Hashimoto’s thyroiditis is one of the most common organ-specific autoimmune diseases. While anyone can develop Hashimoto’s thyroiditis, women are 10 times more likely than men to develop Hashimoto’s. It is also the most common cause of acquired, versus congenital, hypothyroidism in children.

The clinical treatment for Hashimoto’s has remained relatively unchanged since it was first identified in 1912. However, recent insights suggest anti-inflammatory diets can help manage and even reduce Hashimoto’s thyroiditis symptoms. In this article, we’ll discuss the causes and symptoms of Hashimoto’s disease as well as its treatment options, what tests to expect, and how to adjust your lifestyle to manage symptoms in the best way possible. (Source, Source)  

What Is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis and autoimmune thyroiditis, is a form of chronic inflammation in the thyroid — a butterfly–shaped gland at the front of the neck that wraps around the sides of your trachea, or windpipe.

The thyroid is responsible for making hormones that control many of the body’s systems. Thyroid hormones affect every cell, tissue, and organ in the body to help regulate our metabolism, energy levels, mood, growth, and development. Constant amounts of these hormones circulate in the blood every day to ensure our organs are functioning normally. (Source)

People with Hashimoto’s disease develop anti-thyroid antibodies that target healthy thyroid tissue. These antibodies are classified as autoantibodies — proteins that mistakenly identify our own healthy cells as intruders, signaling the immune system to attack. The presence of anti-thyroid antibodies in the blood is a hallmark of Hashimoto’s thyroiditis.

In the case of anti-thyroid antibodies, the immune system is triggered to attack thyroid tissue, gradually destroying the gland over time. When damaged, the thyroid can no longer consistently produce the same amounts of thyroid hormones. Having unusually low (and occasionally unusually high) levels of thyroid hormones disrupts any mechanism in the body that is regulated by the thyroid.

Signs and Symptoms of Hashimoto’s Thyroiditis

The ways Hashimoto’s thyroiditis can manifest are highly variable. However, it most commonly presents symptoms of goiter (enlarged thyroid gland), hypothyroidism, hyperthyroidism, or some combination of these.

Goiter

Goiter is when the inflamed thyroid swells up — sometimes visibly so, causing the neck to look or feel swollen. A goiter is not painful, and usually just feels like a fullness in the throat. But in rare cases, if the goiter is extremely large, it can press against the trachea and esophagus, making it difficult to breathe or swallow.

Hypothyroidism

The symptoms of hypothyroidism arise from an underactive thyroid, when the thyroid simply isn’t making enough thyroid hormones. Symptoms can be both physical and neurological.

Physical Symptoms of Hypothyroidism

• fatigue
• muscle aches and joint pain
• dizziness
• sensitivity to cold
• weight gain
• constipation
• hair loss
• brittle nails
• pale and dry skin
• slowed heart rate (bradycardia)
• heart palpitations
• irregular or heavy menstrual periods

Neurological and Mental Symptoms of Hypothyroidism

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

Hyperthyroidism

In rare cases, patients with Hashimoto’s disease can also present symptoms of an overactive thyroid, or hyperthyroidism. This can happen early in the disease when inflammation stimulates the thyroid to produce too much of its hormones. (Source)

Symptoms of Hyperthyroidism

• fatigue
• irritability
• mood swings
• goiter
• unexplained weight loss
• insomnia
• rapid or irregular heart rate
• frequent bowel movement

(Source)

Causes and Triggers of Hashimoto’s Thyroiditis

Hashimoto’s disease, like the majority of autoimmune disorders, is thought to arise from a combination of environmental triggers and genetic predisposition. (Source)

Environment and Lifestyle Triggers

• deficiencies of vitamin D and selenium
• immune changes that occur during pregnancies
• damage to the thyroid from treatment for other diseases, such as:

• thyroidectomy
• radioactive iodine therapy
• radiotherapy for cancer in the head or neck.

• exposure to toxic chemicals or drugs, including amiodarone, interleukin-2, kinase inhibitors, and lithium  
• extremely low and extremely high dietary iodine

Genetics

The genes involved in synthesizing thyroid hormones can sometimes have inherited defects that are passed down between generations. The risk of developing Hashimoto’s is higher when relatives also have the disease, and the occurrence of Hashimoto’s disease tends to cluster in families. (Source)

Hashimoto’s Thyroiditis Risk Factors

• Women are 10 times more likely than men to develop the disease. (Source)
• Hashimoto’s commonly appears between ages 30 to 50. (Source)
• Patients with other pre-existing autoimmune conditions are more likely to develop Hashimoto’s disease. (Source)

Hashimoto’s Flares

The causes of Hashimoto’s flares vary from one person to another, but there are some common triggers and ways to manage flares.

Common Hashimoto’s Flare Triggers

• stress
• pregnancy (Source)
• alcohol

Hashimoto’s Flare Management

• medication
• diet
• stress management

How Is Hashimoto’s Thyroiditis Diagnosed?

Symptoms of Hashimoto’s disease are non-specific and overlap with a variety of other illnesses, which means a diagnosis cannot rely on the presentation of symptoms alone. Instead, a diagnosis relies on testing anti-thyroid antibody and hormone levels in the blood. This requires a variety of tests to evaluate thyroid function.

Hormone Blood Tests

• thyroid stimulating hormone (TSH). TSH levels are used to test for thyroid dysfunction. Having elevated TSH levels along with low triiodothyronine (T3) and thyroxine (T4) levels may indicate hypothyroidism. (Source)
• free thyroxine (free T4 or FT4). Testing for free T4 is typically done after abnormal TSH levels have been found, or together with a TSH test. There are two forms of T4 in the blood: free T4 and bound T4. Bound T4 is attached to a protein called thyroxine-binding globulin that keeps it from entering cells. Free T4 is the active form of the hormone that is able to enter tissue. For hypothyroidism, free T4 levels are low and TSH levels are high. (Source)
• free triiodothyronine (free T3 or FT3). Similar to T4, T3 can be either free or bound, with the free T3 being the active form that can enter cells as needed. Having low levels of free T and high TSH levels indicates hypothyroidism. (Source)
• reverse triiodothyronine (reverse T3 or RT3). Reverse T3 is the inactive form of T3. T4 may be converted to either reverse T3 or T3, depending on the body’s metabolic needs. Although there is a limit to the clinical usefulness of reverse T3 tests, research has found that those with hypothyroidism may also have low levels of reverse T3. (Source, Source)

Antibody Blood Tests

• anti-thyroid peroxidase antibody (TPO). TPO antibodies are the identifying marker of Hashimoto’s disease. Patients who test positive for TPO antibodies can be diagnosed with Hashimoto’s before they even start showing symptoms. (Source)
• anti-thyroglobulin antibody (Tg). Thyroglobulin (Tg) is a protein that is used to make T3 and T4 in the thyroid gland. Many with Hashimoto’s thyroiditis have been found to have anti-Tg and anti-TPO antibodies. (Source, Source)
• anti-TSH receptor antibody (TSHR). The TSH receptor is located on the surface of thyroid gland cells and is a docking site for TSH. TSHR antibodies bind to TSH receptor sites, blocking TSH and causing a decrease in thyroid hormone production. (Source)

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Imaging Tests

• ultrasound imaging. Ultrasound may be used to visualize the thyroid gland when TPO antibodies are present but thyroid hormone levels are normal. Ultrasound findings in Hashimoto’s commonly include overall enlargement of the thyroid along with proliferation of micronodules, or tiny overgrowths of thyroid tissue. (Source)

Find Out More About Testing

Dive deeper into the tests available to determine if you have a thyroid disease in our article on 9 tests to assess thyroid function.

Hashimoto’s Thyroiditis Prognosis

Patients with positive anti-thyroid antibodies can go years without showing any symptoms. The onset of symptoms may be slow and may not show up until well after a patient has developed Hashimoto’s thyroiditis. The thyroid may slowly become enlarged, which usually isn’t painful. Years later, extensive damage may cause the thyroid to shrink. (Source)

Some Potential Complications of Hashimoto’s Thyroiditis

• high cholesterol
• high blood pressure
• heart disease
• cognitive impairment
• infertility
• increased risk of cancer

(Source, Source, Source, Source)

Although Hashimoto’s thyroiditis is irreversible, symptoms can be managed through diet and lifestyle changes that prioritize reducing stress and inflammation and avoiding autoimmune triggers. Research has shown that diet and lifestyle changes can significantly improve quality of life and immune activity. (Source)

Management of Hashimoto’s Thyroiditis

The extent of damage to the thyroid tissue will determine the best course of treatment. While hypothyroidism is a common result of Hashimoto’s thyroiditis, not all patients will develop it. Without hypothyroidism, the thyroid needs only to be monitored.

If you test positive for TPO antibodies but have a normal thyroid function test with normal levels of TSH and T4 thyroid hormone, then no treatment is needed. If the disease progresses (which may take years), then hormone replacement therapy will be required to treat hypothyroidism.

If you develop hypothyroidism, you’ll be prescribed levothyroxine (a synthetic hormone) to make up for insufficient thyroid hormone levels. Follow up blood tests are done to check whether the hormone is working and if the dose needs adjustment. The good news is that hormone medication can control almost all the symptoms of hypothyroidism.

Managing Hashimoto’s With Diet

Avoiding inflammatory foods may help reduce overall inflammation. Following an anti-inflammatory diet such as the paleo, autoimmune protocol (AIP), or gluten free diet is thought to improve immune function, and may help identify foods that trigger Hashimoto’s flares. (Source)

Studies show that plant-based diets are associated with a lower risk of developing autoimmune diseases, including Hashimoto’s, because they are rich in antioxidants that prevent oxidative stress in the body. Mediterranean cuisine, for example, is high in vegetables and low in meat. (Source)

Supplementing with vitamin D and selenium may help slow the progression of Hashimoto’s disease and lower levels of anti-thyroid antibodies. Zinc supplements may also improve the thyroid function in patients suffering from zinc deficiencies. (Source, Source)

A Note About Iodine

Producing thyroid hormones requires a sufficient intake of dietary iodine. Iodine deficiency is the main underlying cause of hypothyroidism in many regions of the world. However, in developed countries such as the United States, iodine deficiencies are rare because Iodine is present in much of our food (including in the iodized salt used in most meals). Taking iodine tablets to treat hypothyroidism will therefore not have an effect, and may in fact be harmful if you are not suffering from an iodine deficiency. Too much iodine can intensify symptoms of hypothyroidism. (Source)

Holistic Approach to Hashimoto’s Management

A holistic approach to managing an autoimmune disease requires looking at the body as a whole, and not just the thyroid tissue. Stress is one of the triggers that contribute to a Hashimoto’s flare, so focusing on mental wellness to minimize mental and emotional stress can have a positive effect. Exercise, diet, sleep, and conditions in other areas of the body are additional factors that can impact immune function. If you’re looking for a personalized, whole-body approach to managing your Hashimoto’s, consider WellTheory’s autoimmune care membership — you’ll get nutrition and lifestyle coaching so you can reduce your symptoms with support.

Improving Mental State

You can support your mental and emotional health by:

• maintaining a consistent sleep schedule
• taking regular exercise
• treating anxiety and depression

Improving Gut Health

The benefits of a healthy gut are twofold, as a healthy, thriving gut microbiome can:

• positively impact the thyroid
• enhance the overall immune system

Paying attention to how your gut is feeling, and working with a healthcare practitioner to improve your gut health, is another holistic approach to tackling autoimmune diseases. The gut microbiome influences how minerals such as iodine, selenium, zinc, and iron are absorbed into the body. These minerals are essential for the thyroid to function normally, and there is a high prevalence of thyroid diseases coexisting with gut diseases. (Source)

When Should I See a Health Care Professional?

If you have been diagnosed with Hashimoto’s, you should have your thyroid function checked once a year. If you are taking levothyroxine and are experiencing symptoms of an overactive or underactive thyroid, it could mean your prescribed dose isn’t quite right for you. Your health care provider can help you find a dose that works better.

It is helpful to seek medical care for your Hashimoto’s any time you experience new or increasing symptoms, or if you have concerns or questions about your condition.

Resources for Hashimoto’s Thyroiditis

For more information on how to adjust your diet and lifestyle when living with Hashimoto’s disease, we recommend checking out:

• The American Thyroid Association
• The Thyroid Trust