- Hashimoto's progresses through six distinct stages over 20 to 30 years, from genetic predisposition (Stage 0) all the way to complete thyroid gland destruction (Stage 5).
- Most patients are not diagnosed until Stage 3 or 4, by which time significant thyroid damage has already occurred. Early detection at Stage 1 or 2 offers the best chance of slowing progression.
- In the early stages, diet changes, targeted supplements, stress management, and gut healing can meaningfully slow or halt disease progression without needing medication.
- By Stage 4 and 5, the thyroid gland is severely damaged or destroyed, requiring aggressive thyroid hormone replacement with T4 and T3 medication.
- Knowing which stage you are in helps you and your doctor choose the right level of intervention, from lifestyle changes alone in early stages to full medication management in later stages.
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:
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 on to 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 with 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 in which 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 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 FODMAP 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 that 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[10].
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 that 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 with end-stage Hashimoto’s are REQUIRED to be on thyroid hormone for the rest of their lives 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!
Scientific References
1. Kaur, J., & Jialal, I. (2025). Hashimoto Thyroiditis. StatPearls.
2. Jabrocka-Hybel, A., et al. (2018). How much of the predisposition to Hashimoto’s thyroiditis can be explained based on previously reported associations?. Journal of Endocrinological Investigation. doi:10.1007/s40618-018-0910-4.
3. Zaletel, K., et al. (2011). Hashimoto’s Thyroiditis: From Genes to the Disease. Current Genomics. doi:10.2174/138920211798120763.
4. Dittfeld, A., et al. (2016). A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Central European Journal of Immunology. doi:10.5114/ceji.2016.63130.
5. Markomanolaki, Z. S., et al. (2019). Stress Management in Women with Hashimoto’s thyroiditis: A Randomized Controlled Trial. Journal of Molecular Biochemistry.
6. Kaličanin, D., et al. (2020). Differences in food consumption between patients with Hashimoto’s thyroiditis and healthy individuals. Scientific Reports. doi:10.1038/s41598-020-67719-7.
7. Ch’ng, C. L., et al. (2007). Celiac Disease and Autoimmune Thyroid Disease. Clinical Medicine & Research. doi:10.3121/cmr.2007.738.
8. Cárdenas Roldán, J., et al. (2012). Autoimmune Thyroid Disease in Rheumatoid Arthritis: A Global Perspective. Arthritis. doi:10.1155/2012/864907.
9. Li, D., et al. (2019). Vitiligo and Hashimoto’s thyroiditis: Autoimmune diseases linked by clinical presentation, biochemical commonality, and autoimmune/oxidative stress-mediated toxicity pathogenesis. Medical Hypotheses.
10. Baldini, C., et al. (2018). The Association of Sjögren Syndrome and Autoimmune Thyroid Disorders. Frontiers in Endocrinology. doi:10.3389/fendo.2018.00121.
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.
Sarah
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?
Hi Tamara,
Unfortunately, I’m not able to provide medical diagnoses over the internet but you can take a look at this article for more information: https://www.restartmed.com/diagnose-hashimotos-thyroiditis/
I apologize. I didn’t mean to come across as trying to get a diagnosis on the internet. What I meant was is it possible to have Hashimotos without having hardly any antibodies…a value under 1? I read somewhere on your website that the optimal value is 0 but then also read on the link you provided that if antibodies were “elevated” along with symptoms and abnormal tests…what level of antibodies do you consider elevated? When you talk about abnormal lab results do you mean those outside the “normal” range or those outside the “optimal” range?
Hi Tamara,
Yes, it is possible and it’s known as seronegative Hashimoto’s. You can learn more about that condition here: https://www.restartmed.com/hashimotos-with-negative-antibodies-seronegative-hashimotos/
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.
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.
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.
Hi Amy,
It definitely sounds like you are on the right track!
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.
Hi Ashley,
LDN can certainly help some people with Hashimoto’s. Giving it a try is usually worth it but there are plenty of other options available as well. You can learn more about how LDN works and how to use it correctly here: https://www.restartmed.com/how-to-use-ldn-for-hashimotos/
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,
Hannah
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.
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.
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.
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!
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?
Hi Carrie,
Yes, there is. Those with Hashimoto’s are at increased risk to develop thyroid cancer through high VEGF levels and from inflammation.
This is discussed in some detail here: https://www.restartmed.com/black-seed-oil-hashimotos/
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/
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.
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.
Hi,
I believe I am in stage 5 . I was diagnosed as hypo thyroid 29 years ago. I have been developing rashes on my back, chest, shoulders, and stomach pretty regularly now for many years. I’m in immunotherapy for allergies, but it doesn’t help this. I thought maybe I was allergic to something else, but after listening to your video, I Believe it may be due to my thyroid problem. I didn’t know that all these years I should be avoiding gluten and certain foods. Now it makes sense. My sister had been diagnosed with Sjøgrens disease this year. I’m wondering if that runs in my family also a my mom and sister both were also diagnosed with hypothyroidism years ago. Do you think I should get tested for Hashimotos ? I am already taking levothyroxine?
Thank you!
Heidi
Hi Heidi,
It’s certainly worth getting your antibodies checked the next time you get your thyroid labs drawn but you might be close to end-stage Hashimoto’s given the timeline so the antibodies might be negative.
I was just diagnosed this morning so I’m obviously scouring the net looking for more info. Glad I stumbled on this site! I have no idea what stage I’m in- maybe 3 or 4? I developed what I thought was an Adam’s apple a few months ago (and I’m a woman so that was weird lol) and had a normal physical the other day already scheduled so I asked about it. My doctor ran some blood tests and my TSH was 11.8 and FreeT4 was a .80. My doctor told me to start taking the meds right away. I’m kind of confused if I actually have it full-blown since TSH level is high but T4 level is ‘normal’? I’m still not really understanding how bad it is but whatever it is I’m glad it was diagnosed. I’ve been EXTREMELY fatigued lately and just chalked it up to working full-time and talking care of my 1 year old baby. And I finally know what the weird mass in my neck is! It’s interesting the things you outlined that are common ‘triggers’ for someone already predisposed genetically- I contracted EBV when I was 18 and wondering if that could have set it off. I also have been experiencing on and off severe eye pain like a burning behind my eyes for about 10 years. I went to multiple doctors and specialists, had a TON of bloodwork done, had my eyes tested to see if I needed glasses and no one could figure it out. I ended up seeing a highly-regarded neuro-ophthalmologist who ran a bunch of tests and came to the conclusion it was a nerve problem and put me on Gabapentin. Still didn’t quite figure it out exactly but at least I got some relief. Now I’m wondering if the two are related? I doubt it but I’m somewhat hopeful maybe after being on the thyroid meds my eye pain will vanish. What kills me about all this is that I’m overall pretty damn healthy. I eat pretty healthy, I’m not overweight, I rock climb a few days a week and I regularly climb 14,000 ft. mountains. Guess it just goes to show you how strong genetics are!
Hi. Thank you for the time it took to write this article. I am 60 years old now and I was diagnosed with hypothyroid when I was in sixth grade. I was told there was nothing I could do and I just needed to take thyroid medicine. I never knew about changing my diet or looking for “triggers “ I knew was it was important to take my medicine. I have been suffering with constant weight gain no matter what I cut out of my diet. Constant fatigue, hair loss. Constipation. And brain fog all my life. I wish I would’ve known this information when I was younger because I just had an ultrasound today and the ultrasound technician was leaning into the screen, trying to find my thyroid because it has shrunk to the point of not even being visible. I don’t know what’s next and I am scared. I have been trying my whole life to get better and I never knew, until these last few years, there was anything that I could even do.
Hi Tamie,
Those symptoms seem consistent with hypothyroidism, but you’d still want to rule out other coexisting medical conditions that can mimic hypothyroid symptoms. You can find some of those here: https://www.restartmed.com/medical-conditions-that-mimic-hypothyroidism/
Hi Dr. Childs, I have Hashimoto, diagnosed last year. It’s subclinical cause only my TPO is very high (>900). For the past 4 years my TSH, FT3, and FT4 fluctuated but never out of normal ranges. And the last 3 months, my TSH was around 1, but FT3 decreased at the lower normal, and FT4 increased to the upper normal. My cortisol drops as well (still in the lower normal, definetely not optimal). What’s actually going on? I feel unwell for a long time (fatigue, low energy, low heart rate, stress and anxiety, brain fog, dizziness, feeling like I’m on a boat swaying, balance issue, hair loss, gut issues (GERD), trouble with swallowing and breathing, etc..). I can’t function properly, and I feel like I’m getting worse.
Hi Krissie,
You have a pretty classic presentation for Hashimoto’s thyroiditis and your symptoms likely reflect that. You’ll get the most results with some basic natural therapies like changing your diet, taking some supplements, reducing your stress, etc. Once you do those things, you can then determine if thyroid medication is necessary.
My website has resources to help with each: https://www.restartmed.com/supplements-proven-to-lower-thyroid-antibodies/
Hi Dr. Childs…I was diagnosed in 2015 with Hashimotos and have been on different medications. It’s been 9 years and I’m currently on Euthyrox 100 with a fluctuating TSH, sometimes it’s elevated and sometimes it drops to 0.25. I still have elevated antibodies but it’s not as bad as it was when I first got diagnosed. I believe I’m in Stage 3 of Hashimotos after 9 years. However, my questions at this point are: 1) what can be done to reverse it? 2) is black seed oil helpful at this stage to reduce antibodies and reduce the risk of thyroid cancer? 3) Do you have any recommendations for weight loss? 4) Are there any new and updated medications or natural remedies for hypothyroid/Hashimotos patients? Thank you and I look forward to your response.
My name is Dawn I am 49 and all the symptoms and stages you described I e been thru and had including cancer nodule on the left. Removed left side now I’ve been saying there’s more to this I’m literally exhausted all the time I have fibromyalgia as well and most of my aging I’ve spent trying to get Dr’s to listen finally at this age I do my dodiligence and I bring my results and compare to what I believe. I’ve battled my weight most of my life had a hysterectomy in 05,but had to go back on the hormone because I couldn’t take. Being off. After being a 4x stroke survivor for sure got off the hormone and some of the strokes were do to a chiropractor I was seeing when he did my neck I’d get super back head rush,pain and I’d black out within an hour I was full blown stroke. I am the proverbial one in a million….at the age of 8 because of strep throat I developed Sydenham Korea have a still in action mito valve prolapse and a heart murmur the oddity was I was unable to write or walk normal but I could do cart wheels at NIH. Recently discovered I have an extra vertabrae. I’m not sure where to turn now with all my discoveries because for years I was Labled as a drug seeker which is why most of my conditions were missed and diagnosed late any leads to my direction are appreciated.
Why don’t doctors treat the whole body and not just symptoms? And why don’t they stress the importance of food as medicine, or the dangers of chemicals in beauty products that seep through your skin and wreak havoc? They never let ladies know that we are not supposed to be on Levothyroxine forever. We are also supposed to be treated as individuals since each person responds differently to different levels of medications. It’s not “one-size fits all”. I was given a radioactive iodine pill when I didn’t have cancer. Had this not happened I would have been able to balance my immune system because it is an imbalance of that system. I was also prescribed Prozac for my crying bouts in the beginning before my Hashimoto’s diagnosis. Not one doctor was ever interested in getting to the root cause of my symptoms. This desease is very very complex and needs to be researched much much more. It can affect every part of the body. And antiquated charts need to change so that blood tests can be properly interpreted and correct dosing can be prescribed. Sometimes a “normal” result is not necessarily normal. A Functional Medicine doctor is probably the best person to treat this mostly female condition. Medical schools do not teach conventional doctors enough to understand all the symptoms that come with Hashimoto’s and how to treat the body as a whole. Be vigiland and be informed.
I think I am in stage 0. I feel fine except that I don’t sleep well since menopause. I took blood tests on functionalhealth.com just out of curiosity , everything was good heart,kidney, liver, and thyroid biomarkers except Thyroglobulin Antibodies (TgAb) were 9 IU/mL. I got that retested along with celiac disease. TgAb went down to 6 and no celiac disease. My primary care doc admitted that she did not know much about it and just said wait and see. I did not like that answer and google led me here. After reading this I am going to try to be gluten free, and take supplements for black cumin seed oil and get retested. I am octo-lacto vegetarian since 30 years , I would find it hard to quit dairy and soy in addition to gluten. Maybe I should start eating chicken again. Any advice is welcome. One more thing I would like to get eyelid surgery but plastic surgeon said hyperthyroidism could complicate this. Again I don’t have any symptoms yet that I know of , but should I avoid upper and/or lower eyelid surgery ?
I have been hypothyroid for about 27 years now. I never feel good & I go to my doctor every 3 months for blood work & checkup. I am also diabetic 2. Just about every blood test shows either I am high or low. It is never consistence. One time it will be low then the next time it will show high. So each time the doctor either ups my medicine or decreases it. I Never feel good. I sleep a lot because I always feel exhausted. I am overweight by about 50lbs. Is there anything that could help me? I appreciate any help you can give me. Thank you. Denise
Hi Denise,
There are many things you can to do help improve your symptoms. I would start here:
https://www.restartmed.com/product/hashimotos-bundle/
https://www.restartmed.com/the-4x-100-formula-for-thyroid-weight-loss/
https://www.restartmed.com/7-day-hashimotos-diet-plan/