clinical issues. Although the authors did not study thyroid hormone treatment for Hashimoto's thyroiditis, it raises the possibility that optimal doses of thyroid hormone will not completely ameliorate all symptoms. Further studies are required to confirm the findings of Ott et al. and to determine if patients with hypothyroidism due to Hashimoto's thyroiditis still have residual symptoms despite achieving an ideal biochemical response to thyroid hormone replacement therapy."

Interestingly, it's been many years since the March 2001 issue of the same exact journal, Thyroid, published a German study that found that the use of levothyroxine treatment for cases of Hashimoto's autoimmune thyroiditis where TSH had not yet elevated ("euthyroid") beyond normal range could reduce the incidence and degree of autoimmune disease progression. Those researchers concluded that preventative treatment of normal TSH range patients with Hashimoto's disease reduced the various markers of autoimmune thyroiditis, and speculated that such treatment might even be able to stop the progression of Hashimoto's disease, or perhaps even prevent the development of the hypothyroidism.

So Why Won't My Doctor Treat Me For Hashimoto's? 

Unfortunately, treating Hashimoto's patients who have normal TSH levels never became part of the current standard of care in medicine. The medical community still largely denies that Hashimoto's can cause problematic symptoms in the absence of hypothyroidism, even when scores of patients report that they feel ill with a TSH in the normal range.

The bottom line? At some point, we need the medical community to recognize that Hashimoto's, even when the thyroid levels fall into the so-called "normal" range," can cause symptoms. You may want to seek out care with a functional medicine or naturopathic physician in your area, as these doctors tend to be more open to the idea that Hashimoto's can cause symptoms and have a lot of experience treating it.

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Article Sources
  • Ott, Johannes et. Al. "Hashimoto's Thyroiditis Affects Symptom Load and Quality of Life Unrelated to Hypothyroidism: A Prospective Case-Control Study in Women Undergoing Thyroidectomy for Benign Goiter." Thyroid, 2011; 21 (2): 161 DOI: 10.1089/thy.2010.0191
  • Padberg S, et. al. ."One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit?" Thyroid. 2001 Mar;11(3):249-55.