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Hashimoto’s disease is the most common thyroid disease in the United States, affecting 5 in every 100 people. An autoimmune disease that frequently leads to hypothyroidism (low thyroid hormones), it is eight times more common in women.
According to the American Association of Clinical Endocrinologists (AACE), “Hashimoto’s thyroiditis occurs when there is inflammation of the thyroid. It is characterized by the production of immune cells and autoantibodies of the body’s immune system, which can damage thyroid cells and interfere with their ability to make thyroid hormones.”
What Are the Symptoms of Hashimoto’s Disease?
The onset of Hashimoto’s disease is often slow and subtle. It typically begins with enlargement of the thyroid gland in the front of the neck, known as goiter. Sometimes this leads to a noticeable swelling, fullness in the throat, or a (painless) difficulty in swallowing.
Experts at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explain that Hashimoto’s disease often will lead to a sub-clinical hypothyroidism, which can progress to present with one or more of the following symptoms:
- Weight gain
- Trouble tolerating cold
- Joint and muscle pain
- Dry, thinning hair
- Heavy or irregular menstrual periods and problems becoming pregnant
- Memory problems
- A slowed heart rate
Other variants of autoimmune thyroid disease include
- Atrophic thyroiditis
- Juvenile thyroiditis
- Postpartum thyroiditis
- Silent thyroiditis
- Focal thyroiditis
Who Gets Hashimoto’s Disease?
Statistics show the following risk factors for Hashimoto’s disease:
- Gender. Hashimoto’s disease affects eight times as many women than men.
- Age. Hashimoto’s can affect people in adulthood at any age; most women present between the ages of 30 and 50. In men it usually occurs about 15 years later.
- Genetics. Family history of Hashimoto’s increases the risk.
- People with another autoimmune disease, such as Addison’s disease, autoimmune hepatitis, celiac disease, lupus, pernicious anemia, rheumatoid arthritis, Sjögren’s syndrome, type 1 diabetes, and vitiligo (a condition where some parts of the skin become de-pigmented).
- Pregnancy. Among women who develop thyroid disease during pregnancy, 20 percent go on to develop Hashimoto’s disease in later years.
- Excess iodine and some drugs are sometimes implicated in triggering Hashimoto’s disease in at-risk individuals.
- Radiation exposure increases the risk of autoimmune thyroid disease.
Worldwide, the most common cause of hypothyroidism is iodine deficiency, rather than Hashimoto’s thyroiditis.
Clinical Assessment for Hashimoto’s Disease
If you have some of the symptoms described above, see your doctor. He or she will take a medical history and perform a physical examination. You also may be tested; options include:
- Blood test. Thyroid tests may include TSH (thyroid-stimulating hormone), thyroid hormone (T4), free T4, T3, and thyroid antibodies (positive in about 85 of people with Hashimoto’s). Your doctor may also request a complete blood count for anemia (which is seen in 30 to 40 percent of patients), lipid profile, or metabolic panel (including sodium, creatine kinase, and prolactin levels).
- Imaging. Thyroid ultrasound may be requested.
- Thyroid biopsy. Your doctor may recommend a biopsy of any suspicious lumps in your thyroid to rule out cancer or lymphoma.
Treatment of Hashimoto’s Disease
- Medical treatment: Thyroid replacement therapy. Hashimoto’s disease usually responds well to treatment with levothyroxine, a man-made form of T4. Most people need lifelong treatment and regular monitoring of T4 and TSH levels. Fine-tuning of dosage is needed to keep levels within the normal range.Patients can easily slip into hyperthyroidism, which is harmful especially to heart and bone health. Symptoms of hyperthyroidism may include a fast or irregular heart rate, nervousness/excitability, fatigue, headache, sleep disruption, shaky hands, and chest pain.
- Surgical treatment. Surgery is rarely needed but may indicate whether there is a large goiter that causes obstruction or cancer. Surgery also may address cosmetic concerns if the goiter is unsightly.
- Self-care. Since Hashimoto’s disease is an inflammatory and autoimmune condition, lifestyle changes may be a useful adjunct to medical care. There are numerous reports of individuals curing themselves with lifestyle adjustments, but formal research, specific to Hashimoto’s, is lacking.Switching to a plant-based diet low in processed foods and rich in fresh fruits, vegetables, whole grains, healthy proteins and fats (avocados, fish, eggs, nuts, and seeds) is a great place to start. (See our article “Anti-Inflammatory Foods: Do They Work?“) An integrative medicine physician, nutritionist, or naturopath can help you explore which foods may be causing your inflammation.
Other lifestyle changes proven to reduce inflammation include regular exercise, restful sleep, and stress management techniques (e.g., meditation).
Risks of Untreated Hashimoto’s Disease
If untreated, Hashimoto’s disease may lead to the following:
- Infertility, miscarriage and birth defects
- High cholesterol
Severe underactive thyroid is called myxedema and is rare but dangerous. It can lead to:
- Heart failure
In pregnant women, hypothyroidism that is not adequately controlled can lead to:
- Birth defects
- Preterm birth
- Low birth weight
- Birth defects
- Thyroid problems in the baby
- Preeclampsia (high blood pressure, which is dangerous to mother and baby)
- Placental abruption (The placenta separates from the uterine wall before delivery, which can mean the fetus doesn’t get enough oxygen.)
- Postpartum bleeding
If you have Hashimoto’s disease and are pregnant, or are thinking about trying for a baby, talk to your endocrinologist and OB/GYN. Levothyroxine is safe in pregnancy and when breastfeeding, but levels will need to be tested more often.
What Is Hashimoto’s Disease? Sources and Resources
For related reading, see these articles:
- “Underactive Thyroid Symptoms: These Are the Signs of Hypothyroidism“
- How to Find a Thyroid Doctor or Endocrinologist
For more information on thyroid disease visit:
Service, NIDDK, NIH, DHHS.
This article was originally published in 2017. It is regularly updated.