Hashimoto's Disease: 9 Things Doctors Want You to Know

Medically Reviewed By William C. Lloyd III, MD, FACS

Written By Lorna Collier on December 19, 2020

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  Expert Insight on Hashimoto’s Disease: The Top Cause of Low Thyroid

  You may not have heard of Hashimoto’s disease (also called Hashimoto’s thyroiditis), but you’ve probably heard of hypothyroidism, which refers to an underperforming thyroid (a butterfly-shaped gland at the base of your throat). With Hashimoto’s disease, antibodies in your immune system mistakenly attack your thyroid, preventing it from providing hormones necessary to regulate your body’s basic functions. About 14 million Americans have this autoimmune disorder, which is by far the top cause of hypothyroidism. Are you at risk? What should you do if you think you have it? We talked to endocrinologists—the specialists most likely to treat Hashimoto’s disease—to get some facts and advice.
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  1. “Be aware of your risk factors for Hashimoto’s disease.”

  Women are more likely than men to have the disorder—about 7 or 8 women for every man, says Mark Lupo, MD, an endocrinologist in Florida. Other risk factors include having a family history of hypothyroidism, especially in a first-generation female relative (a mother, aunt or sister), and having another autoimmune disease, like lupus or rheumatoid arthritis. Knowing you are at risk can help you keep an eye out for symptoms so you can see your doctor if they occur. Unfortunately, doctors don’t know yet how to prevent the disease from developing into hypothyroidism, says Jacqueline Jonklaas, MD, an endocrinologist in Washington, D.C. But they can help you manage the disease and prevent complications.
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  2. “Don’t ignore symptoms of an underactive thyroid.”

  The first Hashimoto’s disease symptom some people get is a swollen (but painless) thyroid gland, called a goiter, caused by the immune system’s attack on it. As this attack continues, your thyroid may become unable to produce enough thyroid hormone. Symptoms of low thyroid hormone include weight gain, memory problems, fatigue, lack of energy, sensitivity to cold, constipation, and infertility, says Dr. Jonklaas. If you have several of these symptoms, if they continue, or if they don’t seem likely to be caused by anything else, see your doctor to check for possible thyroid problems, she advises.
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  3. “Most people can be treated with synthetic thyroid hormone.”

  After you get a Hashimoto’s disease diagnosis (usually following a physical exam and blood tests), your doctor likely will prescribe a medicine—levothyroxine—to replace your thyroid hormone. “The vast majority of patients feel good on levothyroxine,” Dr. Jonklaas says. You take the pill once daily. It is a synthetic version of a key thyroid hormone, T4. About 5 to 15% of patients may need additional medication, says Dr. Jonklaas, which often involves adding small amounts of another hormone, T3, which may cause side effects. Your doctor will monitor your thyroid levels carefully to ensure correct dosing.
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  4. “If you’re pregnant or trying to be, you may need special care.”

  If you are trying to have a baby or are already pregnant, you need to make sure your thyroid levels are adequate and stable. That’s because low thyroid is associated with infertility, miscarriage, and birth defects. If you have signs of Hashimoto’s disease—such as a family history or the presence of antithyroid hormone antibodies in your blood—Dr. Lupo recommends screening more aggressively for hypothyroidism and maybe starting treatment earlier. If you already are on synthetic thyroid hormone, says Dr. Lupo, you likely will need a “dose increase to support the pregnancy and the baby’s needs.”
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  5. “Just getting a positive antibody test doesn’t mean you have Hashimoto’s disease.”

  Your doctor may test your blood for antithyroid peroxidase (TPO) antibodies, which show whether your body’s immune system has been activated against your thyroid. However, a positive antibody test alone doesn’t automatically mean you have Hashimoto’s disease, says Antonio Bianco, MD, a Chicago endocrinologist, especially if your thyroid levels remain normal. For one thing, he warns, the test results can vary. “One day it might be positive; next week, it’s negative.” Even if correct, this doesn’t mean your thyroid has been damaged. That process could “take weeks or a few months or it might never happen.”
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  6. “Women’s highest risk comes at two points in their lives.”

  While women in general are more likely to have Hashimoto’s, two age groups of women are at highest risk. First are younger women, usually in their 20s and 30s, who are having babies, says Dr. Lupo. The other big group is perimenopausal women, generally between 40 and 55. Hashimoto’s disease appears to start in genetically susceptible people after a triggering event, says Dr. Lupo. This can be hormonal changes associated with pregnancy or menopause. Or it can be triggered by having additional serious medical conditions or injuries, stress, and taking certain medications, such as immunotherapy drugs for cancer.
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  7. “You don’t need to change your diet.”

  “Sometimes in the media you’ll see some celebrity say, ‘I’ve got Hashimoto’s and I can’t eat dairy or gluten,’” says Dr. Lupo. “There’s no evidence for avoiding those things for the average patient with Hashimoto's.” Unless you have lactose intolerance or gluten allergy, you can eat these foods, he says. “People talk about ‘the thyroid diet,’ but really when you look at it it’s just a healthy diet.” He also advises other healthy living measures: quitting smoking, managing stress, and exercising. Dr. Bianco agrees, calling anecdotal diet advice like you might see on Facebook “baloney” and “not evidence-based.”
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  8. “Don’t take supplements without your doctor’s okay.”

  Some people may think they need to take iodine supplements, since their thyroid—which produces iodine—isn’t working as it should. But, says Dr. Lupo, this can be counterproductive. Taking an iodine supplement can confuse your system so much that your thyroid levels drop even further. It’s unnecessary to take iodine pills, he says, since most people in the United States already get enough iodine through a normal diet. Other unnecessary supplements, he says, include selenium, which has only mixed evidence for its usefulness. Check with your doctor if you have any questions about supplements so that you don’t take anything that’s unnecessary—or even harmful.
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  9. “Keep on taking your medication.”

  Dr. Jonklaas says sometimes people with hypothyroidism stop taking their medication—apparently not realizing that “most cases of hyperthyroidism are lifelong and do not resolve by themselves.” Low thyroid levels can lead to medical emergencies. “If your thyroid’s completely knocked out because of Hashimoto’s,” says Dr. Lupo, “you can get severely low hypothyroid” within a few weeks. Your cognitive functioning can be impaired as badly as if you were legally drunk; you could have a heart attack or heart failure; or you could slip into a coma. Warns Dr. Lupo: “It can be fatal to stop your medication on your own.”

Hashimoto's Disease: 9 Things Doctors Want You to Know

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