6 Stages of Hashimoto’s Thyroiditis That All Patients Go Through

6 Stages of Hashimoto’s Thyroiditis That ALL Patients Progress Through

Hashimoto’s Progresses Through Certain Stages Over Time

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Every single patient with Hashimoto’s will go through the same stages over the course of their disease. 

These stages outline are important because they outline exactly what will happen to you, provided you let your disease smolder and damage your thyroid. 

It’s not all bad news, though. 

By understanding these stages, and finding out where you fit within them, you can roughly identify how long you’ve had your disease and you can gain insight into what treatment options are best for you. 

Hashimoto’s thyroiditis is what is referred to as a progressive disease. 

Meaning that it progresses and worsens over time. 

Doctors know this which is why they typically tend to avoid treating the autoimmune component of Hashimoto’s. 

Instead of focusing on the autoimmune aspect, they tend to focus more on the thyroid aspect. 

But by ignoring the autoimmune aspect you will miss out on all of the treatment options available to you along the way! 

Today you will learn:

  • The 6 stages of Hashimoto’s thyroiditis
  • How each of these stages presents in terms of lab tests and symptoms
  • At what stages Hashimoto’s tends to be diagnosed
  • The best stage to start treatment if you have Hashimoto’s (*hint: the earlier the better!)
  • And how to know if you’ve reached the “end-stage” of Hashimoto’s
  • Why this information is important to ALL thyroid patients regardless of whether or not they have been diagnosed with Hashimoto’s

Let’s jump in:


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6 Stages of Hashimoto’s Thyroiditis

I’ve mentioned it before but it’s worth repeating here:

Hashimoto’s thyroiditis is the #1 cause of low thyroid in the United States (1). 

It is estimated that as many as 90% of all cases of low thyroid are caused by autoimmune disease of the thyroid gland (AKA Hashimoto’s). 

This number is probably not accurate when you consider the cases of seronegative Hashimoto’s (yes, you can have Hashimoto’s even with negative antibodies) and the fact that many doctors aren’t ordering antibodies on every thyroid patient. 

This information is important because it means that if you have low thyroid function there’s a HIGH probability that it’s from Hashimoto’s, whether you realize it or not. 

The takeaway here is to check your thyroid antibodies at least once a year if you have Hashimoto’s or not. 

By checking your antibodies you can keep an eye on your disease state to see if your treatments are working and it will also help you diagnose Hashimoto’s if you aren’t already diagnosed. 

With that in mind, let’s get into the 6 stages of Hashimoto’s…

Remember, each person will progress through every stage over a period of time. 

From stage 0 to stage 5, it takes about 20-30 years (depending on the person). 

And unlike a video game, the goal here is to NOT go through every single stage. 

The goal is to identify where fit into these stages and then implement the right treatments so you can avoid further progression. 

And, yes, if you weren’t already aware, it is possible to halt the progression of Hashimoto’s!

Stage 0. – Genetic Predisposition

The first stage is what I refer to as stage 0. 

It’s called stage 0 because there are many people who don’t even know that they are in this stage. 

Stage 0 simply refers to a genetic predisposition that you have in your body. 

When it comes to autoimmune disease, genetics play an important role in determining whether or not you will get a specific disease. 

But just because you have the genetics does NOT guarantee that you will get a disease. 

More important than your genetics (2) are the triggers that you come into contact with on a daily basis. 

It is only when you combine a genetic predisposition with triggers (3) that you are primed to get Hashimoto’s. 

How do you know if you have a genetic predisposition to developing Hashimoto’s? 

You can get a good idea by looking at your family history. 

Do other members of your family have thyroid disease?

Do other members of your family have Hashimoto’s disease?

Do other members of your family have autoimmune diseases like Celiac disease or Vitiligo?

If you answered yes to any of these questions then there’s a good chance that you are positive for a genetic predisposition! 

A family history is not enough to guarantee that you will get Hashimoto’s, though. 

It’s not until you combine your family history with other triggers such as EBV infection (4), other viral infections, major stressors in your life (5), exposure to chemicals or heavy metals, eating an unhealthy diet (6), not exercising enough, and so on, that you will then develop Hashimoto’s. 

It’s not worth spending too much time on this area, though, because most people aren’t even aware of their own family history and because it’s often too late. 

For most people, they don’t realize they have a family history of Hashimoto’s until they’ve already been diagnosed. 

For this reason, we are labeling this as stage 0. 

If the conditions are met above, meaning that you have both the genetics and the triggers, you will progress to stage 1. 

Stage 1. – Immune Cell Infiltration (+ Antibodies)

Stage 1 is when we really get into what defines Hashimoto’s thyroiditis and that is immune cell infiltration of the thyroid gland. 

This means that if you were to take a biopsy of the thyroid gland in this stage, you would find immune cells inside of the gland causing problems such as inflammation and stirring up other problems. 

This is the hallmark of Hashimoto’s thyroiditis. Autoimmune attack of the thyroid gland and it starts in stage 1. 

Under normal circumstances, you should never find immune cells inside of thyroid gland tissue. 

The thyroid gland remains relatively tucked away from the rest of the body and immune cells shouldn’t come into contact with glandular tissue unless something is awry. 

Because there is immune cell infiltration in this stage, you will also see positive antibodies when you look in the blood. 

Despite the fact that antibodies are present in this stage, most people are NOT diagnosed here. 

The reason is simple:

Even though you have positive antibodies, the symptoms associated with this stage tend to be VERY mild and they are often not related to your thyroid. 

While the antibodies are causing some damage to your thyroid, your body is still able to compensate by simply using more effort and energy to pump out extra thyroid hormone. 

This effort and energy take a small toll on the body, though, so you may start to feel symptoms such as slightly low energy, feeling a little “blah”, or feeling run-down. 

These symptoms are easy to miss and may accidentally be associated with extra stress from work or lack of sleep. 

Stage 1 is considered EARLY stage Hashimoto’s and is, therefore, the BEST time to start treatment. 

Unfortunately, most cases of Hashimoto’s are missed here but if you can somehow identify that you have Hashimoto’s then treating here is the most effective. 

Natural treatments such as changing up your diet, using the right supplements, exercising regularly, detoxing (if necessary), avoiding exposure to your triggers, and reducing your exposure to stress, are all highly effective natural treatments. 

Stage 2. – Subclinical Hypothyroidism (+ Antibodies, Normal TSH)

If stage 1 is not halted it will eventually lead to stage 2. 

Stage 2 is defined as subclinical hypothyroidism which I will explain in more detail below. 

You can imagine that the longer you have thyroid antibodies floating around in your bloodstream and interfering with your thyroid gland, the more damage that will occur. 

And this is exactly what we see in stage 2. 

Stage 2 happens when your body is no longer able to compensate for the damage done to your thyroid (unlike stage 1). 

As damage to your thyroid gland mounts, eventually, your thyroid will not be able to pump out enough thyroid hormone. 

When this happens thyroid hormone levels begin to fall and you start to experience low thyroid symptoms. 

As your thyroid can no longer keep up, your body increases levels of TSH which is how it tries to force more thyroid hormone out of the thyroid gland. 

But because the thyroid gland is damaged, it can’t respond to the increased TSH levels. 

So in subclinical hypothyroidism, we see 2 very important markers on your thyroid lab tests. 

The first is a RISE in your TSH levels (this is never normal and means that something is wrong with your thyroid gland). 

And a RISE in your thyroid antibodies (antibodies were raised in stage 1 but they may rise even higher in stage 2). 

These two markers will also now be associated with the start of low-grade low thyroid symptoms

Symptoms such as mild weight gain, mild fatigue, mild constipation, and even some mild hair fall

Unlike stage 1, these symptoms are enough to get people into their doctor’s office but they are usually not enough to get the right diagnosis. 

This is usually the time that your doctor will order your TSH and tell you that it is “normal” even though it is a high-normal and not optimal

Your doctor may also identify that you have positive thyroid antibodies but will tell you that you aren’t “bad enough” to get on thyroid medication

This stage is where many a thyroid patient gets frustrated. 

They will feel frustrated because they know something is obviously wrong, but most doctors aren’t willing to treat them at this point. 

This is very unfortunate because starting thyroid medication at this stage is ideal! 

The early use of thyroid medication may help drive down thyroid antibodies and stop (or slow) the progression of thyroid gland damage. 

If you know that you are in this stage it’s worth spending some time to find a doctor who is willing to prescribe thyroid medication in early Hashimoto’s. 

Of course, you will also want to use the other natural treatments outlined in stage 1 as well, even if you are not able to get thyroid medication. 

These therapies are always more effective if started early!

(Stage 2.5) Thyroid Hormone Fluctuation

Before moving onto stage 3, we need to talk about what I call stage 2.5. 

This is a stage that is highlighted by thyroid hormone fluctuation. 

It isn’t technically stage 3 because not every single patient with Hashimoto’s will go through this problem. 

Thyroid hormone fluctuation refers to changes in your thyroid hormone levels over time

If you know anything about Hashimoto’s then you probably already know that it usually results in LOW thyroid function or hypothyroidism. 

But this isn’t true for everyone!

10-20% of people can also experience episodes of HYPERthyroidism or HIGH thyroid hormone. 

During this stage, your thyroid may swing from hypothyroidism to hyperthyroidism which can make diagnosis difficult. 

One month you may experience weight gain and constipation and the other you may experience hot flashes, weight loss, and diarrhea. 

What happens is that as your thyroid gland is damaged, it can sometimes release MORE thyroid hormone instead of less. 

During times that more thyroid hormone is released, you will experience hyperthyroid symptoms and during times when less thyroid hormone is released, you will go back to hypothyroidism. 

You should know that even if you do have periods of hyperthyroidism, you will always end up hypothyroidism over time. 

Hashimoto’s does NOT result in long-term hyperthyroidism so your symptoms will always eventually go back to hypothyroidism. 

But diagnosis during this time can be confusing which is why it is included in this section. 

Stage 3. – Overt Hypothyroidism (+ Antibodies, Increased TSH, Decreased Free T3/Free T4)

All stages, regardless of whether you went through stage 2.5 or not, will end up with hypothyroidism. 

This stage is called overt hypothyroidism because, by this point, you obviously have hypothyroidism

Even if your doctor wanted to, they couldn’t deny that you are now in a stage of low thyroid by stage 3. 

Stage 3 is associated with HIGH antibodies, an INCREASED TSH (higher than stage 2), and now decreased free T3 and free T4

The decreased free thyroid hormone levels are a dead giveaway that you are now in a hypothyroid state. 

It is never normal for your thyroid hormone levels to be low, and if you find that your free thyroid hormone levels are low you WILL feel it. 

Unfortunately, this is the stage that MOST patients with Hashimoto’s thyroiditis are diagnosed. 

By this time, they’ve been kicked around from doctor to doctor for a few years until their thyroid function finally has fallen to a level that even the most basic doctor can’t miss. 

The good news is that most people are finally diagnosed here, the bad news is that it’s very late in the disease. 

Around 10+ years or so have passed from stage 1 to stage 3, which means that it takes years and years for the average Hashimoto’s patient to be diagnosed. 

It’s also around this time that you will NEED thyroid medication. 

Thyroid medication may have been optimal at stage 2 but by the time you get to stage 3, you will need it. 

If you remain untreated, you will experience significant weight gain, significant constipation, significant fatigue, significant hair loss, significant constipation, and so on. 

The use of thyroid medication here is required to help you feel better but it may also have a positive effect on your thyroid antibodies (in driving them downward). 

Natural therapies are still effective by the time you get to stage 3, but you will have to be more aggressive with them. 

If you catch Hashimoto’s in stage 1, you may be able to get by with just going gluten-free or dairy-free. 

By the time you get to stage 3, those types of diets probably won’t cut it. 

Instead, you will need to do more comprehensive diets such as the elimination diet, going gluten, dairy, and soy-free, or even diets such as the low FODMAPS diet. 

Stage 4. – Additional Autoimmune Diseases

After being at stage 3 for a while you may start to progress to stage 4. 

Stage 4 is characterized by the addition of other autoimmune diseases. 

Hashimoto’s is an autoimmune disease and when you have one autoimmune disease you are much more likely to develop another. 

Some people get confused here and believe that once your thyroid antibodies run out of thyroid gland tissue to kill they will then move on to other tissues. 

That’s not really what is happening. 

The thyroid antibodies in your body are highly specific to certain tissues in the thyroid gland so there is very little cross-reactivity with non-thyroid gland tissues. 

Having said that, if you fail to fix whatever was causing the immune dysfunction which started your disease in the beginning, your body may eventually start to develop antibodies to OTHER tissues. 

If your body creates antibodies to gluten then that is called Celiac disease (7).

If your body creates antibodies to destroy your joints then that is called rheumatoid arthritis (8). 

If your body creates antibodies to destroy your salivary glands then that is called Sjogren’s

If your body creates antibodies to destroy melanin in your skin then that is called Vitiligo (9). 

And so on. 

What you need to understand here is that simply treating your thyroid with thyroid medication will NOT stop the progression of your autoimmune disease. 

It may help you feel better as you provide your body with the thyroid hormone it is lacking, but it’s not enough to fix the underlying autoimmune disease which damaged your thyroid, to begin with. 

And this underlying immune problem, if left untreated, may ultimately lead to additional autoimmune diseases as mentioned above. 

It’s also worth pointing out here that you may start to develop other autoimmune diseases earlier as well. 

These autoimmune diseases do not always come at this stage and can come at any point.

Stage 5. – End-Stage Hashimoto’s Thyroiditis (Decreased or Negative Thyroid Antibodies)

The final stage of Hashimoto’s is what is referred to as end-stage Hashimoto’s. 

End-stage Hashimoto’s is what happens when the autoimmune attack on your thyroid gland persists for years and years. 

When you get to this stage, your thyroid gland has atrophied and shrunk due to this damage. 

It’s become so damaged that it can no longer produce thyroid hormone and is essentially non-functional. 

By this point, those with an atrophied thyroid gland are in the same position as those who have had thyroid gland removed or irradiated from RAI

Patients in end-stage Hashimoto’s are REQUIRED to be on thyroid hormone for the rest of their life because their own thyroid gland no longer functions to produce it. 

In addition, by the time you get to this stage, you may find that your thyroid antibodies begin to decline and eventually fade away. 

And while this is something that you want in stages 1-4, it’s not a good thing when it happens here. 

The decline in antibody levels in end-stage Hashimoto’s occurs because your body has run out of tissue for your antibodies to attack. 

When your body runs out of tissue to attack it believes that the “treat” is gone so there is no need to produce more antibodies. 

Unfortunately, by the time you get to this stage, the damage is irreversible and it usually indicates that you’ve had Hashimoto’s for 20-30+ years. 

At this stage, the natural therapies that I discussed back in stage 1 and stage 0 are still important, but they will not be enough to restore thyroid function. 

It doesn’t mean you should avoid them but it does mean you should be aware of what they can and can’t do. 

The entire goal of talking about these stages is to PREVENT you from progressing to stage 5. 

This is why it’s so important for you to understand these stages so that you can get a start on treatments and therapies EARLY. 

If you are reading this and you suspect you are already here (there will be plenty of people in that situation), that’s okay because you can still optimize thyroid function through thyroid medication, thyroid supplements, and lifestyle interventions. 

It’s much harder to optimize thyroid hormone at this stage but it’s definitely still possible. 

Wrapping it up

When you think about the stages of Hashimoto’s, I want to leave you with this idea:

The earlier you start treatment the better!

The earlier you can catch your disease process the more likely you are to stop the progression of your disease to the later stages. 

Also, the farther down the stages that you progress the more aggressive you will have to be with treatment. 

Easy treatments such as going gluten-free may work when you are in stage 0 and stage 1, but will most likely not be sufficient by themselves when you get to stage 3 and stage 4. 

More aggressive diets, supplements, therapies, and thyroid medications will be necessary to feel optimal in the later stages. 

Lastly, remember that Hashimoto’s does NOT have to be a progressive disease. 

It is possible to both stop and even reverse (sometimes) the damage to your thyroid gland. 

This should always be your goal when treating Hashimoto’s. 

And, in order to do this, you have to focus on more than just thyroid function. You will need to also focus on your immune system. 

Now I want to hear from you:

What stage of Hashimoto’s do you think you are currently at?

Have you had any success in stopping the progression of your disease or in reversing your Hashimoto’s?

If so, what stage did you find the most success?

Are you someone who is just reading this and who is already in the later stages?

Leave a comment or share your experience below! 

#1. https://pubmed.ncbi.nlm.nih.gov/29083758/

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6244553/

#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099387/

#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688766/

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327046/

#7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/

#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505628/

#9. https://pubmed.ncbi.nlm.nih.gov/31203913/

the stages of hashimoto's thyroiditis explained

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About Dr. Westin Childs

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

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132 thoughts on “6 Stages of Hashimoto’s Thyroiditis That ALL Patients Progress Through”

  1. I believe I am in stage 3. No other autoimmune that I am presently aware of. I am almost through one year of treatment and did better in part of spring and summer and early fall. I have been struggling pretty bad since sometime in November . I have also done some med switches with has been challenging. I am eating a strict diet and have been trying the hypothyroidism revolution diet laid out by Tom Brimeyer. He definitely believes in dairy and a significant amount of OJ. What are your thoughts on his program? I recently started synthroid and cytomel . I do work with a functional doc. Thanks Craig

      • I been suffering for alone time now i have heavy sweat no energy I can hear my heart beating chest pains muscle weakness legs hand joints pain I would yawn and painful neck spasms stomach troubles dizziness hair loss and eye headache and my eyes feel like they are big and now it’s hard to swallow food and liquids skin condition itchy skin and food allergies and triggers to wear i get hives and now my hands and legs feels like it’s going out and before all of this i had heavy period to where it wouldn’t go off yeast and Bacteria infection

  2. Hi Craig, I have been recently diagnosed with Hashimoto’s. I had my first blood test 13 months ago and my second recently. I have refused current medication and am seeking a specialist in two weeks. I am uncertain as to what stage I am at but have my blood report. If I may I shall relate them to you for your opinion. Recent Autoantibodies, Thyroglobulin 149, Peroxidase 1300.
    The first Lipid Study 7.0, the second 8.3
    LDL Chol. 4.7, then 5.9
    Non-HDL Chol 5.2 then 5.9
    Thyroid function test, 7.7 then 11.32
    TSH 9.90 then 11.32
    I found your article informative but was confused by the suggested diet as some of the ingredience would seem not good for high cholesterol, e.g. bacon, another query is that you suggest that weight gain is typical, however I have lost weight, mind you I have given up drinking, white wine. I have problems sleeping and have not had a good sleep since mid December when I stopped drinking. If you have any insight I would welcome your advise, should I be taking supplements for example. Hope I have not overburdened you, but as you well know this is a worry and I could use some insight, also I have avoided salt for most of my adult life and though I don’t eat junk food I have always been very irregular with my eating. Many thanks in advance, Chris

  3. I’m definitely in stage 5. I’m taking thyroid meds but dealing with vitiligo, early stages of arthritis in my fingers, eye issues, and I’ve been told my adrenals are “pooling”. I also had to undergo parathyroid surgery, and was told after surgery that my thyroid had atrophied and was “hard as a rock”. I’m taking supplements and have removed almost all gluten and most dairy from my diet, but Hashimoto’s is still thriving in me.

    • Hi Lori,

      Even though it’s a bit more difficult to treat end-stage Hashimoto’s, it’s still not impossible and it sounds like you are on the right track!

  4. I have been struggling with severe depression and anxiety, inability to lose weight despite being in ketosis, extreme fatigue, decrease in libido, and cold hands and feet most of the time. I am working with a nutritional therapist and recently got a full thyroid panel done. It showed that I am hyPERthyroid and my antibodies were very low, such that she ruled out Hashimoto’s. I have been SO confused, because my symptoms do not seem at all consistent with a typical diagnosis of hyperthyroidism. I keep wondering what I should do. I’m not sure who to go to for a further diagnosis and I’m nervous that I’m in what you described as stage 2.5. I don’t want to wait until stage 3 to get a plan in place.

    • Hi April,

      Regardless of diagnosis, it’s never a bad idea to start with cleaning up your diet, taking some supplements, exercising, getting more sleep, etc. These therapies work regardless of what thyroid condition you have and should always be done 🙂

      • It actually can be a bad idea to take supplements sometimes, and it seems irresponsible for anyone to recommend supplements for people already having health issues without providing some caution and more education about possible dangers and side effects.

        As you mention, autoimmune conditions are often comorbid. I had a bout of what doctors believe may have been autoimmune hepatitis. I was told by multiple doctors that supplements can be dangerous to my liver. Also: https://www.consumerreports.org/vitamins-supplements/never-take-thyroid-supplements/

        • Hi B,

          I’ve refuted every point in the article you’ve shared in previous posts including this one: https://www.restartmed.com/are-thyroid-supplements-safe/

          While it’s true that no supplement is 100% safe (the same applies to anything in life), it’s still far safer to take supplements than it is medications.

          For example, thyroid medications themselves may be associated with an increased risk of cancer: https://www.restartmed.com/does-levothyroxine-cause-cancer/
          They may cause hair loss: https://www.restartmed.com/levothyroxine-and-hair-loss/
          And they may contribute to weight gain: https://www.restartmed.com/levothyroxine-weight-gain/

          If you wanted to put thyroid supplements head to head with thyroid medication, you will quickly find that one is far safer than the other.

          The discussion is nuanced, obviously, but the reality is that many more people will benefit from taking supplements than will be harmed by them. This number is so lopsided that I can make general statements like most thyroid patients will benefit from using thyroid supplements.

          As someone who has spent a lot of time around physicians, I can tell you from experience that many of them make assertions about supplements without having ever reviewed the literature on them. This is why you have physicians making even the most elementary blunders like recommending vitamin D2 over D3 and trying to test for vitamin B12 deficiency with a standard B12 serum lab test.

  5. How can we know for sure what stage we are in? I thought I was around level 2.5 but in level 5 you mention antibodies going back to normal range. My levels have been in remission for about 5 years now but I still had symptoms up until about a year ago. I started LDN a year ago and feel great (I take your Hashimoto supplements). I am NOT medicated w medication. I have no other “known” autoimmune issues. So would this mean I am around level 2.5 or 3 or am I in level 5?

    • Hi Nicole,

      It’s hard to know for sure what stage you are in without a lot of history and tests/imaging. It’s relatively easy to diagnose end stage Hashimoto’s with something like an ultrasound, though.

  6. I know I’m in stage 5. I was diagnosed Hashimotos in 1996 and last couple of ultrasounds show atrophied thyroid. First ultrasound in 1999 showed thyroid 4.1 x 2.0 x 2.0 cm and 4.3 x 1.7 x 2.5 cm. Last ultrasound showed 2.8 x 0.9 x 1.0 cm and 3.2 x 0.9 x 1.1 cm. My antibodies have now come down to 12. I am currently on Tirosint and T3 as I always end up with high/over range RT3 if one T4 only. At this time I don’t have any other known autoimmune issues. It’s interesting when you talked about the Synthroid fillers in another blog post because when I was on Synthroid (20+ years) I had allergic type reactions. I don’t do well on dairy and have seasonal allergies. So when someone is at stage 5 what are your suggestions?

  7. I believe I am currently stage 4, and also believe my doctor’s have good intentions, but they have not ever really listened to my concerns regarding my thyroid issues. I never had an issue with fatigue until my TSH was at 27 following the birth of my third child in three years, have significant family history of thyroid disorders (2 close family members with thyroidectomies for masses, 1 was irradiation for untreatable graves’ disease, and multiple other family members with hypothyroidism.) Even since my TSH has been normal (last draw last week was 1.4) and I am on medication for weight loss and energy, I still feel like a complete slug most days. My body stopped tolerating gluten 3.5 years ago (around the same time as my eventual diagnosis) and stopped tolerating dairy one year ago. I haven’t been able to swallow properly for the past week, and an ultrasound today only confirmed Hashimoto’s, but my Endocrinologist has not ever done antibody testing, and essentially refused when I asked her a year ago. Is there anything else I should be asking for? Or do I stop seeing them all together and just have PCP keep prescribing medication while I try other diet and lifestyle changes?

  8. Dear Dr. Childs,

    What will be the lab test needed in order to distinguish wether it is Hashimoto or Graves disease?

    Thanks in advance,
    M. M.

      • Hello Dr. Westin,

        Wondetful content and explanation. I think I am stage 3 or stage 4 most likely. I have severe hair fall, constipation, weight gain, low energy issues. TSH always more than 200 if I don’t take 100 mcg T4 hormone. It is since last 10 years approx. As per sonography last year my thyroid gland is only left 20 percent of its original size.

        Thank you

  9. Hello Dr. Childs,
    I have Hashimoto’s Thyroiditis. I have tried for years to take Levothyroxine in many forms with several different doctors in different states using their individual approaches. Here is my situation and I sure hope I can find some kind of remedy. I also have osteoporosis and two previous fractures. The only thing that gives me more pain than taking Medrol Dose pack (steroids) is taking Levothyroxine….which gives me severe pain in my bones/joins. ….taking Tirosint being the worst. I can tolerate the pain at .25mcg but when bumped up to .50 I am in severe pain I just can’t stand the pain…..hence discontinuation of the medication. T3 & T4 are normal. TSH is high. Can you suggest anything? Thank you for your reply in advance.

  10. I have been hypothyroid for 30+ years. However I wasn’t tested for and diagnosed with Hashimoto’s until 9 years ago. Since I went gluten-free, my antibody levels have stayed very low. I’ve been on the same dose of NDT most of that time too.
    Does this mean I’m in stage 5? I don’t have other AI diseases that I know of. I’ve never had an ultrasound. Should I ask for one?

  11. Stage 4(thanks to my G.P.s who seem to be very “one eyed”when it comes to hypothyroidism) I have now developed chronic hives and would not wish this on my worse enemy (if I had one)I have tried every over counter meds with no effect

  12. Hi Dr. Childs,
    My Hashimoto’s Thyroiditis took a slightly different course than what you describe and am guessing I am in stage 3? In late February of this year I developed acute thyroiditis and was sick with flu like symptoms and painful throat for 2 weeks before being diagnosed. The endocrinologist ordered a radioactive iodine uptake test and did an ultrasound. Turns out I was hyperthyroid with very elevated scores. During those two weeks I lost several pounds and felt exhausted.
    I was put on a beta blocker and sent home to rest. Within a couple of days of the beta blocker I passed out. Turns out my thyroid levels had taken a nose dive and I am now hypothyroid. I have been on Levothyroxine for about 6 months and still having weight gain, hair loss and fatigue issues. I am part of a large HMO and antibody testing is not something they will do so I have no idea of my antibodies status. She also doesn’t believe my symptoms are thyroid related! I have been a modified vegan, I do eat fish, for more than 2 years, post breast cancer surgery, but have now taken out gluten as well. I have purchased your probiotic supplement but am wondering what else you might suggest I supplement with over and above the zinc and selenium I already take. Thanks for listening.

  13. Is there a 4.5? LOL I am for sure in stage 3, but have bad joint pain often, so wondering if some other Auto immune problem is in the works! My Dr just bumped me up to 120 mg of Armour daily. It seems to help with how I feel, but I know its not helping to save my thyroid in the long run!

  14. Dear Dr Childs,

    Very helpful material/education, thanks!
    I think I am stage 4.
    Over 25 years of Levothyroxine various dosages, last 88 mcg, IBS-C in 2020-low Fodmap diet, strong headaches mid 2020, fatigue, brain fog, dizziness, etc. Endocrinologist 2021—>low TSH and T3, high TPOab —>Levo 50mcg+Liothyronine 5cg—>high TSH and TPOab, low T3—>Levo 75mcg+Lio 5mcg, 95% Gluten and diary free diet—>more stable, blood test pending in Dec.
    What do you suggest I do additionally to stagnate Hashimoto’s progression. Thank you.

  15. I think I’m in Stage 1. I was diagnosed in late 2018 with Hashimoto’s – not because of any overt symptoms, but because of high antibodies: TPO was 499. After going (mostly) gluten-free and reducing dairy, plus starting on 4.5mg of low-dose Naltrexone, it came down to under 200 within three months. I’ve continued this regime for the past three years, and am disappointed that the numbers still hover around 170-180.
    So, I found the most success in the first few months. What’s more, going gluten-free has resolved the hip inflammation I experienced for 15 years, and which affected my ability to exercise. Now I run, walk and do yoga to my heart’s content,
    However, I would love your advice on reducing the ABs further.
    Already eating a whole-food, low-carb and “low-crap” diet, I toyed with the idea of the auto-immune protocol diet, but am battling with the idea of excluding so many otherwise healthy foods for an extended period of time.(My health practitioner has a 71-year-old female patient who brought her ABs to zero after 12 months on the strict AIP diet.)
    My strange “problem” is that I have no symptoms that I could monitor for the progressive re-introduction of certain food categories, e.g. nightshades, nuts and seeds, eggs, onions and garlic, etc., and I can’t imagine excluding them forever. (Grains, dairy and sugar are already excluded.) Any ideas on this? – say, regular AB blood testing? Thanks, Dr Childs!

    • Hi Verne,

      I’m generally not a huge fan of the AIP diet due to issues with the reintroduction of food. I just don’t think it’s a sustainable model and if you start adding back foods and your antibodies rise then you put yourself in a tricky situation. You can read more here: https://www.restartmed.com/aip-diet/

  16. Sorry, I forgot to mention that I am 61 years old. Also, I have been taking 50mcg levothyroxine and a compounded T3 every morning for the past 18 months. What’s more, I take a pinch of L-tyrosine each morning.

  17. I think I may be 2.5, as earlier this year my GP relented and got me a TPO test (32) and then recently my TSH was hyper and I had a scan that saw 60% uptake, even though I don’t have any Graves antibodies. After nearly 10 years of up and down TSH (still within the “normal” lab ranges) and many typical hashimotos symptoms. Being gluten free since my 20s seemed to help for a while, but after the birth of my third child every symptom just got worse. I’m almost 40 and this past year I have felt totally broken from tiredness, fatigue, hairloss, anemia, brain fog, tinnutis, etc. Finally found an integrative Dr (thousands out of pocket) and I hope his plan can help with leaky gut and I can get some function back. What confuses me the most is should I focus on the hyper or hypo and how to manage both.

    • Hi Jessica,

      Each person is different but it often makes more sense to focus on immune function as opposed to thyroid function, especially if you believe the underlying cause is autoimmunity.

    • How did you get on here Jessica? I had an enlarged thyroid in my early 20s and nothing really came of it, I had bloods for a while but then stopped as everyone alwasy said normal.
      Have struggled with constipation, heavy periods, lack of libido and energy for many years (assumed the energy was parenthood) but recently some bloods showed my tsh as 0.28 which suggests hyper though all my symptoms point to hypo.
      my tsh levels over the years have been up and down but always heading toward a drop. It just doesn’t make sense the hormones not matching with the symptoms.
      My dr believes it’s autoimmune and will head toward hypo but none of the info I read is quite me (until you!)

      Interested to hear how you are getting on

  18. I started my thyroid journey in 1999 when I could not lose weight ( gained 40 lbs) ..no matter what I did or how little I ate! I went to 6 different dr (one endocrinologist even said you are fat, so what is your problem, I walked out of his office without talking) before I found 1 that listened to me and found the disease and I had my thyroid removed. I am on rx and the last 2 dr I have gone to will not change the dosage because it registers in the correct range. I still struggle with weight loss and low energy. I take vitamins, go to the gym 3 to 4 days a week and am at a loss of how to increase my energy level. I figure I can raise that I will lose weight. I am 69 yrs old now and tired of trying to find a dr to listen again.

  19. November 10, 2021
    My TSH was 2.730, T4 1.06, thyroglobulin antibody <1.0
    Thyroid peroxidase 12 T3 2.7

    My doctor said I had hashimoto thyroiditis but based on what you say I do not. I have a goiter with nodules that I am watching, but all tests seem normal.

    Should I get the thyroglobulin By IMA what does it show you?
    Thanks, Karen
    What do you think? Thanks, Karen

  20. I’m 75. The first time I was told I was hypothyroid was in 2002 and I started taking Synthroid then. Have had antibodies checked only once, maybe 10 years ago, and they were 39. Symptoms have mostly been cold hands and feet. Never a huge problem with weight. I started taking NDT meds 6 years ago, taking NP Thyroid for about 4 years. Just this week my T3 went up high, to 5.1. I’ve been having rapid heartbeat and low blood pressure. Walking on a treadmill my HR will go as high as 203. Am in the middle of trying to solve the problem. Cardiologist says supraventricular tachycardia. Stress test and echo normal. PCP, who tested thyroid, wants to lower NP Thyroid from 60 mcg to 40 mcg and re-check in two months. Another doctor I’ve trusted most with thyroid has not gotten back yet (only wrote her yesterday) so having a little challenge right now. Really want to get back to regular exercise! Have been gluten, dairy, soy free for about 8 years. Don’t know what stage I’m in, but was not aware of any symptoms when I started taking meds.

    • Hi Diane,

      Just based on the timeframe, you are probably in the later stages unless you were able to put it into remission somehow.

  21. Diane again. Forgot to say I have had alopecia areata since before I was told I was hypothyroid. Have had maybe 25 spots since age 35 (40 years ago) but no spots in the past 6 years. Just beginning to have arthritis in my right hand, a gift I got on the day of my 75th birthday!

  22. I’m in stage 7. My pathology report after total thyrodectomy showed Hashimoto’s. Frustrating because I was always told my thyroid labs were normal and that I did not have Hashimoto’s or hypothyroid. My endocrinologist says I no longer have Hashimoto’s. Now what?

  23. I believe I’m in end stage. I’m 38 years old.
    I never really had any issues except feeling more fatigued in the last years. But I thought this is normal and I that just didn’t sleep enough. I slept very little through my early years and have gotten used to this.

    But blood tests for something completely different showed alarming state of my thyroide hormone levels. At the doctors it was revealed my thyroid has shrunk very much, to the point there’s very little of it left. I have no idea how long this has been going on. No one in my family has had these types of diseases. But my lifestyle wasn’t the healthiest.

    I don’t have problems with weight (I’ve always been a slim person), in fact I worked hard to gain 10kg in the last half a year, because I always wanted to be “bigger”.
    I don’t have any other problems, I think my well-being is pretty normal, except for the slight fatigue, and I spotted I’m losing a little bit of hair.

    I found Anthony William and read his book, started doing his diet for a year. Eliminated gluten, dairy, corn, eggs, and a lot of other stuff, too.
    But now I stopped with that.
    I started using back ghee now and will start to eat eggs. I can’t be limiting myself from food like this all my life. I won’t eat gluten.

    So I guess this is end stage.

    I was thinking trying to get natural hormone supplements instead of Euthyrox, but my country doesn’t have those. Will see if I somehow manage to get them.

    I don’t know why I’m writing all of this.

    • Hi Alan,

      Sometimes it helps to collect your thoughts and put them all down in writing. Plus it is always helpful for other people to see what you’ve tried previously.

  24. Hi Dr Childs, I’m on the other side of the board, I’ve never been diagnosed with Hashimotos but had my thyroid removed over 20 years ago after routine scan showed liason. Within the last 2 years finally changed dr who tested my RT3 was 550 and now with her help finally getting some relief with just being on T3, iron,magnesium,Vit D,proboitic,multi vitamin and cumin seed oil caps. Has been a long journey and I wish i had known about all this at any stage prior, i’ve had glandular fever, sardcoidois twice and now being treated for Lyme, You need to reeducate the Gp’s as they don’t know. I found help finally someone just listened to me, wish their were knowledgable Gps like you, thanks Kay

  25. I’m in stage 4 and have been for many years. I have had all the classic symptoms and no doctor will prescribe me medication. I also have significant arthritis, high blood pressure, elevated histamine, osteopenia and have had breast cancer 3 times plus fibroids that became the size of a football. I had 7 operations in 9 years starting with a hysterectomy. My endocrinologist (he is also my breast cancer surgeon) is no help to me what so ever and said the classic “your thyroid will just burn it self out one day”. I have managed to make a lot of improvement to my health via low carb eating and intermittent fasting. I take Vit D, K2, zinc and selenium. I saw a functional medicine doctor recently and he also will not give me any medication. My last bloods TSH, Free T3 and Free T4 showed being biochemically normal!

  26. What if you are in stage 1-3 of Hashimotos and have removed gluten, dairy, soy, caffeine; have prioritized stress management and sleep, maintained a normal steady weight, but are now pregnant? When calcium is vital, are supplements enough? Is this a time to eat a little dairy to help the growing baby?

    • Hi Ceci,

      I’m generally a fan of dairy as long as one can tolerate it. You’ll know pretty quickly if you can or not once you introduce it into your diet.

  27. Thank u for caring about people suffering with Hashimoto, your comments are enlightening! Because I have had this disease since i was in my early 40s, if not earlier, and I am now 70 yrs old, I lost my thyroid 10 yrs ago as it was covered with water filled cysts, non-cancerous tumors and nodules from Hashimoto. I really wished that my previous drs had found out that i was suffering from Hashimoto at a much earlier time. In my 10 yrs of going without a thyroid, i have done much research but i still dont see that this disease is widely known in the world until recently. i now has Parkinsons Disease and from my research, this Disease as well as MS is often caused by Hashimoto, Pls keep letting people know about this autoimmune disease, it will help many peolle be inspired to talk to their drs about the possibility of having it if they notice they are having problems such as you have mentioned in ur many articles. I am in the last stage and can no longer many foods such as meat, bread certain vegetables and fruits.as my stomach acid has become too low to digest these foods. thx!!

  28. Hello Dr. Childs, thank you SO MUCH for this incredibly helpful information!! I believe I am in stage 3. Fourteen years ago I was exposed to mycotoxin mold (Ochratoxin A) at work. I was in the mold for at least three and a half years. My 20+ symptoms (Extreme fatigue, dizziness, massive brain fog, depersonalization, etc.) were beyond extreme for the first seven years and could barely function. Then 10 years into it I changed my diet and was able to start exercising and Intermittent fasting and finally started to feel better. But at the 12-year mark started having thyroid and neuropathy problems. Just found out a year ago it was the past mold exposure making me sick (thank you Great Plains Laboratory!!) and started detoxing with ir sauna, and charcoal pills.  Right now I’m at: TPA 182, TSH 2.11, FREE T4 .9, FREE T3 2.9. My doc just put me on T4 15mcg &T3 4mcg and I feel horrible. Not sure why as she said I would feel better but maybe I’m reacting to something else? I’m back to days of barely functioning and don’t know what to do. I want to take something natural too. Which of your supplements do you recommend? I tried LDN and couldn’t tolerate even at .25.
    Praying once the mold is gone, it will help my thyroid, candida overgrowth, etc. Also have you ever dealt with the mold/thyroid connection? Should my thyroid improve?God bless you and thank you so much for any help.

  29. Great article!
    I’m in stage 0 or between 0 and 1, not sure. Was dx’ed 1.5 yrs ago, with TPO 160. TGab was either 1 or <1.
    I immediately started a gluten, dairy, grains etc. free diet and the TPO went down to 27. Have to check again soon. The Free T4 is optimal, but Free T3 is not, it's 2.9. The Reverse T3 however is high with 24, so I'm guessing that's the cause of the not optimal Free T3.
    Also dealing with EBV, those numbers are going down as well.
    Could EBV be the culprit of RT3 being high?


  30. I have had subacute thyroiditis several times and always in the fall. My infectious disease doc says I have Hashimoto’s but my endo says nothing wrong with me, numbers are normal. My tsh fluctuate from .2 to 4.7. My free t3 is 3.0 and my Thyroid ab was a 79. I think I’m in stage 3 but not sure. I cannot get the endo to help me.

    • Hi Susan,

      If you think you have Hashimoto’s there are still plenty of things that you can do on your own (diet, etc.) to help improve your condition! I would recommend starting there while also trying to find a new doctor.

  31. I’ve been on synthroid for 15 years and NDT for the past two years. My doctor only ordered Thyroid Peroxidase AB test last year per my request. It was at 100 iu/ul on 1/20 now on 9/21 is 574 iu/ul. Clearly in the final stages.

    My doctor isn’t concerned with this number. My dietician is having go gluten free in hopes of lowering it. Any suggestions?

  32. Hello Dr. Childs,
    Just a quick thank you for the great information you put out there on a regular basis. I find the information both interesting and helpful.
    So I started with thyroid antibodies of almost 6000 and TSH of 3.8 (I believe)…and that was around 3ish years ago. I was told they won’t do anything at this point because my TSH is in the normal range. It was super frustrating for me, as I was already experiencing symptoms like unexplained weight gain, hair loss, brittle nails, stressed super easily, etc. So I started working with a naturopath. Before that, I already started going gluten and dairy free, and just that change, made a little bit of a difference in my blood work, but not so much how I felt. It also didn’t change anything with my weight. So I started taking all kids of supplements. Fast forward a bit, I was put on desiccated thyroid, which I took for a few months and the stopped. Later in I went back on the medication. I noticed that it eventually helped my weight, but I was losing SO much hair. And it wouldn’t get better. So about a month ago I stopped my medication because my TSH was already at 1.81 so I figured I might be able to continue just with supplements. Shortly after I noticed that I was losing less and less hair. I’m still losing hair, but it’s SO much better. BUT…now I’m putting on weight again. And it’s coming on quickly. In about 3-4 weeks I’ve gained 4 kg, which is so frustrating to me. It seems like I continued have to figure something out. When I helped my body, my hair was suffering. Now I’m helping my hair, and my body is suffering. I am taking your thyroid adrenal reset complex and the thyroid hair regrowth (amongst other supplements) but it doesn’t seem to do the trick. I’m scared to go back on medication and lose more hair. My hair got so thin already. Do you have any advise for me? Are there any supplements that I can take, without having to take medication?
    Thanks in advance!

  33. I’m 64. In 1990’s was told I was Hypo and was put on medication because TSH was a bit high. I could not take the medication. Just being on anything for 2 days made me feel like going to the ER for heart attack, shaking, flushes. They tried different ones – all the same results. So I never took anymore. So not till 2020, My new Primary Doctor kept saying I needed to go on Medication – but I wouldn’t. So fast forward to March 2021, TSH was 11.39, FreeT4 .73 So was told “you must go on medication” Before trying Prescription Meds – I tried “Thyroid Edge” that didn’t work , started the heart palpations, shaking, feeling horrible. I bought “Selenium 200 mcg” and there again – could not take that – I felt so bad, heart beating out of my chest, – anxiety so bad. So I let Doctor give me .25 mg Levothyrine. I cut it in half and by the 2nd day, I felt I needed to go to ER. Chest hurting, restless legs, arms tingling – couldn’t sleep. It was bad & husband said I looked white as a sheet and I didn’t want to live/function. Just that LITTLE bit did that to me. I normally sleep really good 8 – 10 hrs a night. I have been having my Thyroid checked every 3 months since March 2021. TSH runs 4 – 6, lately Free T4 .76 each time. Free T3 3.3 Reverse T3 11.3 , Thyroid Peroxidase Antibodies runs 283 to 306, Thyroglobulin runs 55 to 66. Anti-Thyroglobulin was 55.7 in March now running <1.0 I'm at a lost of what to do. The Endocrinologist I see is no help. Just says – he doesn't' treat with medication till TSH is over 10. Mentioned this new drug "Tirosint" but I'm so scared of these drugs I am frightened to death cause they make me want to kill myself. I get so depressed, feeling like heart attack, weak, shaking. I was tested for Gluten and Celiac and both Neg. Foods have never bothered me. But I can't loose weight – hair is getting so thin on top. I normally feel pretty good and have energy. My anxiety is sky high 80% of the time and recently noticing very dry – parched tongue feeling. I have had dry eyes bad for years, but thought that was from Lasik eye surgery. I go from hot flashes, sweating to being cold. Hands get super cold sometimes . I have just always said it was "Old age" Joints ache. I started making bone broth and drinking that a few times a week and seems to have helped my aching joints. But if I can't take the medication and can't take supplements – how can ONE fix the problem before it gets to stage 5? Also – had ultra sound on Thyroid and they said that was normal. I"m reading everything and trying to cut back on Dairy – trying to avoid Gluten as much as possible. I cut out 80% of my sugar years ago. So been trying to eat Clean as possible, but it is impossible to do all the time. I know sugar is "Bad" I have High Blood pressure & I'm on BP Pill – but BP is getting high again lately, so the 50 mg – doesn't seem to be working anymore. So may have to increase that medicine. I feel Thyroid prob. has something to do with that causing such anxiety – making my heart beat hard all the time. I don't know. I'm at such a lost because I'm scared of supplements since they make me feel just as worse as Prescription meds. So I feel I just live life waiting for my heart to explode. It is hard to control stress with the world the way it is now, so I don't know if it is stress of what is going on around us or Hashimotos causing this anxiety! Thanks for your information you are putting out there and I wish I could take a pill and be fixed.

  34. Hi. I think I’m stage 3, have had Hashimoto’s for about 11 years… I don’t do a gluten free diet as doctors here don’t even recommend it, as they say if we are not intolerant to it no need to do it. In fact I don’t feel I am… However dairy, maybe…Started with a bit of asthma recently so I believe there’s a link to dairy. I avoid dairy in general, but at times I may have an icecream or smtg, but I definitely don’t drink milk. What else could I do to make things better? I do take supplements: selenium, vit D3, zinc, b12, etc.

  35. Hi Dr. Childs,
    From this article I think I am at stage 2.5 as I am fluctuating between hyper and hypo, thanks for this article, could you suggest relevant supplements I have cleaned up my diet, drown myself with purified water, eat organic, gluten free and use fish oil, liquid selenium, magnesium and ashwaganda, I am having hot/cold showers and doing yoga and have seen some improvement.

  36. Hello,

    I’m 99 % sure i’m in stage 5 and have been for awhile. I was diagnosed with Hashimoto’s Thyroiditis at the age of 19 and i’m now 52. My fathers sister had a thyroid condition but not sure if it was Hashimoto’s. I have had fluctuating TSH and antibodies over the years and both are now in the “normal” range but most likely because my thyroid is dead. I’ve been on levothyroxine since around 2000 but my memory sure isn’t what it used to be so i could have started it before that. I was put on 50mcg initially and remained at that dose for many many years. It’s only been since about 2014 that my dose was gradually increased to 175mcg and then just in the last year taken down to 150mcg. My PCP has tested my levels periodically since 2004 for sure. Unfortunately i do not have any of my medical records from when i was first diagnosed. Of the records i do have access to, my TSH was as high as 16 and is now 0.587. So that’s what i’m basing my stage 5 on, the fact that it has fluctuated so much and the length of time i’ve been on medication that i can remember. My Thyroid AB Group in 2000 were, Thyroglobulin Antibody 1.2 and Thyroid Peroxidase Antibody was 235.9 but are <1IUml now. My free T4 in 2000 was 0.72 and T3 was 2.5 and TSH was 5.73. In 2006 my TSH was 7.36 and T4 was 0.95. In 2007 my TSH was 7.34 and i found results from 1996 for TSH, it was 14.33! In 2014 it was 0.72, i never realized how drastic it actually fluctuated until just now as i'm looking back over my lab results! In June of 2015 my TSH was 2.02, in August, 4.08 and in October, 5.02. I'm sorry I've been reading my results while typing this post and i've started rambling lol I'm going to see an Endocrinologist on 11/19/21 and I'm going to be armed with my list of lab tests I've printed from your post and i'm going to write down a lot of the result's that i've shared here. I sure hope i can get some definitive answers for all of the symptoms i'm suffering with today! Thank you so much for sharing such empowering information!!

  37. This was a great blog post to come across. I am 31 and have had hypo since I was 21. It has never been managed well. I’d be good on my medication for about a year and then levels would creep up, I’d get tired and experience a host of other symptoms. This time around, I was prompted by my obgyn to actually get tested for the antibodies after having two miscarriages back to back. My fatigue and exhaustion have been absolutely debilitating and the hair loss has been unreal. I gained almost 50 pounds in the last 3 years. I just got my Hashimotos diagnosis within the last week and have been trying to do research on my next steps. Thank you for this and I’m glad I read the comments as I see many blog posts and resources to refer to.

  38. Is there any way to know for sure if you are at stage 5?
    I now know I have hashimoto’s and hypothyroidism and probably had it for no less than 10 years, probably 20. I had no idea, until I was just diagnosed and started really learning about it in the last two years.
    Since learning this, I’ve been following a pretty strict diet and taking Armour thyroid 120 mg per day. Now, I feel better at 56 than I have since my 30’s. I’m no longer puffy, my weight is down and I have more energy than I thought I would ever have. I actually feel really good these days! My antibodies also went down. I thought it was because I was following this new protocol but could it really be because I’m in the last stages since I’m pretty sure this has been going on so long? Is it possible that I had these symptoms for so long and can still “fix” it before it’s too late?
    My Thyroid Peroxidase Antibodies are 859 – (I have not had them tested again since May of this year)
    My Thyroglobulin Antibodies went from 24 in May to 20 in August.
    Are these numbers considered high? Is going from 24 to 20 a big difference?
    I was really hoping to follow this protocol and hopefully get off thyroid meds one day but now I’m not sure…..

    • Hi Tina,

      Yes, an ultrasound will usually indicate a small or atrophied thyroid gland in end-stage Hashimoto’s.

  39. Hello,
    Thank you for sharing all your knowledge here. It’s late and I don’t have my lab reports beside me, but Do know that I had my Thyroid was checked at Women and Brighams when I had a reoccurrence of Breast Cancer, in 2016. I’d had a DMX in 1998 so was shocked. My PET scan showed “ increased activity in thyroid “. It was never mentioned until I read the scans myself and asked what TPOs meant. At the time they were at 1300. They informed me at W& B that I tested positive for Celeriac dIsease 1 positive, 1 neg. I had stopped taking AI because of bone density loss, so my breast surge suggested endocrine doc. At that time I was then diagnosed with GUS. I did 33 rounds of radiation and continued on with my life. This winter I found another lump in right breast and am currently preparing for radiation again. Had thyroid checked again and TPOs @ 1500. I asked my oncologist if there could be connection since I’m ER+PRg+Her2-, but he said no. I researched it of course and the research shows there are correlations, and possible big dumps of ER into bloodstream due to thyroid malfunction. My TSH levels were normal so I guess I’m at 1. Any suggest how to stop antibodies. I’m on Keto and 113lbs down from 140, age 65.

  40. I wish that my doctors would have been more informative over the years. I have been on medication for 20 years and only diagnosed with Hashimoto’s when I developed what they called a goiter on my thyroid in the last 5 years. I will look for you on FB and YouTube to soak as much knowledge as I can. Thank you!

    • Hi Cynthia,

      I wish they were more informative as well. In the meantime, I will continue to try and provide information and answers to the best of my ability!

  41. I am both an RN and a person with many symptoms of thyroid disease and autoimmune disease and I have been confused through the years and have a question. Does the term or diagnosis Thyroiditis mean the same as Hashimoto’s Thyroiditis? Or are they separate diagnosis? if they are separate, could you explain the similarities and differences please?
    I started this journey pursuing a diagnosis a little over 20 years ago and without complete success finally had to lay it down and just treat the symptoms, rest, try to eat well, continue to raise my daughter the best I could and stay healthy enough to work. Following endometrial cancer surgery and chemotherapy and currently cancer free but with many new symptoms, extreme fatigue and bad habits developed just trying to get by and stay working in the past in the hopes there have been developments in this area and stumbling on your information I am trying to further diagnose and learn and make changes to improve. Thank you for your anticipated response ad your work!

    • Hi Tamara,

      Great question! They are often used interchangeably but they are not the same. Thyroiditis refers to any inflammation of the thyroid gland. Hashimoto’s thyroiditis is a cause of thyroiditis mediated through the immune system but it is not the only cause of thyroiditis. But Hashimoto’s is the most common cause of thyroiditis so you will see some people use thyroiditis in place of Hashimoto’s even though that isn’t correct.

      You can learn more about all of the causes of thyroiditis in this article: https://www.restartmed.com/thyroiditis/

  42. I have been in a state of chronic fatigue for at least 5 years. It gets more progressive with time. My body will not cooperate with what my brain tells it to. (Ex. Going to run the sweeper, I stare at the sweeper and think to myself..tomorrow. It may not happen for a week) I’m a very neat person, everything in its place. Struggling to do that. I’m currently on synthroid 59 mg. My past medical issues include a total hysterectomy at age 21, splendectomy at age 35, numerous minor surgeries. Had a bout with mono…4 times in a row. I’m very very depressed that I cannot function normally day routines. Not. Becuz of my age.

  43. Apparently, I am in stage 5. I had no idea there were stages. I wasn’t ever told of any other treatment than my daily medication. At this point, I feel hopeless. I have tried so many supplements, diets etc. over the years to help with my symptoms with no real relief.

    • Hi Natalie,

      That’s pretty standard, unfortunately. The good news is that there is always something you can do regardless of your stage. It’s never too late to benefit from simple things like supplements, eating healthy, regular exercise, getting enough sleep, and stress reduction. You don’t get as much bang for your buck in the later stages but you still get some benefits.

  44. Dear Dr. Childs,
    My family, I recognized some years ago, has a history of autoimmune disease. There was limited information here in Trinidad and Tobago and doctors are expensive. Anyway different family members have been to different doctors and told they had vitiligo or psoriasis or diabetes etc but these were of course not under an umbrella term of autoimmune disease or the term inflammation was not common.
    My mum who had psoriasis and perhaps psoriatic arthritis passed away in 2019 with idiopathic pulmonary fibrosis.
    I along with some of my siblings and our children, have psoriasis. I have had it for years though manifested as a small patch of plaque (but mild symptoms I think of eyes, mouth but not sure) I will be 54 this year, and since 40ish have had a little weight gain, hair loss and brain fog. I also have joint and muscle pains I thought were from issues with my spine. I eat relatively healthy and walk for exercise. I started reducing wheat and dairy. I keep wondering about HRT but hear of bad experiences and the doctors aren’t reassuring. This article was very helpful.

    • Hi Doreen,

      The HRT that you will find me recommending and the HRT that doctors will recommend are completely different. When I talk about HRT I am referring to bioidentical hormone replacement therapy and they are usually referring to synthetic estrogen/progesterone replacement. Pharmaceutical companies mask the difference between the two because they don’t make a lot of money off of the bioidentical versions and the synthetics come with a lot of issues. If you use bioidentical HRT, at the lowest effective doses, then your chances of negative side effects are incredibly small if not down to zero.

      You can read more about this idea in the articles below:


      • Hello Dr. Child’s
        I don’t know my stage it is so confusing because of how long I had symptoms. I am talking decades. I had miscarried a couple of times and then had a tubal pregnancy and then never got pregnant again. But I developed symptoms of my tongue swelling in my mouth, my eyes bulging and feelings of extreme anxiety. After that I got exhausted started gaining 2 to3 lbs. per week. I read a lot but doctors always said my levels were in the normal range. I found a Chiropractor what also does Functional medicine and he diagnosed me with Hashimoto’s. Is it possible that I have had this that long without major damage to my thyroid?

        • Hi P.,

          I suppose it’s always possible but I would say it’s highly unlikely given the physiology and progression of the disease. There are some more tame versions of Hashimoto’s, though, which is why there may be a possibility.

  45. I think I am a 2 not sure. I found out I had hashimoto’s 2 years ago. I have dry skin, hair loss and goiter . My levels are normal and the doctor said their more a little on high side. I have vitamin D and B-12 deficiency.

    • Hi Heather,

      If you aren’t on thyroid medication yet then you are definitely still in the early stages which is really the best time to get started with treatment. Don’t miss this opportunity!

  46. Hi!
    I am pretty sure I am a stage 3. When I was originally diagnosed two years ago, my functional doctor said it was “subclinical hypothyroidism”, but that I still needed medication at that time. Most recently my free t3 and free t4 were low, so we increased my medication (armour thyroid). It took about a year and a half to really get my numbers balanced. Took my TSH from 10 to 1, my TPO-ab from 200 to 75, and my Tg-ab from 45- 1. We have increased medication steadily throughout. I’ve been gluten-free and mostly paleo for a little over a year. I have reduced stress and actually also exercise. (I was a competitive weightlifter for about 5 years and did a lot of weight cuts while overtraining, so I think that’s the main reason I ended up with Hashimoto’s. It hugely affected the last couple years of my competing, but I had no idea that’s what was going on.)
    I am TTC right now and struggling with that a bit, not sure if it’s more hormone or thyroid related or both. Anyway, I would always take more advice on how to get my antibodies completely gone or balance my hormones, especially to be able to conceive?

  47. Hi Dr Childs,

    My name is Lidia and I am 57 years old.
    I just had an thyroid ultrasound and one lobe of my thyroid has shrunk to 1mm. My doctor was surprised as well. I have been battling with Hashimoto’s for over 25 years. Mean while I was diagnosed with NAFLD , Coeliac disease, restless leg syndrome and fibromyalgia and more.
    My GP says I am fine and I have never been sent to a specialist, because” I am fine”. My biggest struggle is focus and memory. I work as an integration aide with students from grade 3-6 and I need to be able to juggle maths, history, geography, maths at all levels. I must admit, I struggle. Is there anything that I can do to improve my focus and memorisation.

  48. Hi I’m Giovanna, I’m 35 . Was diagnosed with under active thyroid and hashimotos 7 yrs ago straight after having my first daughter. I went gf immediately but two weeks after having my 2daugyrr 4yrs ago my joints started to cause me sooo much pain . My finger in my right hand swelled up and has never gone bk to full motion after the swelling went down and now I feel it happening in other fingers and toes . Most nights my shoulders feel like I’ve torn my rotator cuff but I havnt . My dr wants me to go on cymbolta but I don’t want to as it’s an anti despressant. I REALLY want to fix this and feel 35 again and not 80 !! My blood work keeps coming bk fine . I was negative for MS and RA . Please help with any suggestions or knowledge you may have . Thank u

  49. Hi Dr. Child’s,
    I was diagnosed wish hashimotos in 2008 by my integrative doctor. I am 63. She caught it right when it started. I’ve been on lowest dose Levothyroxine ever since. I have no symptoms and never have had symptoms the only reason I know I have it is because it shows it in blood. My antibodies have never been above to 223 and now they are down to 87. I’m now going to try and start to get them down to zero because I have the time and I’m no longer distracted with three children. I have been mostly healthy and taking a lot of supplements that my integrative doctor gives me. I did stop taking the medicine for two months and still did not have any symptoms. I’m now back on it and will probably be on it for the rest of my life because that’s what my doctor told me I needed to do although After my most recent testing she is having me cut the levothyroxine pill in hall to .012. My question to you is why have I never had a symptom? Even when I was off the medication? I am very curious

    • Hi Jeannine,

      In the early stages, there isn’t enough damage to the thyroid gland to cause full-blown symptoms. The symptoms tend to increase and get worse over time as the damage to your thyroid gland accumulates. There are also some people who jus have less severe disease compared to others.

  50. Hi,

    My mom has been suffering medically for years and has gone through many, many diagnoses (severe asthma, COPD, possible rheumatoid arthritis, etc. etc.) She has recently been diagnosed with end-stage 5 Hashimoto hypothyroidism(her thyroid isnt working). They have taken a 2nd biopsy which shows mid-severe nodule suspicion. We are waiting for results from a special lab in California which will take another week to get. Everytime my mom gets laughing hard— she starts coughing. We were told it was her asthma/borderline COPD (even though shes not a smoker). She also got pneumonia 10 times in one year once. Now– realizing its probably been this all along. Do you have any advice for what her best course of action is? She just turned 60 in August. Thank you in advance. Also- I have her taking an immune vitamin daily (1MD Immunity)– should we discontinue that or keep it? Thank you so much for any help.

  51. I have suspected I have thyroid issues for at least 10-15 years. But my labs were always “normal” no matter what type of doctor I went to. Finally after having COVID this summer I went back due to extreme fatigue. Wanted to make sure I wasn’t still dealing with COVID issues. He tested a lot and my TSH came back at 5.9. He said oh that’s high let’s retest and get some other. TSH came back “normal” at 1.9 so he declined to do anything other than refer me to another endocrinologist. Because I have depression, endos don’t take me seriously. All my symptoms explained by depression.

    I found a functional doctor who redid my labs and explained them today. She said my thyroid function was fair but I should consider doing T4 replacement. Been reading a lot tonight and wound up on your site. A few things stuck out. I am positive for a prior EBV infection.

    Test results:
    TSH 2020-1.42
    July 2022-5.9 then 2 weeks later 1.9
    August 2022-1.16 (same lab as above)
    Free T3 not tested 2022
    July 2022 3.11
    August 2022 3.55

    FreeT4 2020 .9
    July 2022 .78
    August 2022 .69

    Antibodies Thyroglobulin less than 1 and Perooxidase less than .25

    I have pretty much all the classic signs of hypothyroidism. I had hemorrhoid surgery last fall for many to be removed. Some very large due to bad constipation. I have interstitial cystitis as well. My diet has sucked last few years from divorce and working 2-3 jobs. My vitamin D is 15 and my B is low as well. I am post menopausal but undetectable estrogen and progesterone. My DHEA is low and so is my pregnenelone. I’m also close to pre diabetic.

    So I’m guessing I’m stage 3 or 4 Hashimotos. I can’t afford to keep going to that functional doctor and she referred me to another one who accepts insurance. She is recommending supplements for now but says I should consider replacing my T4 and hormone replacement treatment with new doctor.

    Per your chart above my TSH is higher than optimal a little but my T3 and T4 are low. But with no antibodies detected am I Hashimotos?

  52. I have a TP0 of 285, TSH of 24.3, T4 is .71 and T3 is 2.8. I’m miserable and have been to 2 doctors who said it was anxiety and gave me Zoloft. I finally found a doc to do blood work and this is what they found. I don’t have my follow up for a couple of weeks. My question is twice in 2 years I had 3 week episodes where I could feel a “rush” of something. I would sweat, be terrified, jumping out of my own skin, lost 12 pounds in 2 or 3 weeks, (I normally weigh 135). My urine would have a crazy sweet/cleaning supplies smell and when I felt a rush coming I would have to stop and grip something as it brings you to your knees and my muscles would start to tingle. This would happen as soon as I wake and end around 4pm like clockwork. I’m so sick of docs saying anxiety. I’m praying the blood results will open their eyes. Now I’m the opposite and have gained 22 pounds.

  53. Dr. Childs,
    I am all over the place in your stages, I was born at stage 0. I hit stage 1 back when I was 12, positive for antibodies with normal thyroid function. At that stage, it would have been my 2nd autoimmune disease, hence the testing.
    When I was 44, my breast surgeon asked how treating my Hashimoto’s was going? She asked because she noticed my thyroid was inflamed, not something she had noticed 6 months earlier. At that stage it would have been autoimmune disease # 6+. But late stage 2, maybe early 3 and 4 at the same time?
    After asking my PCP to check my numbers, we started treating. Considering the 3 other relatives I have treating their Hashi’s, I did think it was inevitable.
    9 years later, after doing fine treating with plain L4 at slowly increasing doses, ending at 88mcgs, I was now hyper! (I was also taking Biotin, upon my PCP’s recommendation, live and learn)
    I was immediately sent for an ultrasound, thinking nodes were to blame. Findings were- normal sized, heterogeneous hypervascular gland, without focal suspicious mass. Not stage 5, as one might expect. Maybe 2.5?
    I have since slowly dropped my levo doses and suspended my biotin before testing, until a month ago when levo was completely suspended. My FT3 & FT4 were ideal 3 weeks later. My TSH was still .01, very low, but considering my recently suspended levo, not unexpected.
    Over the last year, I only added biotin and folic acid, finally getting my red cell count into a “normal” range. I lost my Dad and a close friend within two days of one an other, both unexpectedly. I also changed my psoriatic arthritis meds, from a JAK inhibitor, back to an anti-TNF, which is not working well.
    My diet modifications came 7 years back, to lessen symptom of 2 other autoimmune diseases. That was roughly the same time I made meditation, yoga and exercise part of my daily routine.
    It’s also worth mentioning, while my TPO and Tg have always been positive, my numbers, 30’s-50’s, are laughable when compared to many others here. My symptoms are consistent with being hypo, save for a brief bout of muscle weakness, and heart rate fluctuations, that I blamed on my 2nd case of Covid, last May.
    I do have a follow up in a few weeks to check and see if my TSH has “normalized”. I will be perfectly happy if everything stayed like this, but…
    My questions are-
    Have you ever come across a bout of Hashitoxicosis that has come this long after a DX of Hashimoto’s?
    Would you, like I am, be expecting a “crash” of FT3 and FT4 values in a few weeks or months?
    Would you ask to see a TRAb, just to rule out this is co Hashi’s and Graves case?

    • Turns out I am also positive for TRAb. So, it is a case of Hashimoto’s and Graves together. I guess I am just an overachiever when it comes to autoimmune diseases.

  54. I have a strong family history that no one told me until after I was diagnosed! I think giving birth to my second daughter in 2001 set things in motion. I was written off as a stressed and depressed mother of a colicky baby (which was true!). Later, I went through about 8 years of highly stressful jobs that caused burn out and adrenal fatigue. Ironically, I was at my worst working for a functional doctor. I went through phase 2.5 then and lost like 30 lbs in two months, hair came out in clumps and heart palps, etc. I was finally diagnosed a year later after I failed an iron test to donate blood. My doctor said I had Hashi as well as bottomed out levels of iron, vitamin B, D and Magnesium. I have been through many doctors including an Endocrinologist who said dietary changes were not necessary. I kept pursuing education with providers like Dr. Childer’s, Izabella Wentz, etc. I did the protocol diet and found my sensitivities and changed my diet. I have added supplements, many liquid for better absorbency. I also take Synthroid and Cytomel. I left the medical field and found a job that I love with less stress. I think I am in stage 3 at this point. I still have severe cold intolerance, insomnia and despite working with PT and working out 4-5 days a week, my scale will not budge! I am not giving up though. I know it will take longer than a year to fully recover what my body has been through. I am working on an adrenal diet plan and taking yoga with the hopes that my body will realize it is finally in a safe zone to heal. I refuse to give up learning and healing.

  55. Hi there, I am on stage 3 and my doctor has me on something called low does naltrexone 4.5mg. Is this the correct treatment? I have told my doctor in the past that I prefer to do things more naturally, I have switched to GF and am trying to do dairy free as well.

  56. Thank you so much for this article Dr Childs. I have recently had a blood test indicate high levels of TSH (24.9 compared to the range of 0-4), but a T4 level of 11.0 (lower border). The doctor has ordered a repeat blood test for a month later and I am waiting for that. In the meantime, I have been experiencing all kinds of odd symptoms (even more so than the symptoms I have had for years). I would like to ask you – how quickly might fluctuations in stage 2.5 happen? Is it possible that over the course of two weeks a hypothyroid state become hyperthyroid? Or is it all in my head?
    Thank you for your time,

    • Hi Hannan,

      Yes, it’s possible it could occur within that timeframe. You don’t have to guess, though, as you can always confirm your suspicion with thyroid lab tests. They will tell you if you are truly hyperthyroid.

  57. Hi Dr. Childs. Your video was probably the best video and article I have seen/read in providing a greater understanding of Hashimoto’s. I am at a level 2. Only because of being insistent with my doctor after receiving a marker for thyrogloblin antibodies (that should be at 40) was at 321 that I have an ultrasound because I have a family history of thyroid cancer. Results came back at Tirad 4 (suspicious) and biopsy confirmed not cancer but rather Hashimotos. If I did not do this US I may not have known my destiny and caught this at a level 2. However, was further advised that because I have Hashimotos my thyroid will continually be destroyed (if I do nothing) and will need to do a yearly US to see whether I go from Tirad 4 to 5 (cancer). My question is whether it just makes more sense to remove the thyroid and any chance of getting cancer or continue the natural treatments…gluten free diet exercise etc and still hope I never develop thyroid cancer?

    • Hi Mary,

      Outside of situations where it’s absolutely required like for the treatment of thyroid cancer, it’s never a good idea to preemptively remove the thyroid gland. Those who have theirs removed for dubious reasons always regret it and it’s never as easy as you might think to replace native thyroid gland hormone production with thyroid medication. Medication replacement is always inferior to the real deal.

  58. I believe I am in end-stage. I finally have an appointment with an endocrinologist, but it is more than three months away. I was diagnosed with low-thyroid 25 years ago and have been on synthroid/levothyroxin ever since. I wish I had known more about treating this back then. I am exhausted all the time and get easily discouraged over all of this.

    • Hi Tammy,

      Even if you are in end-stage Hashimoto’s there are still things that you can do to help improve your situation. It’s always ideal to find and treat Hashimoto’s sooner rather than later but even finding it later doesn’t mean you can’t do anything about it.

  59. Hi Dr. Childs,

    The video was very helpful thank you! I am 26 and was just diagnosed with hypothyroid in August with my TSH suddenly spiking from 3-something to 13.2 within a year and less than 2 weeks later went up to 17.8. I was put on 50mcg of levothyroxine immediately. My TPO was at 40 when I got my levels taken in August but my doctor is hesitant to diagnose me with Hashimotos since my T3 and T4 are normal. Waiting until next month to get my blood work done again to adjust my medication and see where my TPO and TSH are at. I have a feeling that’s probably what is going on though since autoimmune diseases run in my family.
    Basically I just wanted to know what stage you think I would be in and what your take is on my TSH spiking so much so quickly. I haven’t heard of anyone having TSH as high as mine with normal T3 and T4 and a TPO barely higher than the normal range.

    Thank you so much!

  60. Hi, I am wondering if there is any connection between Hashimoto’s and thyroid cancer. The Hashimoto’s was discovered through biopsy after thyroidectomy. Also, what measures could/should I take to lessen the chances of other autoimmune diseases?

  61. I believe I’m at stage 3. TSH of 4.95 and lowish T3. I’m not able to take T3/T4 meds since they raise my blood pressure. So I tried your Glandular Plus (since they’re free of hormones) for nearly two months, but haven’t seen any improvement. So instead of reordering them, I ordered Thyroid Daily Essentials. Hoping that helps. Otherwise I’m at a loss for how to stop my thyroid’s downward spiral.

    • Hi Regina,

      If you are planning to go the route without thyroid hormones then you will need to plan on using supplements for much longer than 2 months. You’ll want to be very aggressive with all forms of natural treatments available to you (diet, lifestyle, exercise, stress reduction, sleep, supplements, etc.) for at least 6-12 months before determining if they are working or not.

      Natural therapies are still effective, they are just slower to take effect and require more time and effort than thyroid medication so just make sure to plan accordingly.

      In addition to Thyroid Daily Essentials, I would also recommend looking at the supplements found in this bundle: https://www.restartmed.com/product/hypothyroid-bundle/

  62. Hello, I am new to this and am trying to learn. My doctor called me over the holidays to tell me that my TSH was high, but normal. She suspected an early stage of Hashimoto and told me to come back in 3 months. I asked for the results today, as she didn’t mention then on the phone. TSH 6,9. TPO antibodies 431. Free T4 14,4. Free T3 4,5.
    From your text, I’m thinking that I’m in stage 2? The problem is that she will not give me medication yet, but my TSH is definitely over the “normal” levels? I tried to tell her that I have had many of the symptoms for over a year now, but she replied that those are normal symptoms that many people have. Should I ask for an appointment sooner and ask for a second opinion if she’s unwilling to let me try medication? I am also trying out medication for menopause (40yrs), how does that affect thyroid? Sorry for all the questions!

    • Hi Janne,

      Medication may not be necessary so lifestyle changes would be your best option right now. If you do nothing then there’s a very high chance you will ultimately have to take thyroid medication out of necessity. If you aggressively change your lifestyle right now then there’s a chance you could prevent that from happening.

  63. Alread in latter stage and can’t find a knowledge Dr. to help. I tried your multivitamin, but I didn’t see/feel much of a difference.

    • Hi Ellen,

      While Thyroid Daily Essentials is certainly a great place to start, I would recommend using the entire Hashimoto’s bundle which is more focused to the needs of those with Hashimoto’s: https://www.restartmed.com/product/hashimotos-bundle/

      In later stages, this should be combined with aggressive lifestyle changes like completely changing your diet, regular exercise, and so on.


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