How to Test for Hashimoto's Disease

Fatigue, Cold Intolerance, Depression, and More

Hashimoto's disease
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Hashimoto’s disease, or Hashimoto’s Thyroiditis, is an autoimmune condition where your body’s immune system begins to attack your thyroid gland. The thyroid is a butterfly-shaped gland in the front and base of your neck. The primary function of the thyroid gland is to produce hormones, which regulate how your body utilizes energy—the thyroid gland has a profound effect on nearly every cell in your body.

When you have Hashimoto’s disease, your thyroid can become inflamed and damaged, leading to hypothyroidism, or an underactive thyroid. Ultimately, the functions of your body slow down because your thyroid can’t produce the necessary hormone levels.  

In the United States, Hashimoto’s disease is the most common cause of hypothyroidism, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and it affects approximately five out of every 100 people. It’s about eight times more common in women than in men. In some cases, the thyroid may become enlarged and form a goiter.


Initially, a person with Hashimoto’s disease may remain asymptomatic for years until the condition is discovered during a medical exam or routine blood work, reports the American Association of Clinical Endocrinologists (AACE). Following are some of the signs and symptoms of Hashimoto’s disease:

  • Swelling at the base of the neck, which is usually painless
  • A sensation of pressure in the lower portion of the neck
  • Fatigue and lethargy
  • Cold intolerance or feeling cold when other people don’t
  • Hair loss
  • Weight gain
  • Nails become brittle or break easily
  • Constipation
  • Joint pain
  • An increase in joint stiffness
  • Muscles aches and pains
  • Muscle weakness
  • Puffiness of the face
  • Drowsiness
  • Difficulty with memory
  • Forgetfulness
  • Hair loss or dry, brittle, or thinning hair
  • History of miscarriages or difficulty getting pregnant
  • Menorrhagia or excessive menstrual bleeding
  • Depression
  • Decreased heart rate
  • Pale skin
  • An enlarged tongue


To date, one particular cause hasn’t been identified, but researchers believe it’s a combination of factors like your genetics or a bacterial or viral infection that may trigger the disease. The condition is more likely to show up in middle-aged women, though, men can get it as well. Also, you’re more likely to have Hashimoto’s disease if a member of your family has it or if you have an existing autoimmune condition.


To diagnose Hashimoto’s disease, your doctor will review your health history, list of symptoms, and perform a physical exam. Goiters can often be felt during these exams.

Next, your doctor will order lab work to check for hypothyroidism. The standard test is called the thyroid stimulating hormone or TSH. TSH is made by the pituitary gland in your brain, and it signals the thyroid to produce hormones. When your thyroid gland is under-functioning, your TSH will usually be elevated because the pituitary gland is trying to prompt your thyroid gland to produce more hormones.

Additionally, your healthcare practitioner may order blood tests like free thyroxine, or free T4, to test the level of the active thyroid hormone in your blood. But AACE indicates free T4 results may not always be an accurate predictor of whether or not you have Hashimoto’s disease. “A high level of TSH stimulation may keep the free thyroxine levels ‘within normal limits’ for many years,” they report.

Another blood test your doctor will order looks for antibodies called thyroperoxidase antibodies or TPO. These antibodies are present in the majority of people who have Hashimoto’s disease, though, this test alone isn’t a sign that you have the condition.

In certain instances, your doctor may order a thyroid ultrasound. An ultrasound provides images of the thyroid, so the doctor can see if the gland is enlarged due to Hashimoto’s disease or rule out other causes like thyroid nodules.

After Diagnosis

In the early stages of Hashimoto’s disease, you might not have symptoms. In this case, medical intervention may not be necessary, and your doctor may decide to wait and see if your condition worsens with time.

If your condition advances to where your thyroid is unable to make adequate hormone levels, your doctor will prescribe a thyroid hormone replacement like levothyroxine—a synthetic, T4 hormone that mimics the thyroid hormone your body produces naturally. Your doctor will perform routine blood tests and adjust your treatment as needed until you reach the appropriate dose for you.

Occasionally, certain people may not feel well on levothyroxine alone, so they may benefit from the addition of a synthetic, T3 hormone called liothyronine. A combination of T4 and T3 for three to six months is a sufficient trial period to see if you experience relief from your symptoms, states the Mayo Clinic.  

Additionally, while the standard of care for Hashimoto’s disease is to treat the condition using levothyroxine, medication called natural desiccated thyroid (NDT), like Nature-Throid or Armour, may be advised for some people. NDT is derived from pigs and contains both T4 and T3.

There's some skepticism regarding NDT in the medical community about whether or not it works as well as its synthetic counterparts. Why? Because the balance of T4 and T3 in NDT is different between pigs and humans, and the amounts of the hormones have been known to vary within the product.

But healthcare needs to be individualized for each patient, so it’s important to mention that some patients report significant improvements on NDT. For the best possible outcomes, it’s essential that you are aware of all of the options available to you and work with your doctor to pick the treatment that's right for you.

A Word From Verywell   

Because Hashimoto’s disease tends to progress over a person’s lifetime, your doctor will want to test you periodically to make sure you’re on the right dose of medication. Occasionally, your treatment may have to be adjusted. The good news? Most often, thyroid patients with Hashimoto’s disease can be well-controlled through medication, so you’ll want to take your medication as prescribed even if you begin feeling well. 

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