- Hashimoto's is autoimmune thyroiditis, not simple hypothyroidism, so focus on treating inflammation and autoimmunity rather than just fixing thyroid hormone levels.
- Your thyroid hormones will fluctuate unpredictably due to immune attacks and inflammatory swings, which is why chasing perfect TSH numbers often fails.
- Early detection matters immensely because mild symptoms at the beginning mean reversible thyroid damage, but years of untreated antibodies lead to permanent gland destruction.
- Watch for symptom patterns that shift between hyperthyroid episodes (anxiety, heart palpitations, heat sensitivity) and hypothyroid phases (fatigue, weight gain, cold intolerance) as inflammation changes.
Hashimoto’s symptoms can vary drastically from person to person.
Couple that with the fact that the symptoms of Hashimoto’s disease change through time and can “flare” due to certain triggers making the disease even more difficult to diagnose and manage.
It turns out that your symptoms may be telling you something about your body and can help you determine the source and cause of your Hashimoto’s disease.
Managing and treating the autoimmunity and inflammatory aspect of Hashimoto’s is critical for reducing these symptoms.
Let’s dive in:
Progression of Symptoms in Hashimoto’s Patients
Hashimoto’s and autoimmune thyroiditis should be differentiated from other causes of hypothyroidism.
Why?
Because autoimmune thyroiditis should be treated differently.
While it’s true that some patients with Hashimoto’s and autoimmune thyroiditis may need thyroid hormone replacement, this statement is not true for ALL patients with this disease.
Instead of focusing on the thyroid hormones and values, your focus should instead be on the autoimmunity and inflammatory component.
Autoimmunity indicates a deeper problem in the body.
The inability to recognize self from non-self, and an imbalance in the immune system.
This component is usually triggered by various factors (usually a combination of factors that we will discuss later) that results in the dysregulation of this system.
Physiologically this causes a variety of symptoms ranging from general and diffuse non-specific symptoms to alternating symptoms of both hypothyroidism and hyperthyroidism.
These issues result in a disease that can be both difficult to diagnose and manage (unless your provider knows to be looking for it).
In fact, many patients with hypothyroidism likely have some component of autoimmune thyroiditis – they just have never been diagnosed.
- Bottom line: The symptoms of Hashimoto’s and autoimmune thyroiditis differ from hypothyroidism due to both the inflammatory and autoimmune components of this disease. These two factors change how Hashimoto’s should be managed.
Fluctuations in TSH and T4 Over Time
Many of the symptoms of Hashimoto’s can be traced back to 2 main areas:
- Changes and fluctuations in thyroid hormone
- Fluctuations in inflammatory markers
We will talk about both and how they can impact your symptoms:
You can see an example below of how both TSH and FT4 can fluctuate throughout time:
The blue line represents FT4 which you can see varies as much as 6 times between laboratory results.
The FT4 level tends to be inversely proportional to the TSH (meaning as FT4 level increases the TSH level decreases).
The TSH in the pink line varies from episodes of hypothyroidism (high levels of TSH) to nearly suppressed levels (episodes of hyperthyroidism) throughout time.
This variance in thyroid hormone levels can often trick both patients and providers which results in constant changes to thyroid hormone and various symptoms in the patient.
When in reality the focus should be on the autoimmune and inflammatory components and NOT the thyroid hormone themselves.
It’s easy to see how thyroid hormone levels directly impact your symptoms so we will move to the second factor which is changes in your inflammatory markers.
Inflammatory changes cause a variety of symptoms related to your thyroid and related to other hormone systems in the body.
Inflammation by itself can cause a reduction in T4 to T3 conversion (1) (leading to worsening symptoms of hypothyroidism).
Inflammation can also potentiate insulin resistance (2) and make adrenal function worse.
These changes may lead to symptoms such as weight gain (3), fatigue, and neurological symptoms that may complicate or worsen existing hypothyroid/hyperthyroid-like symptoms.
Your inflammatory status can be measured and tracked by checking non-specific markers in the blood including:
- Erythrocyte sedimentation rate (ESR)
- C reactive protein (CRP)
- Ferritin
- Thyroid antibodies and other antibody levels
The elevation of these markers (while not specific) indicates dysfunction in the body and may make the symptoms of Hashimoto’s worse.
Now let’s discuss how these two component changes and alter the progression of the symptoms of Hashimoto’s over time…
- Bottom line: The combination of inflammation and autoimmunity cause variations in thyroid function and other hormone function in the body. This is part of the reason that this disease causes symptoms to change over time.
Generalized and non-specific symptoms -> Symptoms start here
The symptoms of Hashimoto’s usually start out as minor diffuse fatigue.
Because of these symptoms, it can be difficult to pinpoint where your symptoms are coming from.
You may present with a mild weight gain of 5-10 pounds, or maybe just some mild fatigue.
The issue is that most patients know that something is “off” in their body, but when they go to their physician they usually undergo “standard” lab tests that don’t identify the problem.
Or worse, the provider will identify the presence of antibodies like anti-TPO thyroid antibodies but take the “wait and see” approach to management.
The symptoms generally start out somewhat mild due to the low-grade inflammation and autoimmunity that is present.
At this point there isn’t usually significant damage to the thyroid gland, so most damage at this point is reversible if treated correctly.
It also means that undergoing treatment at this point is critical.
Because any treatment you can do to help lower the inflammation and autoimmunity will go a long way to helping reduce long-term thyroid damage and reliance upon thyroid hormone later in life.
How Hashimoto’s symptoms start:
- General fatigue or sensation of being “run-down”
- Mild weight gain(usually 5-10 pounds)
- Flat affect or depressed mood, not feeling like yourself
- Mild difficulty with concentration or inability to focus
- Dry skin, cracked lips, dry & brittle hair, non-specific rashes or patches on the skin
- Mild constipation
- Mild fluid retention(especially in the face and lower extremities)
- Voice hoarseness or sensation of a “swollen throat”
- Reduction in sweating or inability to sweat
- Mild joint pain or muscle aches
- Mild to moderate changes to the menstrual cycle including irregular cycle and/or reduced/increased flow
If you are experiencing any of the symptoms listed below make sure to get your antibody levels checked, and not only that but continue to follow them as you undergo treatment.
This will help to determine if you are on the right track.
This is only the start of the symptoms of Hashimoto’s however, and symptoms may fluctuate between hyperthyroidism and hypothyroidism which I will go over below.
- Bottom line: The initial symptoms of Hashimoto’s tend to be vague and diffuse making the diagnosis difficult. Treatment at this early stage is critical, however, because you can prevent long-term reliance upon thyroid hormone later in life if you can stop the damage early.
Progression through hyperthyroidism and hypothyroidism
Many patients, unfortunately, can go years (or decades) without a diagnosis of Hashimoto’s or autoimmune thyroiditis.
During this time some patients will experience swings or episodes of hyperthyroidism followed by episodes of hypothyroidism.
This can occur as a result of the damage done to the thyroid gland by thyroid antibodies.
As antibodies attach to the thyroid gland your body will react in turn with an inflammatory response that may damage or injure the thyroid gland.
The thyroid as a gland has the job to release hormones under a stimulus. And this stimulus can be triggered by the damage and cause a “flush” of thyroid hormones to be released from the body.
This flush can temporarily trigger symptoms of hyperthyroidism which can make symptoms worse (especially if the patient is already on thyroid medication).
Symptoms that mimic episodes of hyperthyroidism or a “flush” of thyroid hormones in the bloodstream/body:
- Hot flashes or episodes of heat intolerance
- Mood changes, typically on the anxiety spectrum
- Jittery sensation or sensation of “too much energy”
- Fatigue or episodes of energy swings(up and down)
- Difficulty sleeping or episodes of insomnia
- Facial flushing or sensation of warm extremities
- Heart palpitations or sensation of a racing pulse(usually episodic and at night but can occur at any time throughout the day)
- Weight loss/weight gain accompanied by changes in appetite
These symptoms do not occur in every patient, however.
Some patients just have a chronic and continuing decline in thyroid hormone throughout time, but some experience these episodes of “ups” and “downs”.
It’s important to realize that the presence of these symptoms may also indicate antibodies that directly stimulate the release of thyroid hormone from the body (it isn’t always caused just by the inflammatory component).
- Bottom line: The inflammatory component of Hashimoto’s may trigger a “flush” or release of thyroid hormones into the bloodstream which may manifest as hyperthyroid-like symptoms. During these episodes, your free thyroid hormones will be elevated and your TSH will drop.
Overt Hypothyroidism
Over time, if not treated, most patients will eventually develop symptoms of hypothyroidism.
As antibodies remain elevated (and untreated) in the blood for long periods of time, thyroid glandular damage (4) will accumulate.
Once this point reaches critical mass you will eventually lose endogenous production of thyroid hormone.
This is usually the point where your symptoms progress and continue to worsen all of a sudden over a 1-2 year period.
Once patients get to this stage they may ultimately require lifelong use of thyroid hormone replacement due to this glandular damage.
The symptoms experienced at this stage generally mimic hypothyroidism but many patients still have lingering “general and diffuse” symptoms from the autoimmune component.
Hypothyroid symptoms due to glandular damage in Hashimoto’s patients:
- Extreme fatigue and/or exhaustion
- Moderate weight gain (20-30+ pounds usually gained over a 6-12 month period)
- Hair loss, hair thinning, and/or hair breakage
- Changes to mood, usually on the depression spectrum
- Menstrual irregularities and other conditions like PMS/PMDD
- Chronic and debilitating muscular and/or joint pain
- Chronic and daily constipation, development of other GI issues like gas/bloating, acid reflux, low stomach acid, and SIBO/SIFO
- + any other generalized symptoms above
- Bottom line: Once the damage has accumulated the thyroid may become permanently damaged leading to reliance upon thyroid hormone replacement. These symptoms generally match symptoms of hypothyroidism from other causes.
Symptoms of Hashimoto’s Flare-up
At some point in time, you may also experience what I refer to as a Hashimoto’s “flare-up”.
These flare-ups usually result from some sort of “trigger”.
We’ve already discussed how the immune system and inflammatory cascade in your body are dysregulated when you have Hashimoto’s or autoimmune thyroiditis in the previous section but what we didn’t talk about is how sensitive the immune system really is.
Due to these problems, your immune system is hyperexcitable.
Meaning that small changes may result in a cascade effect causing multiple downstream effects.
This cascade is usually responsible for the symptoms of a “flare-up”.
Symptoms of a Hashimoto’s flare-up include:
- Abrupt worsening of fatigue
- Usually weight gain from an unclear source without changing your diet or food intake(rarely some patients do experience some weight loss)
- A general feeling of weakness or malaise
- Abrupt worsening of joint pain/muscular pain
- Racing heart, jittery sensation, or feeling an uncomfortable “rush”
- Abrupt onset of brain fog, difficulty concentrating, or inability to focus on difficult tasks
- Changes to GI function
- Some patients may experience acute symptoms of Hyperthyroidism(see list above)
- Some patients may experience acute symptoms of Hypothyroidism(see list above)
While flare-ups may differ dramatically from person to person, it’s important not to focus on the symptoms necessarily but instead on what they mean for your body.
During a “flareup” both your immune system and inflammatory system have been triggered and you may be damaging your thyroid.
It’s important to find the eliminate the cause of whatever triggered this event.
Manage flare-ups by managing inflammation and finding the source
Since finding the source of the flare-up is so critical I’ve included several possible factors that can all influence Hashimoto’s symptoms and trigger a “flare-up”.
List of Hashimoto’s flare-up sources:
- Extreme physiological or emotional stress (5) (death of a loved one, divorce, problems at home/school/work, etc.)
- Physical trauma such as car accidents or even repetitive physical trauma from extreme exercise/sports
- Chronic nutrient deficiencies (6)
- Viral infections (7) (CMV, EBV, etc.)
- Other hormone imbalances that may alter immune system function
- Exposure to endocrine-disrupting chemicals (8) (see list below)
- Exposure to heavy metals (9) (the removal of dental amalgams has been shown to reduce thyroid antibodies in some patients)
- Increased intestinal permeability (10) due to overgrowth syndromes or intestinal dysbiosis
You will notice that many of these sources of flare-ups can also be potential triggers of the autoimmune disease itself.
This makes sense because you can trigger Hashimoto’s with emotional stress and then make the disease worse by introducing another trigger/flare-up source.
For these reasons I always recommend that patients take a comprehensive approach to managing their Hashimoto’s to eliminate the increased risk of making their disease worse.
If you focus on and treat multiple problems at once then your results will be better and you will have less risk for a flare-up.
You can find information on how to reduce your antibody levels here, and you can find more information on how to manage other triggers of Hashimoto’s in this post.
Recap & Final Thoughts
Hashimoto’s disease should be differentiated from other causes of hypothyroidism because of the inflammatory and autoimmune component that accompanies it.
Addressing both of these components is required for optimal treatment.
On the other hand, the symptoms of Hashimoto’s tend to differ drastically from other causes of hypothyroidism from these components as well.
This results in various symptoms ranging from diffuse and generalized symptoms to “flushes” of thyroid hormone causing hyperthyroidism and ultimately hypothyroidism if the disease progresses enough.
Some patients will also experience flares throughout the course of their disease which can be managed by eliminating the source.
Now it’s your turn:
Do you have Hashimoto’s or autoimmune thyroiditis?
Do your symptoms follow the “textbook”?
Have you experienced a flare before? If so what were your symptoms?
Leave your comments below!
Hello Dr. Child’s, I was diagnosed with autoimmune hypothyroidism when I was 20. I was informed that it was also called Hashimoto’s. I have been on Synthroid for 12 years, I’m now 32 and struggling again. I experience these episodes that are difficult to explain, I’ll do my best to describe. For the past year, I’ve experienced more and more frequently a sudden “crash” which is followed by a severe faint, weak, and dizzy feeling. When this happens, I cannot think, even process words, my joints on my hands and feet throb and my get serious muscle pain. I also become anxious and frustrated and I need to lie down. This episode lasts about 4 hours and I can best describe it as “I don’t feel like myself”. Drinking water, taking that nap, vitamins, don’t help at all. After the 3.5 hours, I feel the heaviness and fog lift and I’m able to go back to working or school. What is most dangerous is when in driving. I’m growing more and more frustrated because I don’t know how to present this to my doctor since my blood tests are normal. Also, I don’t know what triggers this and don’t know how to prevent it. Reading your articles helps to put a name to it, I can mostly identify with the overt hypothyroidism when the episodes come on.
Hi, I was recently diagnosed with Hashimoto’s. It all started after the birth of my second daughter. Both of my pregnancies were rough so I’m not sure if that set it off or what. I have antibodies which are why they deemed it Hashi’s. My more recent flare-up has been lightheadedness and dizziness, weakness in my legs (calves) and bad brain fog. My bloodwork after this last flare looked pretty good except that my t3 was a 67. My antibodies didn’t show on the last test which is weird because the last one was positive. The time before that it was negative and the time before that was positive. I’m so confused. I don’t test know what my triggers are except that I know I’ve been under a lot of stress. I’m a teacher and this year has been rough. Now I find myself in an anxiety cycle too wondering how I’m going to feel each day. It stinks. I went from a gym rat to just trying to make it through a day.
Hi there—great info!
I’m 48 and have known about having Hashimoto’s since diagnosis when I was 33. I am on 50 mg Synthroid, which hasn’t changed in YEARS. I’m currently in an extremely stressful job and work situation. I have gained weight, I’m napping, and many of the other symptoms you mentioned. My annual last October showed thyroid levels normal; however, the stress of this job has gotten increasingly worse over the course of the school year—I’m talking BAD. I also have high cholesterol, which caused me to think FOR SURE my thyroid meds needed to be upped. Should I get checked again? Do I need to ask for more specific tests? Thank you for listening!!!
I have Hashimoto’s and hypothyroidism. I believe I may be having a Hashimotos flare right now brought on by stress. I used to take Synthroid only – for about 30 years. Needless to say a developed a lot of other issues. When I changed to an NDT (Wpthyroid) all those other issues went away – most especially the weight, pain, high cholesterol, brain for and cell deep tiredness. That was 4 years ago. Then in December WPthyroid stopped production. In January I switched to Naturethroid. I did OK on for several months but gradually noticed an increase in sweating. I read that others were also having this same issue. My sweating got so bad that I sweated all day until my NDT was out of my system later in the day. I still had some WPthyroid left in reserve so switched back to that and the sweating gradually stopped. So I called my doctor and asked to be changed to NPthyroid and did so on 5/9/18. The sweating has not come back but I’m very tired. This thing is due to a lot of family stress that began about the same time I started the NP. It was family issues and my husband had an operation on 5/22. We are finally settling back in at home and I’m still tired but getting better. My dose was 2 grains NDT UPON rising and 2 grains just before bed. I also take 30 mcg compounded t3 around 10:30 am and again around 3:30 pm. Today I raised the morning dose to 3 grains and I’m not so tired but I can feel more energy. I also raised the afternoon dose of t3 by 10 mcg. I’m hoping this adjustment will work to get me through this tiredness. I had been out of breath when I even get up to walk or go up the stairs. That seems to be getting better in the last day or so. Please advise is I am making the right med adjustment. I believe if all goes well and I start feeling better that I will be able to reduce it again. I should also mention that I also have an MTHFR gene mutation (a1289c/a1289c) for which I am taking methylated B vitamins and Leaky Gut for which I am taking L-glutamine. Thanks for your help,
Pat
Hi Pat,
If you have any specific questions let me know and I’d be happy to try and help!
I was diagnosed with hypothyroidism back in 2006 and given levothyroxine. I believe I tried 25 mcg for a short period but have been stable on 50 mcg ever since. TSH has always been a reliable indicator in my case of whether or not things are as they should be. My TSH improved after I removed gluten from my diet, either by lowering reverse T3 levels or by reducing GI inflammation caused by reactions (or both), but it did not reduce my need for replacement hormone. I found out later that I was allergic to wheat, but I’ve not tried to see if I have any sort of reaction to barley or rye. Other than the food reactions, my TSH has remained fairly stable. Balancing my diet has also not had an effect on my level of thyroid replacement. I most likely have some kind of permanent damage to my thyroid but am not sure how it happened. I’ve never been diagnosed with Hashimoto’s. I had my antibodies tested back in 2012, and they were negative. I’m having my antibodies tested again now to see where things stand, and I hope to have another round done later if needed. I have an endocrinologist appointment in November. I hope he can provide answers and can perhaps do an ultrasound to find out exactly what’s going on. If it’s not Hashimoto’s, I wonder if a severe ear infection I had in the summer of 2005 might have caused thyroiditis that eventually led to permanent hypothyroidism. The ear that developed the infection I believe was already vulnerable due to acoustic trauma about 10 years earlier, when a child I was babysitting pointed a cap gun at my ear and pulled the trigger. I also cannot recall any serious hypothyroidism (or hyperthyroidism) symptoms leading up to the diagnosis. If any symptoms were present, they were mild.
Hi all, I know this is a dated article but I’m desperate. I’ve been dealing with some sort of an autoimmune response for the better part of a year. Doctors and rheumatologists don’t know what to think. I’ve tested positive for my ana. After being told by my first rheumatologist that he couldn’t help me I felt on my own and decided to do my own research, and have come to the conclusion that I’m dealing with something thyroid related, and possibly of the autoimmune kind. Thyroid dysfunction runs in my family. But I am rather confused as to what I’m dealing with, either hypo or hyper. When my symptoms started I felt very much hypo and now as of the last month or so I feel I am having symptoms of hyper. It’s very confusing, this fluctuation of symptoms. I see my second rheumatologist at the end of this month but I’m very anxious and disheartened, afraid I will be turned away by this one as well. My symptoms scream autoimmune. I have had flare ups of some kind already, my life is in shambles and no doctor can help me. Strangely my TSH has been tested twice in the last year and it’s both been within the normal range. I don’t know what to do. I don’t want to be backed into a corner by doctors anymore but I’m afraid I won’t find a doctor whose willing to run a full thyroid panel.
Hi Chelsey,
I would consider getting tested for thyroid autoantibodies if you haven’t already.
I’ve had Hashimoto for 2.5 years now and my GP put me on 30mg NP Thyroid. My original symptoms were dry crepe skin, thinning hair, foggy brain, achy muscles and joints, plus 10-15 lbs weight gain. Most of my symptoms were corrected rather quickly, especially my foggy brain which made me very happy, but my hair was still falling out and my skin was still extremely dry and thin. All my test results after starting the NP came back within normal range. So I began doing some research and found articles on the promising benefits of turmeric and Hashimoto. I began making my own Golden Milk and drinking it twice a day ( I also take Selenium, Zinc, Desiccated Liver, D3, and B12) and I was thrilled to find my hair stopped falling out after about two weeks on GM!!! I have been pretty much symptom free now since I began treatment and I continue to drink GM at bedtime everyday. Now I’m wondering if Hashimoto can be reversed completely? I’ve been reading about the benefits of celery juice and the connection between EBV virus and autoimmune disease, and so I’ve been drinking celery juice every morning for two weeks at a time with on one-off, for about six months, but now I’m having hot flashes quite often and I’m gaining weight!! I’ll be getting lab work done in Sept. In the meantime, should I cut my NP Thyroid in half? Could I be reversing my Hashimoto? Thank you.
Hi Miranda,
It would be best to get your labs tested and to see those results before you make any decisions about your medication.
Dear Dr. Childs. Thank you for the information. I was recently diagnosed with Hashimoto’s and am trying to figure out what my triggers are and if what I’m feeling is related to Hashimoto’s or something else. I will be seeing an Endocrinologist soon (long wait for new patients), since the physician who diagnosed me originally didn’t think it was much of an issue. My question for you and other posters here is, how long does it take for symptoms to appear once you’ve been exposed to a trigger? For example, if I eat soy products for dinner one night will the symptoms appear the next day or in a couple of days? How quickly does the body react to something that it sees as a trigger? Or does it vary by trigger? Thank you.
Hi Jennifer,
It just depends on your body, it could be very quickly (days) or up to weeks depending on the exposure, your sensitivity and so on.
I have been looking for some way to understand what has been wrong with me for about a year and a half. I’m almost positive it may be Hashimotos. It started with severe fatigue and hormonal problems. I was bleeding abnormally. I take birth control pills. I skip the period partly due to the fact my OCD is bad when I have monthly stuff. They thought just taking a break from the pills would help. It did but only for two weeks. It would constantly happen over and over. It wasn’t like a full blown period but it was annoying and I felt weak and in pain. Not cramps but the pain in my back and joints. I felt awful for like a year. I even went to the emergency room when I felt awful. My back hurt, my joints were in pain, I didn’t feel well at all. I was tired and dizzy but I could only nod off not sleep. I was severely constipated. My stomach was swollen. They did a test. The said I was just constipated and my blood sugar was low. Eat some fruit they said. I ate fruit like crazy and took a stool softener. It didn’t help enough. I had labs that I looked at online. My white and red blood cells were high. TSH was about a tenth of a point below being too high. So cause it was in there range I was ok. I went to my doctor did more blood test. It went down. What a surprise I felt better so everything was better. I’m sure I had a flare-up. But they said I had a vitamin D deficiency. Take some vitamin D3 and then go meet with the psych doctor again. It was so frustrating that I haven’t gone back since. I have done some research and am trying gluten free. But the problem is money. I find myself eating stuff I shouldn’t because it was cheap or work had a pizza party. I usually don’t feel well after eating stuff with gluten. My stomach is still swollen sometimes. Probably because of a flare-up. I also have had several stressors due to my husband leaving two years ago. I don’t know what to do. I’m afraid to go to the doctor. As long as I’m gluten-free and I take a thyroid supplement I found called T8 or Thyro8 for thyroid support I’m fine. But financially I’m having a hard time. I find myself giving in and just eating gluten. When I’m around friends and family I just eat what they have because I don’t want them to go thru trouble for me. Most people think I’m crazy. They don’t get why gluten free if I don’t have celiac disease. Many think I’m a hypochondriac. But I know something is wrong. But no one will believe me. So I try to eat a certain way at home but the problem is when I’m out elsewhere for dinner. I’m not sure what to do but your so helpful thanks.
I am a 25 year old petite female and have just this year been experiencing all the symptoms for hypo/hyperthyroidism, leading me to do a lot of research on Hashimoto’s. I have normal TSH/T4 levels although my TSH has been closer to hypo. I have the TPO antibodies which my doctor has only checked once. My symptoms came on suddenly and have not changed for a month: anxiety, panic, lethargy, fatigue, brain fog, trembling, loss of appetite, weakness, restless sleep, emotional, etc. I’ve also been sick with a cold/flu/post nasal for months on and off with no resolve. I have also stopped driving because of the anxiety, morning sleepiness, so much crying!
Initially, my doctor treated me for anxiety…and sent me to behavioral therapy/psychiatry. Basically calling me crazy! It helps but I don’t think is the root cause because I have never had an anxiety/panic attack before this year.
My Endo has me on 12.5mcg of Levothyroxine to see if it will help my symptoms, it has only been a week so nothing noticeable yet.
I am also trying a gluten free diet because I have heard that has helped other with symptoms. I have never been tested for celiac disease, or any other food allergy.
I am very interested in trying CBD oil, however there is no doctor or anyone I’ve found that would talk about this other than on the internet. Does anyone have an opinion on this?
Thank you for this article!
I’m 44 and I was diagnosed hypo 20 years ago and put on thyroid meds. Only 4 years ago did I find an endocrinologist who got my levels within the “normal” range.
I was diagnosed with Hashimoto 4 months ago.
My situation is complicated by a nasty fight with BRCA1 breast cancer in recent years. I was on study meds, intense chemotherapy radiation, tamoxifen for 4.75 years now and had 17 surgeries. It gets hard to tell what symptoms are from what.
I have been tired got a year now.
I am 60 lbs heavier than I used to be but am one of the healthiest eaters I know.
Due to my Hashimoto’s, I recently eliminated every bit of gluten and lectins. I eat an anti-inflammatory diet containing no soy, gluten, nightshades, sugar, grains and specific and limited dairy (following the plant paradox diet). My food is organic and my animal products grass fed.
I have not sweated in 10 years which leads to overheating (heat strokes) in the summer.
My legs recently started hurting a lot. My knees started last year.
My question: how do I know what is caused by Hashimoto and how do I know I am on the right track and that my strict dietary efforts are worth it? I read so many books on these topics, take loads of supplements and exercise daily. What am I missing and why is there never any progress despite 10 years of efforts? I want nothing more than to be thin again.
Hi Jennifer,
It will just take a lot of diligence and a caring doctor to figure out what is what. The truth is that most physicians won’t have the time to devote to such a task but it is certainly possible. And it is also definitely possible to improve your weight, but it sounds like you have more issues than just your thyroid contributing. You’ll need to identify and treat those issues as well.
Good Morning,
My Dr.. insists that I don’t need my antibodies checked due to the fact we know I have Hashimotos – but I feel that’s how I know if I’m having a flare ( like currently ) or if all these symptoms are something else I should be looking into. Wondering if anyone experienced air hunger, slight blood pressure swings – blood sugar swings during your flares?
Thank you!
Hi Kathleen,
I have definitely seen patients experience very similar symptoms during flare-ups.
I was diagnosed with Hashimotos about 4 years ago, after struggling with symptoms for about 15 yrs. As a simple sono and then antibodies test made it impossible to deny, something that no dr before cared to even check. I was 12 when I started feeling there was something wrong with me and I convinced my mother I needed to see a doctor. Because of my age, and I feel like because I was female, doctors never took me seriously all the times I visited one, and I was made to suffer in silence, made to feel like it was all in my head. I was a very depressed, child, teen, young adult with absolutely no energy and constant pain and discomfort.
Anyway, my younger sister has been having symptoms that to me seem mostly hyperthyroid.
She’s gained 30 lbs in less than a year, she has anxiety, heart palpitations, can’t sleep, has developed a red rash on her face that never really goes away. I keep telling her to continue to check her thyroid but the results always come out within range and doctors dismiss her. She wants to rule out thyroid issues because as they don’t find anything, she trusts it must just be stress and anxiety-like they tell her.
I just want to help her, I don’t want her to suffer as I did, but I don’t know-how.
Would you recommend any tests that may be telling or any way that doctors will take her symptoms and suffering seriously?
I have been experiencing one of the worst flare ups I’ve ever had. I gained 7 lbs in a week; my hands, face and feet are so swollen, especially my feet, which makes walking extremely painful; GI issues; rough red dry patches on my skin; fatigue; brain fog; feeling out of breath… And the list goes on. My doctor simply raised my medicine and now I’m at 150mc of Synthroid and 5mc of Cytomel. I’ve reached my max dose in a little over two years. Is it normal for this disease to progress so quickly? I feel like my doctor just throws medicine at me every time I see her. It leaves me wondering what my next steps are now that I can’t increase my medicine anymore.
Hi Kira,
Once you’ve reached that point your only option is to try natural therapies or deal with the symptoms. I think natural therapies can be particularly effective, especially when combined with medications. You can find more information here: https://www.restartmed.com/tpo-antibodies/
When I was 7 I started gaining weight at an insane pace and by the time I was in 3rd grade, I had started my period and was already overweight reaching the point of obese for my age. This never made sense to me or my family because I was, and always have been very active ( I am always on my feet doing things around the house or in the yard. Playing with my, then, siblings and now my girls) and I never ate more than any of my 6 other siblings. The doctors didn’t have any other advice for my mom than to put me on a series of ever more stringent diets that did nothing as I continued to gain weight at a pace of 15-20 pounds a year. it wasn’t until I was in high school and I realized that the bump on my throat was not normal that anything changed. They removed the bump, benign, and I lost 30 pounds in 2-3 months doing NOTHING!!! not even an occasional run or burpee… Nothing. I wasn’t even in sports! I was on robotics for gosh darn sakes! Anyway, the weight stayed off for five years until suddenly it all came back within a matter of months. It seemed like there was nothing I could do to stop it. My lifestyle didn’t change I was still as active but I could not get rid of it or stop it from happening. Then I became unexpectedly pregnant with twins and so I stopped trying to lose the weight. Over the next 6 years, I have gained an additional 30 pounds that will not budge. After they were born I dealt with depression, which I have NEVER experienced, coupled with brain fog, memory problems, intense fatigue, and just recently my hair is falling out, my joints hurt as if they are swelling up, stomach problems that range from each spectrum day to day, and a constant pressure in my brain that radiates to my eyes. I am very conscious of how and what I eat and I am always moving, you have to with twins, but the only thing the doctors tell me are your tests are normal, maybe you should take this class on portion control and how chips are not an appropriate snack. I am so frustrated and angry especially after bawling my eyes out at one doctor and saying “it has to be my thyroid I don’t think it could be anything else.” And her response “what do you want me to do about it? Your tests are normal… Here is a pamphlet on healthy choices.” I feel like I’m going crazy, every couple of months it’s a new symptom or a worsening symptom from before. One month I can’t sleep and my heart is racing strangely to the next I sleep for 9-10 hrs and it’s never enough. day to day I go from having the energy to do anything to laying on the couch all day, or being able to remember the entire script of beauty and the beast ( my girls love the movie) to not remembering my brother-in-law’s name, someone I have known for ten years!…… I just want to know if I’m crazy or if I am on to something. Is it really that I’m just fat and too lazy to do anything about it? Or do I have a serious problem?
Now if only I can convince my GP that Hashimoto flare-ups are a real thing. Apparently “hypothyroid symptoms are only ever gradual. They don’t ‘flare-up'”. I love having my symptoms completely invalidated like that.
Hi, my thyroid antibodies are 6k, is this serious? The doctors I saw just shove the issue aside 🙁
Hi Serene,
Yes, I would consider it serious. Most doctors ignore antibodies because they don’t believe they can be treated. They would rather wait until your thyroid gets destroyed and then put you on Synthroid/levo, this is just how they approach Hashimoto’s.
I’ve had all of these symptoms getting progressively worse for 13 years. Three years ago I got pneumonia and I’ve really struggled afterwards, I have no life due to fatigue, low energy, hip and shoulder pain, migraine and bloating etc.
I’ve had fluctuations in TSH for years and was told borderline Hypothyroidism and was monitored.
I have a diagnosis of ME and Fibromyalgia. I have Microvascular Angina.
Finally, in March. I was found to be hypothyroid and started on Levothyroxine 50mcg. My TSH came down to 1.1 so GP happy to leave me for a year.
We just got my bloods done privately and TSH up to 2.4. Thyroglobulin antibodies positive/high. T4 not converting to T3 very well. Low vitamin D. The doctor who reported said I may have autoimmune disease, possibly Hashimoto.
Reading this article and some posts I can identify with everything. Sudden brain fog, fatigue, lack of energy, mood changes, painful debilitating hips and shoulders, flushing, intolerance of cold, bloating, weight problems…etc
I feel a bit overwhelmed at the moment, taking it in and wondering whether to see my GP (who can be stubborn) or see if I can go private??
To begin.. I’m not trying to sound Unsympathetic to the side effects of Hashimoto Disease. But I work with a female that says She has Hashimoto’s. Trust me I understand the feelings of some of the symptoms due to my Anti Estrogen medication. But I do have a question regarding the other thing she says is going on… I am not finding anything connecting her other issues with Hashimoto’s. She says she is having Muscle Biopsies on her leg… 2 0f the 3 tests I have ruled out ( I know I’m not a Doctor) But ruled out because she is not male. She says she has Thyroid cancer but has not been diagnosed.. I know approx. 90% of the nodules on a thyroid of a person with Hashimoto’s is usually Benign. I ended up having a muscle spasm due to over exertion of my pectoral muscle after a fill of my tissue expander. A few days later a co-worker asked me about my spasm and asked if I knew of any problems prior to this and explained that this girl was complaining of having Spasms. She is also said that she was in the hospital for one afternoon with Kidney stones and a kidney infection, but a few hours later..she told someone else she was sick at home and not going anywhere. Now she is saying that all of her organs are failing and they have given her one year to live. I am not finding any branch, avenue or bridge to connect these ailments to Hashimoto’s. I am beginning to believe this is a ploy to get sympathy Is there a possibility that these issues/ailments are connected to Hashimoto’s or could there be another underlying condition that is present?
Hi,Dr. Childs,
I have no idea if I’ve had Hashi’s flares since I also have fibromyalgia. How can I tell the difference?
Hello,
I was diagnosed many many years ago, now my son had been diagnosed with hypothyroidism now. Neither of us have a doctor here that actually understands what’s going on with us, I lost my job (a job I had done for years because the brain fog was so bad I couldn’t even remember how to do my job) my son is overweight had sleeping problems, falls asleep driving, and he can’t breathe. It’s been terrible, some days I wake up fine sometimes I can’t even walk or use my hands.
Hi Dr. Westin Childs,
While I don’t have Hashimoto’s Disease, I do have multiple sclerosis. So, I read and try to absorb any and all information I can find on autoimmune diseases.
What was particularly interesting was the view that autoimmunity is a deep-rooted problem in the body. This is true, with the same probable causes, for MS.
I am not entirely sure, what role hormones play in multiple sclerosis, but they are certainly likely to be a factor. This is something new for me to investigate.
Thank you for the very detailed write-up.
Dr Child’s:
Thank you for this article that saved my sanity! I’ve been back to my Dr several times asking “why do I have these high/lows”! I’ve battled Hashimotos for 11 years now, have been on AIP diet for last 5 years. My husband was in near fatal vplane crash 5 years ago, which took a toll on my health & I can’t seem to get on top. My TSH is suppressed for last 2 years, with correlating T3/T4 moving like a seesaw! So, I flip between hyper/hypo.
It’s frustrating & very lonely since you don’t tell anyone because no one “gets it” anyway, and especially Drs!
Just this past month my brain issues have been so bad, I CANNOT talk on the phone past 20 minutes anymore because I get so antsy & feel like screaming..my patience, ability to focus, memory is SO bad right now!
I just had him switch me to Armour (from compounded levo/cytomel that I’ve taken for years) to see if that will help.
Thank you for this article,, I need to back up & check for triggers. Drs like you are so few, who REALLY care..God bless you!
Hi Susan,
So glad you enjoyed it! Thanks for sharing and I hope you are able to find a doctor who is more willing to listen.
I’ve had Hashimoto’s since 2000. My experience with foods that contain a lot or even moderate amounts of iodine is that I’ll feel hyper, which means I’ll feel too warm and the most disturbing effect is trouble sleeping that night. But by the next day, the effect wears off.
Hi Bill,
Make sure you check this list of foods that contain iodine: https://www.restartmed.com/16-foods-with-iodine/
It’s my experience that most people do quite well by taking iodine, especially with Hashimoto’s.
I’m 43, diagnosed with Hashimoto when I was 16. Been on Levo/synth. since diagnosis, with little issues.
However, within the last few weeks I’ve developed a horrible rash directly on my thyroid gland area. It comes and goes, gets really red and inflamed, is triggered by heat, and not only itches like hell, but burns like a chemical burn would feel. There are also two distinct red lines across my throat that consistently come and go as well. This has never happened to me before, what the heck is going on?!
Hi Solana,
It’s hard to know for sure what is going on with your skin without pictures but I would take a look at this list of skin conditions that are common in those with Hashimoto’s: https://www.restartmed.com/skin-conditions-caused-by-hashimotos/
I was diagnosed over 2 years ago with Hashimoto’s. I have been through several flare ups since. My NP keeps telling me that my numbers are fine. Then why do I feel like I did before I started thyroid medicine? I’m being to think I am “crazy” and it’s all in my head. That’s how many of my family members treat me. I wish they could feel for 1 hour like I do, just so they would maybe understand. The fatigue, IBS, brain fog and migraines are horrible. I just want my life back.
Hi Tara,
I would recommend checking out these treatments/therapies which can be used to manage Hashimoto’s. The degree to which they work is variable but it’s certainly better than nothing!
https://www.restartmed.com/natural-remedies-for-hashimotos-thyroiditis/
https://www.restartmed.com/can-hashimotos-be-reversed/
https://www.restartmed.com/natural-thyroid-remedies/
https://www.restartmed.com/thyroid-treatments/
Dr. Child’s,
Thank you for your response. I will definitely check into those treatments/therapies.
Thank you!
Can a person have Hashimotos but have normal labs and no antibodies? My thyroid ultrasound showed thyroiditis and recommended a fine needle aspirant my labs are fine even according to my functional medicine doctor.
Hi Kelly,
Yes, that condition has a name, and its called seronegative Hashimoto’s: https://www.restartmed.com/hashimotos-with-negative-antibodies-seronegative-hashimotos/
I have been dealing with hypothyroidism for years with the last 3 years being the worst. At the start my doctor kept telling me I was in the normal ranges, then I was borderline so let’s just wait and see. Finally my doctor acknowledged the hypothyroidism and started me on 50mcg of synthroid. Three years later that has increased to 125mcg. My symptoms are all over the place between hypo and hyper. I can be freezing cold to the touch but burning up inside and sweating through my clothes. Then in an instant I’m so cold nothing will warm me up, my temperature frequently drops to 35 C (95 F) which is basically hypothermic. Extreme fatigue to the point of afternoon naps and falling asleep at work, gained 40 pounds in 3 months but lack of appetite, lack of concentration, muscle weakness, achy joints, terrible constipation, headaches, depression. The list is exhausting. I am now on 5 different prescriptions: 125mcg synthroid, 60mg duloxetine for depression, 20mg dextroamphetamine to keep me awake during the day, 1000mg metformin to try and balance my hormones and 10mg oxybutynin to control the excessive sweating. I also have an inhaler to use as needed and get a B12 shot every month. I’m 42.
I went to a naturopath a few times and my number was in the 600s. I took her talk of hashimotos to my doctor and he brushed it off and didn’t want to even consider it. Unfortunately the naturopath hasn’t been available lately due to 2 maternity leaves and her own health issues.
Stress is my major trigger. During Covid I worked from home for over a year, it was great and my stress levels were down. Since going back to the office 8 months ago, my antidepressant had to be changed because it was no longer effective and 2 of my other meds had to be increased. Everyday I come home and I am absolutely exhausted, I want to go to bed before supper. My doctor tells me I just need to exercise, and that will solve most if not all of my problems.
Hi Brenda,
I would recommend using this resource to help you find a more thyroid-literate doctor: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/