Hashimoto’s Disease

Hashimoto’s disease is an autoimmune condition that affects your thyroid gland. It’s the most common cause of hypothyroidism (underactive thyroid).

Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. It’s a part of your endocrine system and releases thyroid hormones.

With Hashimoto’s disease, your immune system mistakenly attacks your thyroid, making it harder for the gland to produce enough thyroid hormone. It causes symptoms like fatigue and weight gain.

Hashimoto’s is a lifelong (chronic) condition. There’s no known way to prevent it.

Hashimoto’s disease is also called Hashimoto thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis.

Symptoms of Hashimoto’s

You may not have any symptoms of Hashimoto thyroiditis at first. As the condition slowly progresses, your thyroid gland will sometimes become enlarged (a condition called goiter). Goiter is a common first sign of the disease.

If Hashimoto’s disease leads to hypothyroidism, it can cause the following symptoms over time:

• Fatigue
• Unexpected weight gain
• Constipation
• Dry skin
• Feeling cold
• Slower-than-normal heart rate
• Joint and muscle pain
• Dry, brittle hair or hair loss
• Low or depressed mood
• Puffy eyes and face
• Memory problems or difficulty concentrating
• Heavy or irregular periods
• Decreased sex drive
• Infertility

How do you feel when you have Hashimoto’s?

You might not notice any symptoms if you have Hashimoto’s disease without hypothyroidism. But if you develop hypothyroidism, it can make you feel “off.”

Because you don’t have enough thyroid hormone, many of your body’s normal functions slow down. You may feel tired, sluggish or have trouble thinking clearly. Talk to your provider if your body and mind feel stuck in slow motion.

Hashimoto’s disease causes

Hashimoto thyroiditis is an autoimmune disease, which means your body’s immune system attacks your cells and organs.

Normally, your immune system protects your body against harmful external invaders, such as bacteria and viruses. But in Hashimoto’s disease, the following happens:

1. Your immune system makes antibodies that attack your thyroid tissue for unknown reasons.
2. Large numbers of white blood cells build up in your thyroid.
3. This buildup causes inflammation (thyroiditis) and damages your thyroid.
4. Over time, the damage prevents your thyroid from making enough thyroid hormone. This leads to hypothyroidism. But not everyone with Hashimoto’s disease develops hypothyroidism.

Experts don’t know the exact cause, but they think genetics and sex are factors.

Risk factors

Anyone at any age can develop the condition. But females are 4 to 10 times more likely to get it than males. Most people get a diagnosis between the ages of 30 and 50.

Research suggests that your genetics increase your risk. If you have biological family members with Hashimoto’s disease or other thyroid conditions, you’re more likely to get it.

You’re also more likely to get Hashimoto’s if you have other autoimmune conditions, like:

• Addison’s disease
• Celiac disease
• Lupus
• Pernicious anemia
• Rheumatoid arthritis
• Sjögren’s syndrome
• Type 1 diabetes

How doctors diagnose Hashimoto’s

First, your healthcare provider will talk with you about your symptoms and medical history. They’ll do a physical exam and feel your thyroid gland.

Then, they’ll order these blood tests:

• Thyroid-stimulating hormone (TSH) test: A high TSH level most often means your thyroid gland isn’t producing enough thyroxine (T4) hormone.
• Free thyroxine (T4) test: This measures the amount of thyroid hormone in your blood to see if your thyroid is making enough.
• Antithyroid antibody test: This looks for antibodies that attack your thyroid. These antibodies usually point to Hashimoto’s disease.

In some cases, your provider may recommend a thyroid ultrasound to check the size of your thyroid and look for thyroid nodules (growths).

How is Hashimoto’s disease treated?

Not everyone with Hashimoto’s disease develops hypothyroidism. If you have high antibody levels but don’t have hypothyroidism, your healthcare provider will likely monitor your thyroid levels instead of starting treatment.

If Hashimoto’s disease leads to hypothyroidism, the go-to treatment is a medication called levothyroxine. It’s a synthetic form of the hormone T4 that your thyroid makes.

Brand names of levothyroxine include:

• Ermeza®
• Euthyrox®
• Levo-T®
• Levolet®
• Levoxyl®
• Synthroid®
• Thyro-tabs® (formerly known as Levothroid)
• Thyquidity®
• Tirosint®
• Unithroid®

This medication helps restore the normal levels of thyroid hormone your body needs. You’ll need to take it every day for the rest of your life.

Over time, you may need a different dose of the medication. Your provider will adjust the dose if needed.

There’s no special diet for Hashimoto’s disease. But some foods, medicines or supplements may affect how your body absorbs levothyroxine. Talk to your healthcare provider or a registered dietitian about any dietary questions you have.

Complications of Hashimoto’s

Without treatment, hypothyroidism can lead to certain health problems, including:

• High cholesterol
• Heart disease and heart failure
• High blood pressure
• Depression

In rare cases, it can lead to a myxedema coma. This happens when your body functions slow down to dangerous levels.

Without treatment, hypothyroidism can also cause problems during pregnancy. It can increase your risk of miscarriage, preterm birth and preeclampsia.

When should I see my healthcare provider?

If you have Hashimoto’s disease, you’ll need to see your healthcare provider regularly. They’ll do routine thyroid hormone blood tests to make sure your levels are in range and that the dose of medication you’re taking is right for you.

Otherwise, see your healthcare provider if you develop new or worsening symptoms or notice a change in your thyroid.

When should I go to the ER?

If you have symptoms of myxedema coma, call 911 or get to the emergency room as soon as possible. This complication of severe hypothyroidism is life-threatening.

Symptoms include:

• A body temperature below 95 degrees Fahrenheit (35 degrees Celsius)
• Swelling (edema) in your body, especially your face, tongue and lower legs
• A slow heart rate and faint pulse
• Slow breathing and difficulty breathing
• Confusion or loss of consciousness

What can I expect if I have Hashimoto’s?

With lifelong monitoring and treatment, the outlook for people with Hashimoto’s disease is excellent.

Most people can manage the condition and live healthy, active lives with the right treatment. Your provider may adjust your treatment over time to make sure your thyroid hormone levels stay in a healthy range.

With the right treatment, your activity levels and life expectancy shouldn’t change just because you have this condition.