Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disease in which the immune system attacks healthy thyroid cells and gradually destroys the thyroid gland. Periods of increased symptoms are known as Hashimoto’s flare-ups. In this article we’ll discuss symptoms of Hashimoto’s flare-ups, what triggers them, and how to manage them. (Source)

Signs and Symptoms of Hashimoto’s Thyroiditis

Symptoms of Hashimoto’s thyroiditis may not be noticeable at first, and can progress for years before it is diagnosed. In time, the thyroid may be damaged enough to stop producing adequate amounts of thyroid hormones, which is when hypothyroidism sets in.

Possible physical symptoms of hypothyroidism include:

• increased fatigue (tiredness)
• muscle and joint pain, aches, or weakness
• heaviness or feeling as if your body is weighed down
• dizziness
• sensitivity to cold
• weight gain
• constipation
• hair loss
• brittle nails
• pale, dry skin
• slow heart rate (bradycardia)
• enlarged thyroid (goiter)
• irregular or heavy menstrual periods
• heart palpitations

Neurological and mental symptoms of hypothyroidism may include:

• brain fog
• migraines
• difficulties with memory
• mood swings
• anxiety
• depression

(Source)

Neurological and mental symptoms of hypothyroidism may include:

• brain fog
• migraines
• difficulties with memory
• mood swings
• anxiety
• depression

(Source)

Hyperthyroidism in Early Hashimoto’s

Sometimes inflammation of the thyroid gland in the early stages of Hashimoto’s can cause the production and release of excessive amounts of thyroid hormones, a condition known as hyperthyroidism.

Symptoms of hyperthyroidism may include:

• increased metabolism
• unexplained weight loss
• rapid or irregular heartbeat
• sweating
• nervousness
• irritability
• mood swings
• difficulty sleeping
• shaky hands
• frequent bowel movements or diarrhea
• goiter

(Source)

Hashimoto's Thyroiditis vs. Hypothyroidism

Hashimoto’s thyroiditis and hypothyroidism, or thyroid hormone deficiency, are related conditions. Hashimoto’s disease begins with inflammation of the thyroid gland and often leads to hypothyroidism as the thyroid gland is damaged. Until thyroid levels start falling, there may be no noticeable symptoms of Hashimoto’s disease. However, having Hashimoto's thyroiditis does not necessarily guarantee experiencing hypothyroidism.

Although Hashimoto’s disease is the most common cause of hypothyroidism in the United States, other causes include over-response to anti-thyroid medication, thyroid surgery, radiation therapy, and medications such as lithium. (Source)

Causes and Triggers of Hashimoto’s Flare-Ups

There are several possible causes of Hashimoto’s flare-ups, and these differ from person to person. However, some common triggers for changes in thyroid function include:

• drinking alcohol (Source)
• pregnancy (Source)
• stress (Source)

Hashimoto’s and Diet

Diet also plays an essential role in Hashimoto’s disease. Iodine and selenium are vital to thyroid function, so if you have Hashimoto’s thyroiditis you should maintain an adequate amount of these nutrients in your diet. (It’s important to note, however, that excessive iodine intake can also damage thyroid function. In countries such as the United States, lack of iodine in the diet is seldom an issue.) Zinc deficiency has also been associated with Hashimoto’s, and studies have shown zinc supplementation improved thyroid hormone levels in people with goiter, an enlarged thyroid gland. Vitamin D and vitamin B12 deficiencies have also been observed in people with Hashimoto’s. (Source, Source)

Hashimoto’s and Medications

Some medications and supplements can also interfere with thyroid function or with absorption of levothyroxine, the synthetic thyroid hormone used to treat hypothyroidism. These include: 

• calcium and iron supplements
• antacids
• estrogen found in contraceptive pills and hormone replacement therapy (HRT)
• cholesterol-lowering drugs such as cholestyramine and colestipol
• rifampicin (antibiotic)
• sucralfate (ulcer medication)
• seizure medicines such as phenytoin and carbamazepine

Adjusting the dosage of levothyroxine or changing the time of day when you take other medications can help reduce these effects. (Source, Source)

Hashimoto’s and Stress

The relationship between stress and function of the thyroid in Hashimoto’s thyroiditis is not fully understood. However, stress has both direct and indirect effects on the immune system, and your stress level may make a difference in whether or not you develop thyroid autoimmunity. (Source)

Common stressors include emotional stresses with family or relationships; physical stress such as injury, surgery, or illness; and life changes, such as pregnancy or moving cities. Stress management techniques, such as meditation, may help alleviate stress and improve health.

Managing Hashimoto’s Thyroiditis

Hypothyroidism due to Hashimoto’s thyroiditis is usually treated with levothyroxine, a synthetic form of thyroid hormone. Taking the correct dosage of levothyroxine balances hormone levels and prevents Hashimoto’s flare-ups.

Whether or not you are prescribed medication for your Hashimoto’s, there are proactive steps you can take to help manage your symptoms, limit disease progression, and prevent flare-ups.

Manage Hashimoto’s With an Anti-Inflammatory Diet

Having Hashimoto’s makes it essential to maintain a healthy and anti-inflammatory diet. There is no one specific diet for people with Hashimoto’s disease, but adding in aloe, licorice, and foods high in omega-3 fatty acids may also help heal inflammation and improve gut health. The paleo, gluten free, and autoimmune protocol (AIP) diets may help reduce inflammation and identify foods that can trigger an immune response. (Source, Source, Source, Source, Source) 

Manage Hashimoto’s by Protecting Gut Health

With all autoimmune diseases, the immune system attacks its own tissues. Hashimoto’s flare-ups are likely initiated by an overzealous immune response causing inflammation in the thyroid. For many patients, these autoimmune flares are linked to poor gut health or interference with the two-way communication system known as the thyroid–gut axis. (Source, Source, Source)

Thus, improving gut health may reduce inflammation, frequency, and severity of flare-ups, and thyroid autoimmunity. Research has shown that infection with Helicobacter pylori, for example, is associated with onset of thyroid disorders including Hashimoto’s, and that eradicating H. pylori can reduce anti-thyroid antibodies. (Source, Source) 

Managing Hashimoto’s With Probiotics

Probiotics are beneficial microorganisms that can be taken by mouth to help balance the gut microbiome, eliminate harmful microorganisms, promote a healthy immune response, and reduce inflammation. People with Hashimoto’s often have smaller than normal intestinal populations of Lactobacillaceae and Bifidobacteriaceae bacteria, and nourishing their growth has been found to reduce the need for thyroid medications and decrease fatigue in people with the condition. Probiotics combined with prebiotics — compounds that fuel bacterial growth — are known as synbiotics. (Source, Source, Source)

Managing Hashimoto’s With Dietary Supplements

Many people with Hashimoto’s are deficient in vitamin D, and bringing levels of this vital nutrient  up to normal may help slow progression of the disease. Selenium, a trace mineral that is needed by the body in small but important amounts, is an essential component of proteins involved in production of thyroid hormones. Supplementing with selenium has been shown to reduce autoantibodies that damage thyroid tissue. (Source, Source, Source, Source) 

Managing Hashimoto’s With Lifestyle Changes

Lifestyle changes may help reduce symptoms of Hashimoto’s and the incidence of Hashimoto’s flare-ups. These include: 

• creating a regular sleep schedule and getting better quality sleep (Source)
• exercising regularly (Source)
• reducing mental, emotional, and physical stress (Source)
• controlling blood sugar levels (Source)
• treating anxiety and depression (Source, Source)

The Bottom Line

Hashimoto’s flare-ups may include both mental and physical symptoms. There is no one definitive cause of flare-ups, but certain foods or stressors are believed to trigger them. 

When Hashimoto’s leads to a permanent decrease in thyroid function, the standard medical treatment is to replace thyroxine with levothyroxine, a synthetic thyroid hormone. However, it may be possible to prevent the condition from progressing to that point with attention to lifestyle factors such as diet, exercise, and stress management. A WellTheory membership can provide one-on-one support and guidance to help you manage your Hashimoto’s and prevent flare-ups.