How Hashimoto’s Symptoms change over time + “Flare” up Symptoms

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 makes 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 cuases of hypothyroidism. 


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.

warnings signs of hashimotos low res

This component is usually triggered by various factors (usually a combination of factors that we will discuss later) that results in 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 component 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: 

TSH fluctuating over time with autoimmune thyroiditis

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 component 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 (leading to worsening symptoms of hypothyroidism). 

Inflammation can also potentiate insulin resistance and make adrenal function worse.

These changes may lead to symptoms such as weight gain, 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) indicate 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 somewhat fatigue and ​diffuse. 

Because of these symptoms it can be difficult to pin point where your symptoms are coming from.

You may present with 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. 

Thyroid diet 4 week plan side bar

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 of 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 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 a 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 blood stream/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 racing pulse (usually episodic and at night but can occur at any time throughout the day)
  • Weight loss/weight gain accompanied with changes in appetite

These symptoms do not occur in every patient, however. 

Some patients just have a chronic and continually 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 blood stream 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 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 life long 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 other generalized symptoms above
  • Bottom line: Once damage has accumulated the thyroid may become permanently damaged leading to a 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 is dysregulated when you have Hashimoto's or autoimmune thyroiditis in a 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 hyper excitable.

Meaning that small changes may result in a cascade effect causing multiple down stream 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)
  • 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 what they mean for your body. 

During a "flare up" 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. ​

thyroid metabolism reset poster for side bar

Manage flare up 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:

Endocrine disruptors on thyroid function

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 increased risk for 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 for 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 accompany 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 "text book"?

Have you experienced a flare before? If so what were your symptoms?

Leave your comments below! ​

Dr. Westin Childs

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 38 comments
Jennifer - February 28, 2017

I was recently diagnosed with Hashimoto’s and am still working to figure out exactly what that means. It is comforting to know that I am not crazy but disheartening and depressing, especially when I am experiencing a flare up and no one around me understands why I feel so horrible. The most recent flare up has resulted in a severe migraine-like headache, upper body aches all over shoulders and neck area, so much so it hurts to breathe. My face and eyes burn like I have a fever, but none is present, I alternate between chills and hot flashes, and did I mention my head hurts…? I feel like my brain is foggy and it is more difficult to see because of the tightness in my head. Depression has increased mainly because my husband still thinks I am crazy and that my attempts at a Paleo diet are just a fad and will garnish no real results. I think this flare up was triggered by a stupid moment of weakness and one dinner with bread and pasta. Lesson learned… but is it? I have such food anxiety right now I am not sure what to eat anymore. I struggle tremendously with making sure I have the right foods to eat in the morning especially.

Debbie - March 1, 2017

I have Hashimoto’s thyroiditis. I was diagnosed approximately 20 years ago and I’ve been on levothyroxin for quite some time. Last last year, my doctor upped my dosage from 100 mcg to 125 mcg. But then I was adjusted back down to 100 mcg. My last blood test in October said I was normal, so my internist doesn’t want to do another blood test until October.

I had rotator cuff surgery Jan 6. I was pumped full of dilaudid and morphine while in recovery. I felt good that day. I was on Percocet for about two weeks, and then on Norco (5/325). I’ve been off the opioids for awhile. I noticed that my judgement seemed to be off from the day of the surgery onward, but not my reflexes. I assumed it was due to the anesthesia and pain meds.

When I first started driving again, around the 5th week of surgery, I seemed to make a few mistakes, which was unusual for me, and potentially dangerous. But I’ve been off the opioids for weeks and my judgement is fine now.

My shoulder was massaged by my physical therapist on my first day of PT, which was Feb 20. My shoulder was very sore. I subsequently felt achy all over. I iced the shoulder twice. I felt achy for two days. Ever since then, I have days when I feel achy all over—it’s not every day, but it’s more often than I’d like. I hate that feeling.

My ortho surgeon told me that feeling achy all over is not directly related to my shoulder. I felt so lousy today, I took a Norco.

I’m wondering if I’m having a Hashimoto’s flare-up. I’ve been having problems sleeping but that’s a common issue with RC surgery.

Can the trauma of having surgery trigger a flare-up? In fact, this is my second surgery in a little over eleven months. The first surgery was because I had a torn meniscus. Both surgeries were arthroscopic.

I made an appointment with my internist for March 6 because of how lousy I’m suddenly feeling. He tends to dismiss things though… for instance, even though I told him that my ortho surgeon had told me I needed surgery because the MRI had showed I had rather large full thickness rotator cuff tear and muscle atrophy, all due to a fall in 2013, the internist didn’t think I needed one because I had full range of motion. Well, I’ve been in pain for 45 years due to musculoskeletal issues, so I’m used to working through the pain—and somehow other muscles stepped up to the plate.

I’m thinking of asking for a referral to a specialist. Hope he doesn’t fight me on that too.

jaci - March 12, 2017

I have had Hashimoto for about 19 years. I have managed fairly well until two years ago when my menstrual cycle stopped.I am 52 and have not had my period since. I have been having a flair up of various symptoms ever since. I have adjusted my meds at least 10 times and am still suffering with brain fog and acid reflux and low stomach acid seems to be a problem which i did not have before.
I am at my wits end and looking for guidance! any suggestions on how to proceed?
Thank you,

Bonnie Turnbull - March 13, 2017

I have had hypothyroidism for 35 years and was on Armour thyroid and doing well. When it was reformulated, it didn’t work for me anymore. I was also in a motorcycle accident that left me in a coma for over a month. While still in the hospital and rehab, they had me on 1 synthetic thyroid replacement pill a day. After returning home, I started on my Armour (original formula) and had lost the 23 lb. weight gain in the hospital and rehab. When they reformulated the Armour, I went on another natural thyroid medication but, 1/5th of the dose I’d been on for 30 plus years. I had been on 5 grains of Armour thyroid. To this day I have gained 65 lbs. even on thyroid replacement and trying everything to stop the weight gain. I only consume around 500-600 calories a day just to maintain my current weight. Can’t lose even 1 lb. with my medication so low yet, the doctor said the TSH is within range. What can be going on?

Jackie - March 13, 2017

Hi, I hope you can clear up some confusion I have on my thyroid.
my TSH is 1.20
T4,free is 0.90
T3,free 2.50
T3,reverse 11.0
sex hormone binding globulin 83.0

I have been told that I have Hypothyroidism some say I am normal but then I was told are you sure you don’t have Low T3

I eat very clean to the point of measuring I also do cardio 5x a week and weights 2x a week. I feel if I don’t do what i do now that I gain weight very easily and look thick. I also take cytomal compound 15

Do I have a thyroid problem?

Laurie - March 13, 2017

I have had Hashimotos for almost 32 years. It started after the birth of my first child. Over the years I have had flares, with increased classic hypothyroid symptoms, every 5-6 years. The doctor told me that it was another piece of my thyroid dying off. Which made sense as my thyroid tests indicated a need for more medicine after a flare. 2 1/2 years ago I became very sick. In 6 mos my TSH had gone from 3.4 to .1 My endocrinologist did an US which showed my thyroid gland to be very small. She ran a battery of tests trying to find a cause for the dramatic change. All the tests were normal. My levo dose was adjusted and changed to synthroid(name brand) and everything leveled off. Now over the last 6 months, I am slowly becoming hyperthyroid again. TSH has been May~2.3 Oct~1.1 Jan~.7 March~.4 I am having classic hyperthyroid symptoms that are worsening every month. I am not sleeping, I feel like I am buzzing with energy, have panic/anxiety attacks. I have tried almost everything to get my levels to stay consistent where I am symptom free. Could there be something we are missing that might be causing this hormone disruption? I am going back to the endocrinologist Thursday.

Beverley - March 13, 2017

Hi, diagnosed with a prolactinoma and Possible Addisons but not confirmed, is it likely an autoimmune disorder will automatically follow and medication be required even if there are no symptoms. Diet and medication has reduced the prolactin levels from 285,000 to 211 in 4 weeks. Also TSH levels and T4 levels have dropped to 0.3 from 3 and 6.7 from 9.7 respectively. Is that a hypo to hyper scenario? Any information would be greatly appreciated. Thank you.

    Dr. Westin Childs - March 13, 2017

    Hey Beverley,

    There isn’t enough information to give you a definitive answer, unfortunately. And yes, if you truly have Addison’s disease then you will be dependent upon cortef or other corticosteroids to preserve your hemodynamics.

Deb - March 13, 2017

I was diagnosed with Hashimoto’s about 6 months ago. After seeing one endocrinologist several times, he prescribed Levothyroxine. I was on it for 3 months and still felt crummy, not to mention I was still gaining weight. His response was to eat 6 times a day and exercise more. (I also have bouts of hypoglycemia)

I changed doctors a couple weeks ago who changed my meds to Naturethyroid. I’ve noticed a change in just a few weeks…feeling much less exhausted. I have labs scheduled in a couple weeks.

I’ve changed my diet to eliminate gluten and dairy and found the inflammation a bit less. I still have neuropathy in both feet, though not quite as severe. I’m still a bit foggy, mentally. My eyesight has been affected too.

Thanks for all of the comments and stories people are sharing, it’s nice not to feel like I’m the only one with this. (or going crazy!)

    Dr. Westin Childs - March 13, 2017

    Thanks for sharing, Deb! Sharing stories is definitely important and can help patients understand that they are indeed NOT crazy.

Barbara - March 13, 2017

I was diagnosed with Hashimoto about 10 years ago, about one year ago I started seeing a Funtional Medicine doctor, but I am getting worse. I am gaining weight again, started having heart papaltations, loosing more energy. I’m just really frustrated that I am getting worse instead of better. I feel like all I do is takes supplements with no help from them. Any suggeestions?

    Dr. Westin Childs - March 13, 2017

    Hey Barbara,

    Not all functional medicine doctors have the same understanding as others which can lead to what you are experiencing. Functional medicine is more than just conventional medicine with some supplements on the side.

Anne - March 13, 2017

Hi.I eventually got my doctor to check my TPO antibodies
It came back 924!! Doc said that’s fine .but I feel awful my TSH was 3.53 in normal range.
What’s your views on these results

Cathy Thomas - March 14, 2017

Dear Dr Childs, I have been working very hard for some time to reduce my antibodies and TSH. I managed to 1/2 my tpo and lost 40lbs my tsh however is all over the place and is constantly being adujusted. Last fall I took a supplement reccomended by a functional Dr with Iodine in it-I do take selenium – wasn’t sure what would happen. My tsh jumped 5 pts and my tpo 80. I have since been able to bring the tsh down but the tpo has not. I did read an article you wrote about this lately but I do not remember reading where you go from here and would like some guidance if possible. Also wondering if the b12 shots have ever been linked to cardiovascular issues

    Dr. Westin Childs - March 14, 2017

    Hey Cathy,

    No, B12 shots do not cause cardiovascular issues. They are simply filled with vitamin B12 which is essential for proper cellular function, in addition it is a water soluble vitamin which means elimination isn’t a problem.

Muriel - March 14, 2017

Dear Dr. Childs,
I have been treated medically for Hashimoto’s since my 20ties. I am now 53, have been through ups and downs, getting bloodtests every 4 months.
Lately, I lost a lot of weight, but I think it might be in my genes, my mom is very slim but very healthy, with no Thyroid issues whatsoever. Except 4 years ago, I lost like a third of all my hair… but I had a lot of stressful situations back then, I think it was a connection to stress as well.
Lately, I have had a TSH of 0,02..(!!) and an slighly elevated T4. But I think I might be a very unique human ;-). I feel like a young woman, I work out, I play acoustic and electric guitar, I have 3 rescue dogs, I am vegan (though I am fully aware that soy products are not very positive on Hashimotos), but I think going vegan 5 years ago made a huge difference in my quality of life.
I am on the Novothyral 50 microgramms per day.

Navina Østergaard - March 14, 2017

I was diagnosed with hashimotos last August, but already in 2013 I accidentally was tested for low metabolism (tsh 6), however, couldn’t believe it and my medical doctor let it pass. Last year numbers got worse and TPO proved to be 113. After receiving thyroid hormone fro 6 weeks in October T4, T3 and TPO all went into the normal range. Generally I have felt good, slim, work 6-10 hours a day, exercise. Although when checking on symptoms I realise that I am always cold compared to others, often constipated and late afternoon after teaching for hours my brain sometimes feels muddy. January 19th my test results were all worsened and TPO was 76, tsh 10 and t3 down to 0.9. My doctor rose eltroxin to 450 mkg pr. week from 350 (1 pill 5 days a week and 2 pills 2 days a week) And I started studying, checking out diets etc. February 2nd I dropped gluten, diary and soy, February 9th I went on the paleo autoimmune diet. Also started taking vitamin D and selenium (200 mg pr. day). My new test results are better on all parmeters: vitamin D, LDL cholesterol, B12, T3, T4 and tsh, BUT TPO rose to 86 which is the wrong direction. I wonder if all the improvements are just due to the rise in hormone-intake, and the diet does nothing for me. The reason why I do the diet is in order to reduce the immune system inflammation. Now I am at a loss about the root cause and what to do in my case. I continue the diet, just in case, but rather demotivated. Also I should mention, that I have never suffered from food intolerance of any sort, that I know of. But having read that about 90 percent of hashimoto patients are intolerant to gluten I avoid it. I feel better on the diet because I eat more, I used to go hungry a lot to stay slim, and I don’t put on weight in spite of eating more, probably because of the no sugar policy. I should maybe mention that I am past my menopause (last period June 2014) and I suffer from occasional heatwaves, while usually feeling cold. Any idea why TPO goes up even though I follow the autoimmune paleo diet?

    Dr. Westin Childs - March 14, 2017

    Hey Navina,

    I would check out this article for more info on what causes fluctuations in your antibody level: https://www.restartmed.com/anti-tpo/

      Navina - March 19, 2017

      Dear Dr. Childs! Thank you so must for answering my question. I have studied the article and will probably look through it again and take some of the measures suggested there. Hopefully that will help. So far I am only taking Vitamin D3 90 iu’s pr. day and I don’t test deficient for that. Selenium I am taking 200 mcg. All other supplements I am not taking yet, so that will be my first step, especially probiotics and probably zink.
      Your mention of LDN sounded also very interesting, so I will ask my physician if she can prescribe that. Thank you so much for all your great articles.
      I have one more question: Have you ever experienced clients who “feel” their liver, ie. has a sensation that it is swollen although not hurting? My physician says numbers on that issue are fine and I have had an ultrasound scanning that showed normal too… still I am suspecting that it is not working too well, since T4 to T3 conversion is so poor that my T3 level is lower now (1,0) than in August 2016 (1,2) before I started taking T4 hormone.
      Hope to hear from you again 🙂
      Sincerely, Navina

Linda Papison - March 14, 2017

Dear Dr. Childs, I have been diagnosed with Hashimotos for 25 years, after my Mom was killed tragically. Since then I have gained about 75 lbs, after initially losing about 25, (and gaining it back with the additional 75) when I stopped eating for about 1 year. When I was diagnosed my TSH was outside the normal curve, so whenever I get tested the less knowledgeable want to lower my dosage. Since it was so long ago the initial diagnosis is no longer available (on paper in the clinic’s basement, I assume). I was on 150 mcg levothyroxin for quite a while, but had the above scenario and it was lowered to 137. I gained 12lbs almost immediately. In the last year I switched to Amour at 60, then 70. I had my t3 and t4 tested and t3 was low,so they increased to 70.

I have a very difficult time losing weight and often use sugar to combat the chronic fatigue. I am mostly gluten free as I noticed it caused inflammation. I am on the weight loss program called OMADA where I weight in daily, and my weight is ‘all over the place’. I have fairly severe stomach problems, and am not regular with bm’s. I often have to eat something to calm my stomach since I got off omeprazole after 4 years.

I really would like to lose some weight and be more active as I have in the past.

Diane - March 14, 2017

I have been diagnosed with hypothyroid but believe I likely have hashimotos. I have every symptom and have been in a flare for about a year due to several major stressors. Because of that, my joint pain and swelling have been off the charts. I am taking 30 mg of Armour Thyroid every other day. Should I suggest that my doctor test me for hashimotos?

    Dr. Westin Childs - March 14, 2017

    Hey Diane,

    It would be a good idea to have a complete thyroid panel to have a better understanding of what is going on in your body.

ruth - March 15, 2017

Thanks for your website with great information. My hair is thinning, very brittle and falling lots due to hashimotos. My DHEA is 2.1 (normal range 0.95 to 11.65) My Best’diol is 273 (normal range 100 – 977). I like to try DHEA but I do not know the side effects and what to look for. Please comment on the symptoms of intolerance to DHEA supplement. Is evening primrose oil can be used to balance my hormone and how is it in comparison to DHEA?

Louise - March 15, 2017


I was diagnosed with hypothyroidism a year and a half ago. I’m 31 years old and my Dr told me it was ‘auto-immune.’ I take 75mcg levothyroxine every morning but the last couple of weeks I’ve been waking up at 4.30-5am every morning (despite being really tired!) low mood and more worryingly, I’ve had two strange fluttering sensations in my heart this week. I know I’m not quite right… been making silly mistakes at work. I’m not really sure what I should be doing to help… brain fog has well and truly set in, so clear advice would be really appreciated.

Samantha - March 26, 2017

I’m REALLY hoping you can shed some light on some symptoms that I’ve been having the last few months. I started having what seems like a “flare up” of some sorts where I will have a few days of feeling more exhausted than normal and just a general unwell/malaise feeling. It will typically last a few days and it seems to occur every 2 weeks or so. My blood work all came back normal except my TSH was 6.148 and T4 was normal range at .81. Do you think it’s possible that what I am feeling could be thyroid related? I have even been tested for mono wondering if that is the cause and that was negative. I would greatly appreciate any input that you have, as I am desperate for some answers! Thanks so much!!

Shellie Hurst - April 8, 2017

I was diagnosed with Hashimotos as well as Sjogrens 2 years ago after the birth of my son. Have taken synthroid and then was changed to WP thyroid without any improvement. I deal with many symptoms ( chronic muscle and joint pain, fatigue, fluid retention, digestive, hormonal, weight gain, hair loss, and many others you have mentioned. I was in top shape just a few years ago and now exercise is exhausting and have gained body fat and lost muscle. I have become very frustrated. I have had some success with diet and supplements but always seems to have relapses. I cant figure out how to manage this and without docs that know how and what to look for. Are u accepting patients do you have distance consulting?

Kay - April 17, 2017

I was diagnosed 8 years ago with Hashimoto’s., thyroid cancer 4 years ago followed by a total thyroidectomy. I tried eating a gluten free, dairy free, soy free diet for 6 months and it didn’t help my symptoms or flare ups. I have a positive ANA and thyroid antibody levels are still high. All other Auto immune diseases have been ruled out. The inflammation now affects the tendons in my arms, etc.. All the Doctors I’ve seen, agree on what I have but no one seems to know how to help me feel better.

Ebony - April 26, 2017

Hi, I was diagnosed with Hashimoto’s this year in February. My Dr. is currently treating the Hypothyroidism with 75mg medication, and my levels are good. However, my problem comes when I call and tell him that I am experiencing other symptoms and having a flare up. I become tired, weak, my back hurts, and my legs feel heavy and numb. I even have numbness in my hands. He says that it has nothing to do with my Thyroid because my TSH levels were not that high. It seems like he does not recognize the Hashimoto’s at all. He even checked my blood levels for Diabetes and said that I was on the borderline of being prediabetic with my A1C being 5.6. I’m not sure what to do, and it seems as if they believe that I am making these feeling up because he told me to see my PCP. What can I do to feel better?


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