5 Signs of End State Hashimoto’s (& What it means)

5 Signs of End Stage Hashimoto’s (& What it means)

As someone who has Hashimoto’s thyroiditis, you should be very aware of a late-stage complication of that disease known as End Stage Hashimoto’s. 

End-stage Hashimoto’s refers to the later stages of this disease in which there are complete atrophy and damage to the thyroid gland. 

For all intents and purposes, you can consider end-stage Hashimoto’s and complete thyroid atrophy in the same ballpark as having your thyroid removed or completely irradiated with radioactive iodine

Even though these conditions are all different they all result in the same thing:

Complete inactivity of the thyroid gland (either through removal, as is the case in surgical removal of the thyroid gland, or functional inactivity, such as RAI and end-stage Hashimoto’s). 

Why should you care?

Well, for several reasons. 

But I think the most important is the fact that there may be a chance for you to either SLOW down this permanent damage or completely reverse it. 

You might think to yourself, “Great, I’m already doing that with my doctor!” but this is where you would be very wrong. 

Doctors, including endocrinologists and primary care physicians or family practice doctors, don’t really care about the diagnosis of Hashimoto’s or the diagnosis of end-stage Hashimoto’s. 

Both of these conditions (early and late) are treated the same way to them, with thyroid medication. 

But thyroid medication does NOT stop the inflammatory damage that accompanies autoimmune thyroiditis (Hashimoto’s thyroiditis). 

In order to stop and reduce this damage and inflammation, you need to take extra steps on top of using thyroid medication (more on that below). 

As a Hashimoto’s patient, you should be aware that your main goal in managing your disease is to try and PREVENT end-stage Hashimoto’s from occurring and to try and retain as much native thyroid function as possible. 


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5 Signs of End Stage Hashimoto’s

The good news is that it takes a long time for end-stage Hashimoto’s to really set in. 

And I mean a long time. 

We are talking probably somewhere around the order of 20-30 years (sometimes more and sometimes less). 

In order to reach this late stage of this disease you really need to have not treated or attempted to treat/manage your Hashimoto’s for several decades. 

So, if you are reading this there is a good chance that there is still time for you to do something about your condition to try and prevent this issue from occurring!

But there is also bad news. 

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The bad news is that MOST people with hypothyroidism (low thyroid function) have Hashimoto’s and a great many people have no idea that they do. 

It’s not common for doctors to test thyroid antibodies routinely so many people with hypothyroidism have Hashimoto’s without realizing it. 

And I’ve lost count of the number of patients that I’ve treated who have no idea why they take thyroid medication but who have been on it for 20+ years. 

These patients are often surprised when I check their thyroid antibodies and notify them that they have Hashimoto’s thyroiditis. 

Some of these patients may have had it all along and others may have only developed it recently but it’s impossible to tell for sure. 

So it may be the case that you already have late-stage Hashimoto’s even if you never knew you had the disease in the first place. 

It’s a big bummer if this happens but it does occur from time to time. 

The reason for this article is to highlight the symptoms associated with late-stage Hashimoto’s so you can try to figure out if you’re there or if you still have some time. 

#1. Thyroid Gland Atrophy. 

The first, and probably most important symptom associated with end-stage or late-stage Hashimoto’s is complete thyroid gland atrophy. 

Atrophy refers to the shrinkage of a target tissue or gland which typically indicates it is either damaged or nonfunctional. 

Atrophy occurs in your muscles if you don’t use them (muscle atrophy) and even occurs in some inflammatory conditions such as cirrhosis (1) (liver damage). 

In the case of your thyroid gland, atrophy is never a good sign. 

In the case of Hashimoto’s thyroiditis, it indicates that your thyroid has been damaged from inflammation and autoimmunity for years and years. 

Once you get to this point there is typically very little if any native thyroid function present. 

And, sadly, thyroid gland atrophy is not a reversible condition. 

Your thyroid gland can handle some damage from inflammation and even some swelling. 

It can bounce back from these things but this doesn’t appear to be the case in thyroid gland atrophy. 

How do you know if you have thyroid gland atrophy?

The easiest way to diagnose this condition is with a thyroid ultrasound. 

All thyroid gland ultrasounds provide you with information on the size and appearance of your thyroid gland

If your gland is atrophied, your ultrasound report will say something to that effect. 

It will mention that the thyroid gland has reduced volume and that it looks atrophied. 

If you don’t see this on your ultrasound report (under the impression section) then you don’t need to worry about it. 

This is not something that is easily missed (unlike other aspects of thyroid function and monitoring). 

You can also assess the size of your thyroid gland by simply feeling your thyroid gland in your neck. 

If your thyroid gland is of normal size you should be able to feel it through your skin and on your neck. 

As your thyroid gland atrophies, it becomes more difficult to feel your gland until it is imperceptible to physical touch. 

This method is obviously less accurate and more difficult to do than ultrasound but it’s also very quick and easy and cheap!

But don’t freak out if you can’t feel your thyroid gland, it’s often missed by many residents and medical students before they become skilled at testing for it. 

#2. Lower levels of Thyroid Antibodies. 

Another sign of end-stage Hashimoto’s is that your antibody levels may DROP or REDUCE. 

I’ll explain why this happens in just a sec, but let’s talk about your antibodies for a moment. 

When I talk about thyroid antibodies I am talking specifically about TPO antibodies and thyroid peroxidase antibodies. 

You can test for these antibodies in your bloodstream and if they are present they most likely indicate that you have Hashimoto’s thyroiditis. 

The presence of these antibodies is an indication that your own body is attacking itself. 

So you really don’t want to see them elevated at any given time. 

But if your antibodies are dropping isn’t that a good thing?

You would think so and in most cases, it would be true

But in the case of end-stage Hashimoto’s it’s quite different. 

You see, there are really two ways to reduce these damaging antibodies. 

The first is to reduce inflammation and autoimmunity by focusing on your own immune system. 

This is good and something that you want. 

The second is to take away the tissue or organ that these antibodies are targeting. 

If that tissue isn’t around anymore then obviously those antibodies won’t be created. 

And this is what happens with end-stage Hashimoto’s. 

As your thyroid becomes irreversibly damaged and nonfunctional your antibody levels may drop. 

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Not because your body has improved but because it basically annihilated your thyroid gland into nothing. 

And I’ve seen a number of patients who think that their condition is improving because their antibodies are gone who don’t realize that the only reason they have dropped is that their thyroid is destroyed. 

Tracking your antibodies is important because it can help you determine if you are on the right track (or wrong track) and it can also act to help you determine how advanced your disease state is. 

This isn’t a perfect test by itself, however, which is why you still may want to get an ultrasound if you think you have complete thyroid atrophy. 

#3. Extreme Difficulty with Weight Loss or Unexpected Weight Gain. 

Another important symptom has to do with your weight and metabolism. 

Once your thyroid has been completely destroyed you are really in the same boat as those who don’t have a thyroid at all (those who are post-thyroidectomy or post-surgical removal of their thyroid gland).

And these patients have a very difficult time managing their weight. 

Most patients who have their thyroid removed gain about 15-20 pounds immediately afterward (2) and most never get back to their normal weight. 

This is because no matter what medication you take by mouth to replace the lost thyroid hormone your body used to produce it will never be the exact same. 

As a result, your metabolism tends to drop and your weight tends to go up

If you are someone who has unexplained weight gain over the last few months to years AND you have a long-standing diagnosis of Hashimoto’s then this may be a sign you have reached the later stage of your disease. 

A closely associated symptom is that of weight loss resistance or the inability to lose weight. 

Late-stage Hashimoto’s may manifest as weight gain initially but it can also manifest as the inability to lose weight despite your best efforts. 

Both symptoms are important to look out for. 

#4. Stable Thyroid Lab Tests. 

Another sign of end-stage Hashimoto’s is that of stable thyroid lab tests

At first glance, you might think of this as something that is good. 

Don’t you want your thyroid gland to be stable?

And the answer is yes, you do. 

But you want it to be stable because it’s functioning on its own! Not because it can’t function at all.

As someone with Hashimoto’s, you are probably well aware of the ups and downs associated with this disease. 

Hashimoto’s thyroiditis can cause hyperthyroidism, hypothyroidism, and even immune-mediated symptoms. 

All of these symptoms stem from the impact that inflammation has on the thyroid gland. 

5 signs of end stage hashimoto's

Sometimes it will push out more thyroid hormone than necessary (causing hyperthyroidism) and other times not enough (causing hypothyroidism). 

But if your thyroid gland is completely atrophied or destroyed, you won’t see the fluctuations that you used to in the early stages of your disease. 

You should keep an eye on your thyroid lab tests periodically no matter what but make sure you look for stable lab tests which are ALSO accompanied by persistent symptoms of hypothyroidism. 

This presentation may be an early indication that you have late-stage Hashimoto’s. 

#5. Reliance Upon Thyroid Medication for Symptom Control.

The last sign to watch out for is complete reliance upon thyroid medication for symptomatic control. 

Why is this important?

Because in early Hashimoto’s your thyroid gland is damaged but not irreversibly so. 

So even if you are taking some thyroid medication your thyroid gland is also producing some thyroid hormone on the side as well. 

This means you are getting thyroid hormone from two sources:

#1. Your own thyroid gland (the function depends on how much damage is present). 

And #2. From whatever thyroid medication you are currently taking (depending on your dose).

And this is a good thing!

Most thyroid patients probably don’t realize or appreciate how much thyroid hormone their own gland can produce even when it is damaged. 

They start to appreciate it once it no longer works, though, as once this occurs you are completely reliant upon thyroid hormone medications for all of your needs. 

And this reliance makes managing your medication quite difficult. 

Your own thyroid gland can make changes on an hour-by-hour basis, it knows when to convert T4 into T3, when not to, and so on. 

All of these things are done without you even realizing it. 

And once your thyroid stops doing this, your doctor puts you on a once-a-day thyroid medication dose and calls it a day. 

Do you really think that all of these things will occur on the backend by taking the same dose each and every day?

Not a chance, which is why many people without a functioning thyroid gland struggle with thyroid symptoms despite taking thyroid medication. 

So keep an eye on your own native thyroid function by seeing how you respond to various doses of thyroid medication. 

If you see that your thyroid medication dose is consistently increasing over time that is generally a sign that the damage to your thyroid gland is progressing and it’s something that you should pay attention to!

Preventing End Stage Hashimoto’s, is it possible? 

What are you supposed to do, though?

Is there any way to actually stop or prevent end-stage Hashimoto’s from occurring?

The answer is yes but it requires therapies and treatments which you won’t get from your current doctor

As I mentioned previously, doctors focus primarily on the thyroid hormone aspect while neglecting the immune and inflammatory components. 

We can talk about all of the reasons why they do this but it’s really not important for this conversation. 

You should just know, however, that 99% of them think this way. 

So don’t expect them to bring it up in conversation and don’t be surprised when your doctor throws you on thyroid medication and calls it a day. 

This is just how it’s done for conventional doctors. 

The good news is that there are therapies that YOU can do which can impact the inflammatory and immune components. 

These therapies include things like:

All of these therapies target the most critical aspect of Hashimoto’s which is the immune component. 

By targeting your immune system (and regulating it) you can stop the damage to your thyroid gland before it becomes irreversible. 

Final Thoughts

If you have Hashimoto’s thyroiditis then you should be keeping an eye out for these 5 signs! 

If present, they may indicate that you have reached end-stage Hashimoto’s thyroiditis. 

Your goal, as a thyroid patient, should be to try and avoid this at all costs!

Do whatever it takes to manage and control both your thyroid and your immune system. 

Now I want to hear from you:

Do you have any of the signs or symptoms associated with end-stage Hashimoto’s listed above?

If so, which ones?

Are you concerned that you may have thyroid atrophy? Or do you know for a fact that you do?

If so, which symptoms are you currently struggling with?

Which therapies have or have not worked for you?

Leave your questions or comments below to keep the conversation going! 

#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271178/

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595360/

signs of thyroid gland atrophy and end stage hashimoto's

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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52 thoughts on “5 Signs of End Stage Hashimoto’s (& What it means)”

  1. I’m a seventy year old female , , I’ve been taking thyroid replacement for about FOURTY years !! I haven’t been tested in a bout two years , but the last few times , there have been no changes .. ,From what I gather from this text I guess I have been in ” end stage ” from about the beginning ! I was first tested after giving birth to my eighth child ..I know after my fith child was born , I began a rapid wight gain, and unlike previous times , I wasn’t able to get my wieght down …I first saw definate problems after my seventh child , I could not keep my eyes opened ,and I was just SO EXHAUSTED ,all the time … Then I had an eptopic pregnancy, followed three months later with my last , my right child , my wieght after just went off the charts for ME !! And I was having difficulty with my sight , and becoming so swollen, I was shocked by what was happening to my body !! By the time I convinced my O B to help me , I couldn’t walk to the corner mail box !!! , When I finally had the testing done , by a credited Endocrinologist , My thyroid was only operating at tenpercent !! … When I first started the thyroid meds , it felt like some one had oiled my whole body on the inside !! Everything started to move more easily !! Later I was told by the same Doctor , that I would have to watch my health , as I would EXPIERENCE drastic changes in different organs , and finally , my heart would give out on me !! That my immune system was attacking all my organs , at a time , never knowing which would be next .. as of now , I have developed MYTRAL VALVE PROLAPSE , lost my Gallbladder , have Carole tunnel , high blood pressure , a diesse of the ribs , that causes pain and inflammation of the ribs , and at times pockets of fluid collects between the ribs and muscle … VERY PAINFUL !! , Now ,I EXPIERENCE kidney stones , and a fatty liver , out of control diarrhea , Chrone’s disease , , degenerative disc disease , bone spurs up and down my spine , collapsed disc, bulging discs , I had serious damage to my spine from age of fuor , layerore accidents , that led to more spinal stenosis, patio arthritis, , developed a ” Backers cyst” , doctor ignored me when t I attempted to point it out , it got so bad , swollen and painful.. one day it ruptured… Now that leg is always more swollen then the other , and always painful in the knew , ” doctors” wanted me to opt for a ” NEW KNEE”!! I said no thanks ! Now I am having new problems , a recent mild ( thank God )stroke , and half my face now gets red , and hot with break outs !?? I’ve been given a steroid cream a while back for this immiune rash the dermatologist said I had , the sun is also now my enemy , Inot only can develop a rash from the sun , but extreme fatigue as well , like I’ve got the flu !! I know my thyroid is doing something now , as I jumped up in weight , then began for the first time in my life a rapid weight loss of twenty pounds ! But I feel like hell , I have extreme insomnia , I feel like my whole SELF , is out of control !! Mood swings , I’m on hydrocodone for pain from spine , and levothyroxine , estrotest , and Baclovin(sp?) I USED TO have oxicodone , and Soma , as well as blood pressure meds and a long lasting angina med..with
    Nitro tabs for occasional chest pain from angina , I’ve had a couple of mild heart ” inccedents”… That’s about my health picture today …now long ago before the first test for this hashimotos … my only complaint was my ” BACK ” of course … And the bowel problems .. when I was twenty five I developed a bad appendix , but it went undiagnosed for a year , and when it went ..the doctors refused to believe my pain and agony was appendicitis !!until twenty four hours AFTER it blew!! I was on deaths doorstep as they rushed me into surgery !! *#$!&!!…. For some reason since then I have not trusted doctors.. about three years later following a DnC ..I went into cardiac arrest .and ended up PARRALIZED for “six ” hours to long !!
    Yeah ..I hate doctors ,!! Any way hey Doc … So I believe I’m in *END STAGE* HASHIMOTOS !! DO YOU !?? Anyway do YOU think anything you have can do anything for me ?? ( I forgot … I’ve been diagnosed with LUPUS ..(yeaaa ….not) Life is not fun any more to say the least ….any hope for me !??

    • Hi Lily,

      Even if you are in end-stage Hashimoto’s it doesn’t mean you can’t be treated and have almost normal thyroid function. This is still very possible but it just becomes more difficult and the chances of a regular doctor helping you obtain this are very slim. But with the combined use of T4 + T3 you should be able to closely approximate feeling optimal.

      • Hello. I don’t think I have a thyroid atrophy, as my doctor still feels it and the ultrasound’s result doesn’t mention it. The size of the right and left lobes is 45.5mm and 45mm respectively. Here people don’t have the habit of not eating gluten… My doctor says it can be inflammatory, but all she said is it could help. But I do know several people with the same issue and they eat everything. I also don’t feel I’m intolerant to gluten…What do you think? Thanks.

  2. It appears as though I have End State Hashimoto’s what is the most aggressive treatment approach I can take to reverse this. Or is it too late?

    • Hi La Quinta,

      Once you have thyroid gland damage and atrophy it doesn’t appear to be reversible. You can still manage thyroid function afterward but I’m not aware of anyone who has ‘healed’ their thyroid gland in this state.

      If you feel that you are in this category, it just means you need to shift your mindset away from managing inflammation/autoimmunity and more towards thyroid function.

  3. Hello; I left a comment some time ago; and you recommended that I get a ultra sound done. Which I have done. It came back as saying real time images demonstrate a small heterogeneous thyroid gland measuring 3.1 x 0.9 x 0.8 cm on the right and 3.8 x 0.8 x 0.8 cm on the left. The isthmus measures approximately 1 mm. No focal cystic or solid masses are seen. Impression: small heterogeneous presumably atrophic thryoid gland without focal cystic or solid mass.
    I am concerned on what or how to treat myself now. My thyroid Dr didn’t seem to concerned and quite frankly was a bit shocked at what the test said. And then had to feel for my thyroid. Which had not been done in some time. I am not sure what to think; i had to ask them about iodine. Which I have not ever been on or tested for.
    Out of all the Dr.’s that I have seen. Not 1 have done a ultra sound on me and checking of all the supplements I might need. I am very upset and scared. I have been on Nature Thyroid at 1.5 gr taking 1 tab 2x a day. I kept forgetting the 2nd dose; so I started taking them all at once. Went to get refills of this and it was not available in the dose they had raised it to; after seeing my lab results. So I am now on NP Thyroid at 1.5 gr at 2 tabs a day. & 1.4 gr at 1 tab a day. I currently take the 2 tabs at night and the other one mid day usually. Should I do something different?
    My current labs drawn were:
    T3, free 2.4
    Thyroxine (T4) 4.0
    TSH 0.16
    Reverse T3 – LC-MS /MS 10.2
    Please help with some info as to what I can do to help myself. I am scared. Thank you for your time

      • I had an ultrasound because a CT scan showed left side calcification. Earlier an endocrinologist said he thought
        my thyroid would shut down. I grew up in Sioux Falls, SD, part of the goiter belt. I think I began taking Armour
        Thyroid as a teen, which I’ve continued taking except for a short time. I’m seventy. I have another immune problem & I need B vitamins & fiber so I do eat wheat. I couldn’t get the bad foods list to work. Would appreciate any suggestions!

  4. Dr childs, thanks for your response to my earlier comment, I don’t seem to have end stage hashimotos disease, my thyroid gland is partially swollen and my antibodies are elevated, but I haven’t been on any medication, the doctors say I just have to do a surgery to remove the thyroid gland, maybe not all of it because the swelling is more on one side. I am not comfortable with the surgery due to the after effects. Please what medication can I use, I Hv noticed the swelling for about 7 years, but I haven’t been on any treatment. Thank you. Toyin.

  5. I’ve been diagnosed & treated, though not always consistently, for 21 years. I did have a thyroid ultrasound about 3 months ago and the results did note gland atrophy. I am and have been experiencing all the listed signs of end stage Hashi’s. So, damage done. What now?

    • Hi Jennifer,

      You are in the same boat as those who have had their thyroid surgically removed. It means you need to rely more on thyroid medication and managing weight/hormones will be more difficult from here on out, but not impossible.

  6. No, I don’t believe I am at the end stage of Hashimato’s. I had full panel taken last year, with the only thing that was high was my thyroglobulin after much physical exertion and some exposure to mold. My TSH was normal and I currently take a compounded medication of 13.5 mcg Liothyroine and 88 mcg Levothyroxine. I didn’t fare too well with Armour Thyroid after they changed the mix and it became very difficult to find in my locality. My doctor didn’t seem to know that swelling was a symptom of Hashimato’s but she is willing to be educated. So do you think your Hashimato’s bundle can reverse some of this? My daughter if also Hypothyroid and has been on similar meds since she was 11…now 25 but a lower dose.

    • Hi Karen,

      If you are early enough in your disease then yes, the bundle can definitely help. It would still be helpful in late stage Hashimoto’s but less so compared to early stage.

  7. Hello Dr. Childs

    I have enjoyed many of your videos. I am 64 years old and have been on thyroid since 1994. A year ago I noticed that fasting seemed to help my thyroid. I do have a goiter which is (non-cancerous) but would love an internist that could check my leptin and T3 levels. I wish I could come and see you to get real help. Thank you.

    • Hi Keyna,

      I definitely agree that fasting can improve thyroid function, as long as it is done correctly 🙂

    • From Sweden
      Jag fick problem med sköldkörtel 1996,1999 gjordes ett ultraljud som visade kronisk inflamation. 2020 ultraljud igen och sköldkörtel hade krympt och var väldigt liten och inflammerad. Har Hypotyreos och Haschimoto samt Sjögrens Syndrom. Har antikroppar vet ej värdet.
      Tål inget T4 preparat=viktuppgång snabbt. GBP opererad 2004 pga sköldkörtel och T4 hormon.
      Jag står på endast T3 hormon idag.
      Jag har haft, tyvärr, Liothyronin som har ojämna matcher sedan skandalen december 2016 där pillerna var mer eller mindre verkningslösa. Jag har fått Hypoglykemier som endokrina läkare säger det är operationens fel 2004 men jag påstår sköldskörteln.
      Oavsett vet jag hur jag ska hantera detta då min vuxna son har Typ 1 diabetes i 18 år bästa mentorn.
      Efter GBP operation är allt fel i kroppen järnet sjunker snabbt PTH hormonet, Parrathormon hoppar upp och ner i mätningarna i blodet. Är detta pga Hypotyreos Haschimoto eller GBP?
      Väntar på annat T3 hormon som tyvärr måste skrivas på licens i Sverige. Tar T3 två gånger/dag .
      Vad ska jag tänka på med mina immunsjukdomar? Vissa saker är tyvärr inte godkänd av svenska staten och vi sköldkörtel sjuka får kämpa för att få må bra då 95% av läkarna har noll koll på våra hormoner och *får inte tänka utan för ramen* så att säga.
      Min Hypotyreos Haschimoto är troligen utlöst efter ett överfall i tjänsten pluss sonens 2 sjukdomar det är det jag relaterar till.
      Kan jag göra något för att stoppa min sköldkörtel att *bli lite piggare* förutom kost och så?
      Tack på förhand

  8. Recently diagnosed with Hypothyroid – started medication for that + HRT (for menopause).

    As soon as I started these medications, my weight jumped up 13lbs (within 2 months) and is hanging on tight.

    Doc started me off very conservative with NatureThroid
    (1/2 grain) & I seemed to have decent results that show my T4 & T3 are now in “normal” ranges (after a about 7 weeks on 1/2 grain), but for some reason, he bumped my dose up to 1 grain. Maybe the level are not “optimal”? I’m not sure. ??

    I have requested to have my Leptin levels checked the next time I get lab work done (in about 3 more weeks). Wondering if I should have a full Adrenal lab reviewed? And should I ask for a ultrasound of my Thyroid?

    If what you are saying is correct, and most doctors don’t really do much aside from giving you thyroid meds & calling it a day – then who would you recommend a person see for end stage Hashimoto’s?

    I’m so new to all of this and totally terrified, as there is so much scary information. I am totally overwhelmed & I know that is not good for cortisol levels, either…. ugh!!

    Can you advise?

    • Hi Stefanie,

      That is the paradox, patients will get a complete thyroid lab panel from an uneducated doctor only to find out that they have no idea what to do with the information and revert back to treating based on the TSH and with levothyroxine anyway. As you stated, you need to find the right doctor to help. You can use this resource to help you find one: https://www.restartmed.com/thyroid-doctor/

      Just be aware that if you want to find anyone good you will most likely need to look outside of the insurance model. Conventional doctors that take insurance tend to be the worst doctors for managing thyroid and hormones and this includes endocrinologists, ob/gyns, etc.

  9. Hi, I was first told I’d only slight underactive thyroids so was monitored yearly. I had trouble conceiving but after my first child symptoms really kicked in. It wasn’t until a year after my second child was born that I was finally put on levothyroxine at 50mcg and now 27 yrs I’m on 150 .over the yrs my dose has been lowered a couple of times but I gained weight and felt crap so back up to 150. I’ve had kidney stones for 15 yrs and 10 operations to date to remove. At moment I’m lowering dose to 100 mcg and taking iodine drops.i did paleo diet 5 yrs ago and was best I’ve ever felt in my life & still try to follow it. I have had Scleritis flare ups but now manage with certain foods as I can’t take anti inflammatory due to lowered kidney function after stone op caused a kidney bleed & I got urosepsis. I don’t know if I’ve atro
    phy or not as never found out.

  10. I’ve just skimmed through your article and it seems I am in the category of end stage Hashimoto’s!
    I had a total thyroidectomy due to cancer in 2011!
    I eat two brazil nuts every day to get selenium but haven’t ever had the other supplements recommended! I’m on T3 & T4 meds!
    I have read some articles about implanting thyroid tissue into muscle of people and it being succesful, do you know of this and could it be done effectively?
    Thanks for giving us this helpful information!

    • Hi Barb,

      Maybe you are referring to parathyroid gland transplantation. I don’t think thyroid transplantation is high on the list of things to do for researchers and doctors because they feel that thyroid hormone replacement is curative.

  11. I have been in the End stage since over 30 years l have just started taking armor thanks to you how ever I’m thinking surgery it’s totally Dead will not can not produce harmones

  12. Hi Dr Westin, Thoroughly enjoy you informative expertise. I am wondering how a person would take thyroid meds specially WP Thyroid, what time of day since waiting 3 hours to eat or drink (coffee) before or after taking meds? Thanks!

  13. Dr. Childs,
    I’ve read all the emails with info on meds, supplements, diet, Hashimoto, etc. I’m 70, female, 5’3′, 91 lbs, very clean diet of steamed vegetables, salads, berries, keto bars, only water, a LOT of supplements taken with bone broth, don’t smoke, exercise 6 days a week, work (by choice), widow, never sick and highly disciplined.
    Blood tests for decades have come back with below normal thyroid readings; been put on everything with no results- Synthroid, armour thyroid, lyothyronine, etc. Was heavy as a kid but finally got thin and work HARD to maintain it. I’m always tired, very sensitive to cold, thin, fine hair, metabolism is so slow I think it runs in reverse and all the fun things that go with hypothyroidism.
    My doctor is a DO and had me get my thyroid scanned a couple months ago and there was nothing in the report of concern. All I want at this point is a med, protocol, supplement(s) anything, that allows me to get up in the morning and not feel like I’ve been run over by a convoy of trucks. I work out in the AM to get my heart moving a little and the older I get the more work it takes (DUH!) I have a very slight amount of arthritis that flares up in my one bent finger but aside from that I’m in great health.
    I don’t expect miracles but think there must be something that can give me a little more energy. I thought about buying the complete list of items you suggested but I hesitate to put the money into something and find it does no good — I’ve been there.
    Is there a particular test(s) I should get? (I pay cash so insurance is not an issue) I’m open to suggestions.

  14. I had an ultrasound of my thyroid 2 mo. ago and my thyroid is atrophied so I guess I am in end stage Hashimoto’s. My antibodies are also low and I thought, before getting the US, that I was in remission but after seeing your video, I see that I am not in remission at all, I just have a useless thyroid. Now… After I was first diagnosed with Hashimoto’s 7 years ago, I gave up gluten immediately and my antibodies started to decline. I thought I’d found the key to lowering my antibodies. My question for you is–now that I have end stage Hashi’s, I suppose it doesn’t matter if I eat gluten because I can no longer control my antibodies, they’ll always be low. Bring on the gluten!

    • Hi Dr. Childs,
      I’m not sure if I’m at end stage Hashimotos. I was diagnosed around 1992 or 1993 and prescribed Synthroid, which I’ve been on ever since. My last ultrasound was in 2018 and the endocrinologist showed me areas of thyroid damage, atrophy wasn’t mentioned. Prior to the ultrasound, I was already taking supplements and working on improving my thyroid function. My lab work at that time indicated my TPO antibodies just making the cutoff for Hashimoto’s. I continued researching, supplementing, and running my own labs. I eventually got my PCP to add Cytomel and over time lost about 50 pounds, which I’ve kept off. I repeated my antibody lab work a year later (2019) and my results indicated no TPO antibodies. Also, after watching your video I realized that my medication stayed the same (Synthroid 50 mcg)until I was around 30 years old. After 30, I had to continuously increase my dose. The past couple of years, my dose has been high (175 mcg) but consistent, aside from adding the T3 meds (5 mcg x 2). I’m wondering if I should repeat the ultrasound in addition to my lab work that’s due again, or if I should contact my former endocrinologist for the report even though it’s a few years old?
      Thank you for the information you provide!

      • Hi Christine,

        It makes the most sense to start with your old ultrasound to see what that shows. It’s your property because it’s in your medical record so you have the right to access it whenever you please. You can get another if the old one doesn’t have much helpful information.

  15. I was diagnosed with Hashimoto’s thyroiditis in 1987 . I found out approximately 5 years ago the right lobe of my thyroid was just about gone it shrank so much in size. The question I have is should I be taking T3 as well as t4?

  16. Dr. Childs – I was originally diagnosed with hypothyroidism 7 months after the birth of my first child. For about 12 years, I took Synthroid. My TPO antibodies were sky high. Then I went to a functional doctor who made encouraged me to go gluten-free and switched me to Naturethroid. Now, about 5 years later, I am still gluten-free. About 6 months ago, my endocrinologist told me that my thyroid is gone…totally atrophied. What supplements do I no longer need to take (selenium)? Because of the Naturethroid recall and because my T3 was too high, I am now taking a mix of Synthroid and NP Thyroid.

  17. I am end stage. Long story short, I had a headache for years and despite everything including a brain scan no answers. It wasn’t until unexplained and consistent weight loss that my thyroid was tested. TSH was 127 and ultrasound showed end stage hashimotos with no function at all. This was 5 years ago. I am in a high stress career. Lately it seems I’m feeling much worse than ever and it’s simply depressing . I just ordered the hashimotos bundle and open to any suggestions. I have found that cutting gluten, drinking lots of water, and reducing alcohol has helped.

    • Hi Tracy,

      Once you are in end-stage the treatment becomes more of a management type of deal compared to a preventative one. So as long as you find supplements and therapies which improve your quality of life then you are doing it right 🙂

  18. Hello!

    I have had hashimotos for almost 19 years. I was diagnosed a year after giving birth to my first child. I recently was told my thyroid was completely atrophied – which is what I was trying to avoid. So my question is – what do I do now? I have tried combos of T3 & T4 which made my hair and eyelashes fall out. I have been out on adipex for 3 months on 6 months off steadily now for the last few years. It actually helps my inflammation but doesn’t not help much with weight loss. But as soon as I’m off it for the 6 months I’m immediately up 10lbs of inflammation. I don’t want to keep taking adipex.

    I currently take vitamin E, Vitamin D, Milk Thistle and Vitamin B-12 along with my synthroid. I have tried everything from fasting to whole 30 and no budge in weight and I struggle daily with my fatigue. And most recently – my joints have been painful – bilateral pain in my hips, wrists, knuckles and knees. I worry about gaining another autoimmune disease as my De mentioned that I would be susceptible to others such as rheumatoid.

    I am 47 years old and feel like I’m 60. What can I do to feel normal again. I now have at least 50lbs to lose and I need help with brain fog and fatigue so I can continue to work and care for my family.

    Thank you!

  19. Hi – I honestly have NO clue.. and am beyond confused. 28 years ago, I was diagnosed with hypothyroidism about a year after the birth of my 3rd and last child. I was started on Synthroid at that time. 10 years ago (2012), My weight suddenly went up from 110 to 155, My blood pressure, normally low, shot up to 191/111, my vision changed and I now wear glasses, I had sudden severe brain fog where I could no longer do my technical job, my platelets went up, I had high Cortisol and low ACTH. I began searching for what was wrong with me. I went to many, many doctors over the next following years. I even went to the endocrine clinic at Harvard and Johns Hopkins. No one at any of those medical facilities could tell me what was wrong or figure it out. Since that time, I have had had to get a total hysterectomy, gall bladder removal and have been told I have fatty liver disease. Last October (2021) I was told I had Hashimoto’s for the first time. I was also told to go to a Hematologist for my high platelets. My endocrinologist did not explain Hashimoto’s, how serious it was, or what I could do for it. The Hematologist was the one who told me. Since that time, I have completely removed ALL gluten from my diet, ALL sugar, ALL Nightshades and have gone to 100% clean eating. I have also gotten into LabCorp and downloaded ALL of my lab test reports for the last 10 years. In going back over my labs, I have noted that the most that was ever tests via lab work has been TSH, TPO and a couple of times T3Free or T4Free. My TSH has been both high and low. My TPO has has ALWAYS come back negative. My T3 / T4Free tests came back within normal limits. In October 2021, the endocrinologist did an ultrasound “to confirm the findings”. At that time, she said my thyroid was definitely Hashimoto’s Thyroiditis. She told me the right side was dark in color and the left side was lighter but not as bright as it should be. The surface was not smooth and there were 2 nodules on the right side. The ultrasound findings were as follows:
    “The thyroid gland is heterogeneous and hypoechoic consistent with Hashimoto thyroiditis.
    The right lobe measured 1.1 x 1.7 x 4.4 cm
    The left lobe measured 0.8 x 1.4 x 3.8 cm
    The isthmus measured 0.4 cm
    Right Lobe Nodules(s):
    1. Right mid to lower lobe posteriorly, pure cystic nodule with comet tail appearance, represents colloid nodule with grade 1 vascularity, which measures 0.4 x 0.6 x 0.7 cm.
    2. Right lower lobe anteriorly, hypoechoic spongy nodule with a cystic component with grade 1-2 vascularity, which measures 0.5 x 0.8 x 0.9 cm.
    Left Lobe Nodule(s): No discrete nodules.
    Limited neck ultrasound shows no abnormal lymph nodes on the bilateral lateral neck.
    Ultrasound Impression and Recommendations: Echotexture of the gland is consistent of autoimmune thyroid disease with two nodules on the right lobe, one cystic and one solid. Neither of the nodules fit criteria for fine-needle aspiration per ATA guidelines. Recommendation is for review in May 2022.”

    I am confused about the lack of Antibodies? It is not subclinical Hashimoto’s (unless it just developed into Hashimoto’s after 28 years of meds), but It could be End Stage Hashimoto’s ???? or I am just one of the rare ones that do not present with antibodies. I have looked at the size of my thyroid to the average size with Dr. Google (Ha!)… and my thyroid is smaller than normal. Does this mean it is atrophied? Can you please provide me with thoughts? I’d really appreciate it. BTW – Trying to find a Functional Medicine Doctor. Have not been very lucky with that. My PCP refused to do any standard tests like Comprehensive Thyroid blood panel to include rT3 and other antibody tests. Oh I also discovered I have a MTHFR gene mutation by researching my DNA test results. Thank you!

  20. Hi I have been diagnosed with atrophy thyroiditis – I knew I had an underactive thyroid since age 18 but never knew I had hasimotos.
    Is there anything I should be doing now to feel better?
    I do now have a great specialist and take thyroxine and liothyronine

  21. Hello Dr Childs,
    I have the gene of Hashimoto’s. Was diagnosed in 2015, August.

    I have been watching your videos and really have learned a lot.
    On one of the Stages of the 5 steps of the end of Hashimoto’s, I have lab work that comes back looking like a roller coaster.
    I have learned by doing some research that a person with Hashimoto’s can go into remission but I was wondering if that was true for the ones that have the genetic type.
    My Endocrinologist said “no” that I would not ever go into remission and it is what it is.
    Any thoughts???


    • Hi Gwendolyn,

      It’s possible for those with genetic-based Hashimoto’s to go into remission. Whether or not you are in remission is another story, though! It typically doesn’t happen accidentally but only with careful and intentional treatment.

  22. Hi Dr. Childs,

    I was diagnosed at 21 with hyperthyroidism. I am now 59. At 21 I was diagnosed with hypothyroidism. Then I took radioactive iodine pill and within 3 seconds of the take my thyroid had absorbed the iodine. So, they said I was hyper. That switched again to Hashimotos. I had an ANA test recently with a positive ANA no RA and titers were 1:1280. I just had an Ultra Sound yesterday and my thyroid showed atrophy. The tech who read the US recommended an iodine uptake again. My TSH 0.22 My Free T3 is on low side and Free T4 normal mid-range. I am only on levothyroxine 88mcg’s 7 days a week. My symptoms are increasing. My rheumatologists wants me to start taking Hydro chloroquine. My symptoms are excessive sweating, high anxiety, depression, swelling, pain in joint, fatigue, pain in neck area along with clicking in my larynx. I’m hoping you can help by leading me in the right direction. Thank you in advance for all you do to help those of us who feel alone and scared. It’s not in our heads, this is real. Blessings, Cassie

  23. Hi – I’ve been diagnosed since 2007 and based on my results then, I should not have started Levo. But the doc put me on it. Had typical poor results so spent about 8 years on NDT. Felt better but other health issues in 2015 meant I had to stop and go back on Levo. I’ve been on 100mcg since then and my t3 has been in range (albeit the low end) and t4 has been mostly midrange – but my TSH has been all over the map! From as low as 0.03 to as high as 11.49. Just last year in March, June and October it was 7.86, 5.88, and 11.49…all on the same dose. I’ve had high antibodies in the past – 1000 at diagnosis and 1600 in 2016. I am hoping these fluctuations in TSH mean I am not in end stage Hashis – although I was told in 2016 (and confirmed last year) that I only have a half a gland remaining. I guess that means it did not get worse in the 6 years between? I have researched regarding patients who have to have a partial thyroidectomy and the research suggests that the majority do not need to supplement with thyroxine after the procedure. One of my sisters had Graves and had 5/6ths of her thyroid removed. The remaining portion kept her going for ten years. I guess I am asking if you think it is worth trying to reduce my dose? I can honestly say I have never felt well since I started taking any thyroid meds. I am sitting here now still feeling sluggish, with dry skin and excess weight. I did unintentionally lose loads of weight a couple of years ago while on this same dose (42lbs less than I weigh now) but gradually put it back on – due to a different class of meds the docs gave me (I believe). I had a hyperparathyroid condition discovered in 2021 and had the 14mm adenoma removed a year ago. I am so sorry I rambled on. I intended only to give you minimal info but of course, I don’t know what is important or not. Thanks in advance.

    • Hi Rose,

      It’s likely the case that you still have some residual thyroid function left based on the fluctuations in your thyroid lab tests. If there was no function left then those numbers would be more stable, assuming the dosing also stayed stable during the same period.

  24. It is actually quite sad, that Doctors don’t give a damn about your health. I had the same experience as you write down there. When i could find balance with my medication and keep going between ups and downs, i asked my doctor. He told my i thought that i was sick. And he felt sorry for me feeling that way.
    I was depressed for months and thought euthanasia. Cause this wasn’t the life i chose for.
    It was my dietician with whom I could have a normal conversation about it. She told me about the leaky gut syndrome and the importance of skipping gluten and dairy when having Hashimoto. So i did. A year later i could stop medication. Scary thing to do, but my body was so hyper and painfully and tired.
    Now, almost 3 years later. It’s not like i have the energy of a healthy human being. Still nog able to work for my money and that’s a problem for the government.
    Last April I made a tiny dairy mistake, my anti bodies have been raised again. Sadly. But i also started the GAPS diet, to restore my gut health.
    So far so good. I overwon at least 2 of my intolerances. The eggs and nuts. Which provides healthy fats that apparently help healing the body from the inside out.
    Right now I’m experiencing the effects of a Hashimoto’s flare up. I know that the severity of this is lessening, and I can only hope that the diet will do its promised work in the long run.

    Thank you, for being one of those few people that ar honest about this disease.

  25. I’m 53, and my thyroid has atrophied, confirmed through ultrasound. I’ve always felt tired and exhausted as long as I can remember, diagnosed with thyroiditis about 10 years ago when my friend recommended I’d go see a doctor, not because of the way I was feeling, but I had a goitre that I didn’t even notice. I’m taking levothyroxine which has never helped me, and now multidose with T3 along with taking my prescribed 100mcg of levo. I’m hoping that will help. Can you recommend anything else to help. My thyroid is completely dead now, and I struggle with all the symptoms sadly. I take vit d regularly.

  26. Dr.Childs,
    I had bad covid in ‘21 & even worse in ‘22 w/Pneumonia & hospitalized because it was bad.
    After being released from hospital in late Jan. of ‘22 I was still very sick.
    I had a primary Dr appt in March w/annual blood test…because symptoms of unexplained weight gain, extreme tiredness, & extreme hair lose a Full Panel Thyroid test was added. Result was Hashimoto’s. Antibodies were there but low. They went very high fast. I am now on 75mcg Synthroid.
    As the months went by I was diagnosed w/hypertension, very high LDL & Triglycerides, (cardiologist wanted to put me on statins but didn’t) blood test results were going crazy! Then I was diagnosed w/Acute Kidney failure that eventually turned into stage 4 CKD!
    This all happened in ‘22
    It is now ‘23 and in Feb my blood test came back showing all of these problems were getting better! And, I was hyper thyroid. It’s crazy how over the months my blood tests are almost normal…including my kidneys.
    I’ve been tested & feeling hyper more than hypo thyroid since the beginning of this year. I am still taking 75mcg Synthroid.
    Everything that was wrong has equaled out as fast as it came on.
    The hyper has been so hyper ppl think I’m drunk or something.
    I’ve decided to stop taking the Synthroid as of 8/9/23 I told my doctor & he referred me to an endocrinologist. I have an appt in 2 weeks.
    If covid is what caused my Hashimoto’s and all the other serious illnesses & I’m getting better….
    If I stop my medication do you think my thyroid has a chance of healing just like all the other things?
    Have you heard of anybody else this happened to? If so…what were the thyroid results?
    Thank you for your time and any advice you have for me.

  27. I have had hashimoto’s disease for the past forty years. Against my feelings, my doctor gave me radioactive iodine for a CT scan of my pelvis and abdomen after a bout of c-diff. He said it would be safe. About two months after that scan I began to have chronic and debilitating hives. I heard and read that hives and hashimoto’s are related. I have also heard and read that radio active iodine should not be given to patients with thyroid disease. Over the years I have changed doses and brands of thyroid medications. I am did well on NatureThroid, but they had quality control issues and changed to NP thyroid. After the radio active iodine in addition to hives, my TSH levels fluctuate quite a bit, but remain low. My T3 is slightly low and my T4 is normal. Can you address the the situation with radio active iodine and hives


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