There are few topics out there riddled with as much bad information, misinformation, and just plain wrong information as Hashimoto’s thyroiditis.
This applies to all thyroid conditions but especially to the most common cause of hypothyroidism in the developed world (1), Hashimoto’s.
But, guess what?
That’s not going to matter because we are going to set the record straight.
Today we are going to discuss cold hard facts about Hashimoto’s.
The same facts that I wish every single patient with this condition knew prior to their diagnosis.
Whether you’re recently diagnosed or you’ve been a Hashimoto’s warrior for a long time, you should find the information presented here very helpful.
Before we jump in, I have one favor to ask:
If you are someone who struggled after your diagnosis to find the type of information I’m about to share here please let other people know in the comments that this information is factually and physiologically correct.
It’s hard for newly diagnosed patients to get set on the right path, especially because their doctors are sometimes the spreaders of the most heinous of misinformation.
Alright, with that out of the way, let’s jump in:
#1. Hashimoto’s Will Cause Shrinkage or Atrophy of Your Thyroid Gland (If Untreated)
Let’s start with the basics:
The first thing you should know is that Hashimoto’s thyroiditis is an autoimmune disease in which your immune system targets and attacks your thyroid gland.
If untreated, this attack results in permanent damage which will cause the atrophy or shrinkage of your thyroid gland.
And this is something you definitely do not want to happen!
The good news?
Just because this can happen doesn’t mean it has to happen.
And your singular focus if you have Hashimoto’s should be to prevent this from occurring.
The bad news?
It’s going to be up to you to do something about it because the standard treatment from doctors does nothing to stop this progression from happening.
There are plenty of things you can do as a thyroid patient, which we will discuss shortly, but you should be aware of this potential future and potential threat.
This concept of thyroid gland atrophy is important because it can help set the stakes for your disease.
Here’s what I mean:
The sooner you identify that you have Hashimoto’s and the sooner you start treatment, the better.
The longer you wait, the more damage occurs, and the more difficult it is to manage your symptoms.
Some of you reading this have had Hashimoto’s for many years and are probably thinking you might already have experienced thyroid gland atrophy.
If that’s the case, you can always check with a thyroid gland ultrasound.
An ultrasound will give you a general idea of the size of the thyroid gland (2) which can then give you some idea as to its remaining function.
It’s not a perfect measure or test, by any means, but it’s relatively quick and easy.
As a general rule, it takes many years (10-20 or more) to experience complete thyroid gland atrophy but this can be accelerated if you have a particularly aggressive case of Hashimoto’s.
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#2. Supplements May Work Better Than Thyroid Medication.
Did you know that supplements may work better than thyroid medication if you have Hashimoto’s?
It may sound too good to be true but let me explain why.
Most doctors (and patients) incorrectly think about Hashimoto’s as primarily a thyroid disease when the reality is that it is primarily an immune-mediated disease (3).
Taking thyroid medication is important because it can help manage your symptoms but it will do nothing to treat the underlying cause of the disease; immune dysfunction.
But guess what can help treat immune dysfunction?
And guess what happens if you target your immune system?
You may be able to improve your thyroid by preventing thyroid gland damage.
This is such a simple but important topic that you must understand if you have Hashimoto’s.
If you put 80% of your attention on your immune system then you have the potential to increase thyroid function by a similar amount.
Of course, this assumes that your thyroid gland is capable of producing thyroid hormone which isn’t always the case so don’t completely neglect thyroid medications.
But instead of focusing 80% of your energy on optimizing your thyroid medication, spend that energy on improving your immune system instead.
This ratio flips if you are in end-stage Hashimoto’s, though, so be aware of that,
#3. Hashimoto’s Can’t Be Cured But it Can Be Put Into Remission
This is somewhat of a controversial topic but as I explain what I mean here it should make a lot of sense.
Depending on who you ask, you will be told that Hashimoto’s is either a continually progressive disease that is manageable but not curable or you will be told that Hashimoto’s can be cured with the right treatments.
I’m here to tell you that both of these statements are incorrect.
While it is possible to put Hashimoto’s into remission, curing Hashimoto’s isn’t really possible, and here’s why:
When you cure a disease you are basically eliminating its existence from your body as if it had never been there, to begin with.
While it’s possible to completely eliminate the symptoms and negative consequences of Hashimoto’s, you will always be susceptible to recurrence.
For this reason, I think remission is a far more accurate term than cure, but as long as you understand the underlying physiology you can use whatever term you prefer.
Instead of getting hung up on the difference between these two what you really need to understand is that Hashimoto’s can be 100% controlled.
This is important because your doctor will tell you that Hashimoto’s is a chronic disease that you will have to deal with for the rest of your life and that the only treatment available is thyroid medication.
This assertion is just plain wrong.
There are so many other things you can do aside from just taking thyroid medication and it is absolutely possible to put Hashimoto’s into remission.
And putting your condition into remission should always be your goal and target, no matter what.
But let me be clear:
I’m just saying it’s possible, I’m not saying it’s always possible or even that it’s easy to do this.
In fact, I don’t think remission is possible in every single case.
I’ve treated and recommended some of the most aggressive and comprehensive treatments you can think of to certain patients and, despite our best efforts, we’ve been unable to put their Hashimoto’s into remission.
This suggests to me that only some cases are capable of being put into remission while others are left to smolder and cause continual damage.
The good news is that even if you can’t completely control your symptoms you will always see some improvement in how you are feeling.
For instance, you may not be able to remove 100% of your symptoms but my experience suggests that you can always feel better from whatever your baseline is.
You may not get complete control of these symptoms, but what if you could back to 80% of normal or 90% of normal?
That’s still a whole lot better than where most people started.
And for this reason, it’s always worth doing something and making your goal remission even if you can’t achieve it.
#4. You Don’t Always Need Thyroid Medication To Treat Hashimoto’s
Number 4 is sort of a piggyback off of number 3 and that is that you don’t always need thyroid medication to treat Hashimoto’s.
This may seem somewhat contradictory based on what I’ve said previously, but let me explain.
Hashimoto’s disease exists on a spectrum which means that some cases are more severe than others.
The more mild and less severe cases can usually be managed with natural treatments and without the need for thyroid medications.
This is especially true for those people who have what is called seronegative Hashimoto’s but it also applies to patients who only require a low dose of thyroid medication.
For these patients, it’s sometimes possible to control their symptoms with natural remedies like diet, lifestyle changes, over-the-counter supplements, exercise routines, and stress management.
If you want to go this route then you’ll need to be very vigilant because you don’t have thyroid medication to fall back on, but it can be possible.
There’s no reason to take this approach, though, unless you want to.
I personally believe that thyroid medication, when used correctly, has a dramatic effect on helping thyroid patients feel better.
So why not use it temporarily while you also use those other natural therapies and then, when the time comes, just get off of the medication at a later date?
To me, this method makes more sense than just using one treatment or the other because you can take advantage of the benefits of both.
Thyroid medications can provide much faster relief to pressing symptoms like weight gain and hair loss, the kind of symptoms that can have a big psychological effect on patients, compared to natural therapies which tend to take much longer.
Get the best of both worlds by combining them!
It’s worth pointing out there that there will be situations in which thyroid medication will be required, no matter what.
Situations like thyroid gland atrophy or end-stage Hashimoto’s necessitate the need for thyroid medication.
This is because thyroid hormone is required for life and when you have thyroid gland atrophy, your thyroid gland can no longer produce its own thyroid hormone.
So be cautious trying to avoid thyroid medication if you’ve had Hashimoto’s for a long period of time.
#5. Hashimoto’s Can Cause Both Hyperthyroidism and Hypothyroidism
Another fact that you should be aware of is one that can be kind of confusing for patients and that is that Hashimoto’s has the potential to cause both hypothyroidism and hyperthyroidism (4).
Hyperthyroidism refers to a state of too much thyroid hormone and hypothyroidism refers to a state of not enough thyroid hormone.
The normal progression of Hashimoto’s is to cause hypothyroidism or low thyroid function and this happens the majority of the time.
But sometimes, it can temporarily cause bouts of hyperthyroidism.
This occurs due to thyroid gland damage from inflammation and can occur when you first get diagnosed and also during flare-ups.
It can even get more confusing because the antibodies associated with Hashimoto’s also have some crossover with Graves’ disease and this combination of symptoms and lab test results can be very confusing for some patients.
When Hashimoto’s causes hyperthyroidism it tends to be short-lived and only lasts a few months so this is probably the easiest way to differentiate between the two conditions.
#6. Treating Your Thyroid May Not Help You Lose Weight
This one will be frustrating to hear but let me explain!
There’s no question that low thyroid function leads to weight gain which is why it’s one of the most common symptoms that patients with this condition present with.
The only problem is that treating your thyroid rarely results in weight loss, at least to the degree that you are expecting.
In general, your thyroid is typically only responsible for a minor to moderate amount of weight gain, usually somewhere between 10 to 15 pounds.
For many of you reading this, you may have a lot more weight to lose than just 10-15 pounds so what accounts for the difference?
This extra weight is usually the result of downstream effects of thyroid dysfunction on various hormone systems like insulin levels, leptin levels, and sex hormones.
While the low thyroid state is directly responsible for 10-15 pounds of weight gain it is often indirectly responsible for much more than that.
The problem is that treating your thyroid doesn’t treat those other conditions which is why patients often don’t lose as much weight as they think when they start thyroid treatments.
This may sound depressing but it doesn’t have to be because you can still target those other hormone imbalances to help you lose the remainder of your weight.
Just realize that treating your thyroid only fixes your thyroid, it doesn’t fix the downstream negative consequences that this condition has on other hormone systems in your body.
#7. There are More Options Than Just Levothyroxine
Many thyroid patients are surprised to hear that there is a big wide world of thyroid medications available to them outside of just levothyroxine and Synthroid.
You’d never know if you just asked your doctor, though, which is why most patients with Hashimoto’s are left in the dark.
But I’m here to shine the light!
Here’s just a quick list of the medications that are available for you as a patient with Hashimoto’s:
- NP Thyroid
- Armour Thyroid
- Sustained Release T3
- Compounded Thyroid Medication
This list doesn’t even include some of the prescription thyroid medications which are currently not available like WP thyroid and Nature-throid!
The bottom line?
If you aren’t feeling well on levothyroxine or Synthroid don’t assume you are out of luck because there are still tons of options available to you.
And it’s been my experience that there’s always some combination of thyroid medications that can help you get back to your old self, it just takes some trial and error and a doctor willing to work with you.
#8. Levothyroxine (& Other Thyroid Medications) May Actually Help Lower Your Antibodies
This one may seem confusing because I just mentioned that focusing on thyroid function isn’t the best way to treat Hashimoto’s but that isn’t entirely true.
There is a place for the use of thyroid medications in treating the underlying cause of Hashimoto’s including medications like levothyroxine.
We predominately think of these medications as treatments for the low thyroid aspect of Hashimoto’s but they can sometimes also impact the immune aspect of it as well.
Taking thyroid medication (of any type) causes suppression of thyroid hormone production from your thyroid gland for as long as you are taking the medication.
This suppression is dose-dependent so the more thyroid medication you take the more your own thyroid hormone production will be suppressed.
How does this help inflammation in your thyroid gland?
Because the process of thyroid hormone production is thought to be an inflammatory inciting event (5) in the thyroid gland and may be the first place that things go wrong in patients with Hashimoto’s.
If you are able to reduce that production event with the use of thyroid medication then you can potentially decrease that inflammatory event.
You can think of it like this:
Temporarily shutting down your thyroid hormone production factory allows inflammation to settle down which means your thyroid gland function will actually improve.
The only catch is that this doesn’t always work and it’s hard to know when it will be helpful.
My general advice is to use thyroid medication if you need it and if it helps with thyroid gland inflammation then that’s even better.
#9. Keeping Track Of Your Antibodies Is Important
This fact flies in the face of what most doctors will recommend which is to not worry about your thyroid antibodies.
They don’t care about your thyroid antibodies because, from their perspective, the problem is related to your thyroid and not your immune system.
Your thyroid antibody levels are more a reflection of the status of your immune system than they are a reflection of thyroid gland function so your doctor isn’t really interested in them.
But that’s the completely wrong way to look at it.
If you change your diet, for instance, and you see a drop in your antibodies then you know whatever you are doing is helping.
If you take supplements and you see a drop in your antibodies after a few months then you know those supplements are helping.
And if you take an off-label medication like low-dose naltrexone and your antibodies drop afterward then you know that medication is helping.
See how this works?
Your thyroid antibodies help track your immune status and your thyroid labs like TSH, free T3, and free T4 help you track your thyroid function.
Both are important.
#10. Doing Something Is Always Better Than Doing Nothing
Finally, and this is probably the single most important thing you can take away from this entire article is that you should always do something rather than nothing.
I know that Hashimoto’s is a complicated and debilitating disease.
And I also know that there are many patients out there with this disease who get overwhelmed when reading information like what is presented here.
But here’s what I also know:
You can never go wrong by focusing on the basics.
It doesn’t matter if you are in end-stage Hashimoto’s or if you’ve just been diagnosed with your thyroid problem or if you just suspect that you have a thyroid problem.
Do you really think it will hurt to make these changes in your life?
So don’t think about doing them, just do them.
You’ll feel better for it.
I’m here to tell you that managing Hashimoto’s is way different than just managing everyday run-of-the-mill hypothyroidism.
I’m also here to tell you that you can’t count on getting the type of information you need to feel better from your doctor.
It’s going to take some learning and researching on your part but it will be worth it.
If you like the information you’ve seen here then I’ve got some good news for you:
There’s plenty more.
I’m well on my way to creating the single best thyroid resource that exists on the internet and I’d love for you to join me.
Now I want to hear from you:
Did any of these facts about Hashimoto’s surprise you?
Are you a recently diagnosed patient or would you consider yourself a battle-hardened Hashimoto’s warrior?
Are you planning on making any changes to your treatment regimen?
Why or why not?
Leave your questions or comments below to keep the conversation going!