Hashimoto's disease, also known as Hashimoto's thyroiditis, is an autoimmune condition that attacks the thyroid gland, often resulting in an underactive thyroid (hypothyroidism).
Treatment for this condition depends on whether it is causing subclinical (without symptoms) or overt (causing symptoms) hypothyroidism.
Some people with Hashimoto's have normal thyroid-stimulating hormones (TSH). The treatment for Hashimoto's with normal TSH usually does not involve medication. Instead, there are lifestyle changes a person can make, like getting optimum nutrition, that can help them manage the disease.
The standard treatment for Hashimoto's with abnormal TSH is synthetic levothyroxine. There are also lifestyle changes, supplements, and complementary alternative medicine options for Hashimoto's.
Hashimoto's disease can cause overt or subclinical hypothyroidism. In general, the distinction is made based on whether there are symptoms, the level of thyroid hormone, and thyroid-stimulating hormone (TSH) levels.
Typically, when the thyroid gland is not making enough thyroid hormones, the thyroid hormone levels are low and the TSH is elevated.
Overt hypothyroidism is diagnosed when the TSH level is elevated (generally above 4.5 mIU/L) and the free thyroxine (T4) level is low (under 0.8 ng/dL).
Overt hypothyroidism is typically accompanied by symptoms such as sensitivity to cold, weight gain, enlarged thyroid, and dry skin.
- When TSH levels are above 10 mIU/L, treatment with thyroid hormone replacement is required.
- If TSH is between 4.5 and 10, thyroid hormone replacement might be recommended, but not always.
Symptoms of Hypothyroidism
Subclinical hypothyroidism can cause mild symptoms, but many people have no symptoms at all. It's diagnosed when the TSH level is above normal, but the free T4 level is normal.
Treatment for subclinical hypothyroidism is complex because TSH level doesn't always correlate well with symptoms or prognosis.
Understanding TSH Levels
Hashimoto's Disease Without Hypothyroidism
Hashimoto's disease doesn't always cause hypothyroidism. The majority of people with this condition have thyroid peroxidase (TPO) antibodies present in their blood.
The presence of these antibodies indicates that you may have Hashimoto's disease, but it doesn't necessarily indicate that you have hypothyroidism. You may have TPO antibodies present with normal TSH and free T4 levels, which suggests that your thyroid is functioning as it should.
If thyroid tests are normal, treatment with thyroid hormone is unnecessary, but there are things that may potentially improve the underlying thyroid autoimmune condition.
- Avoiding nicotine, including second-hand exposure
- Consuming 100-200 mcg of selenium per day
- Boosting omega-3 fatty acids intake
- Keeping vitamin D level in the normal range
How Hashimoto's Disease Is Diagnosed
The standard treatment for hypothyroidism is synthetic thyroxine (T4), and there are also other options for specific situations.
Synthetic thyroxine (T4), generically known as levothyroxine with brand names Synthroid, Tirosint, Levothroid, Levo-T, Levoxyl, and Unithroid, is typically the only treatment that's needed for hypothyroidism.
This medication is generally taken once a day, every day. It replaces thyroid hormones and reduces symptoms of hypothyroidism. It may take some trial and error to find the right dose, and the medication has to be continued throughout a person's life.
Brand Name vs. Generic Levothyroxine
Treatment recommendations vary for subclinical hypothyroidism, depending on TSH level, age, and other factors. In subclinical hypothyroidism, the free T4 level is normal.
TSH of 10.0 mIU/L or Greater
If TSH levels are 10.0 mIU/L or above, treatment with levothyroxine is recommended by most experts, including the American Thyroid Association (ATA).
- Studies have found that around 33 to 55% of people with subclinical hypothyroidism go on to develop overt hypothyroidism. The chances of overt hypothyroidism increase with a TSH level higher than 12.0 to 15.0 mIU/L and the presence of TPO antibodies.
- Subclinical hypothyroidism may be associated with a higher risk of heart diseases, such as atherosclerosis (a condition in which plaque builds up in the arteries), heart attack, heart failure, coronary artery disease, and stroke. This risk is higher with a TSH level above 10.0 mIU/L.
Taking levothyroxine may slow down or halt progression into overt hypothyroidism, and decrease the risk of heart disease.
Research has found that treating subclinical hypothyroidism in patients whose TSH is under 10.0 mIU/L doesn't improve hypothyroid symptoms. However, for people under 65 years old, treatment may reduce the risk of heart disease.
Reading Your Thyroid Blood Test Results
TSH of 7.0 to 9.9 mIU/L
Treatment with levothyroxine may be appropriate for people under the age of 65 with a TSH level in this range because of the potential link between subclinical hypothyroidism and heart disease.
For patients who are 65 and older, levothyroxine is usually only prescribed when they also have hypothyroid symptoms.
TSH of 4.5 to 6.9 mIU/L
The upper limit of the normal range of TSH is 4.5 mIU/L. In people under the age of 65 whose TSH falls in this range, treatment with levothyroxine may be helpful if they have symptoms of hypothyroidism, an enlarged thyroid (goiter), and/or high levels of TPO antibodies.
Treatment usually isn't necessary for those who are 65 years or older. And TSH levels tend to increase with age even for people who have normal thyroid function.
For people with subclinical hypothyroidism whose TSH falls in the 4.5 to 9.9 mIU/L range but who don't need levothyroxine, the ATA recommends close monitoring to check TSH and free T4 levels yearly.
For women with subclinical hypothyroidism who are having problems with infertility and/or are trying to get pregnant, the ATA recommends treatment with levothyroxine if the TSH is above 2.5.
How Thyroid Challenges Can Affect Pregnancy
Most people respond well to levothyroxine, so the ATA doesn't advise routinely adding triiodothyronine (T3), called Cytomel (liothyronine), to the daily dose of T4. However, adding T3 can be helpful for people who still have hypothyroid symptoms while taking T4.
This can include:
- Those who've had part or all of their thyroid removed, known as a thyroidectomy
- People who've had their thyroid treated with radioactive iodine therapy
- Those whose T3 level is at or below the normal range
Desiccated Thyroid Extract
Made from pig thyroid, desiccated thyroid extract is a natural combination of T4 and T3, rather than synthetic like the other options. It goes by the brand names Armour Thyroid, Nature-Throid, NP Thyroid, and WP Thyroid, and it's available only by prescription. The ratio of T4 to T3 is 4:1.
Desiccated thyroid is an old treatment that was used for decades before levothyroxine became available. It isn't recommended by the ATA, but it's considered an alternative for people who aren't responding well to levothyroxine alone or to a combination of synthetic T4 and T3.
Cytomel (Liothyronine) – Oral
The Need for Close Monitoring
A major part of Hashimoto's treatment plan is regular follow-ups to ensure that symptoms are well controlled and testing of TSH and free T4 to make sure that the medication is at the right dose.
Making sure you're getting adequate nutrient levels can help in managing your hypothyroid symptoms.
If you are taking supplements for you, it can affect your required doses of thyroid hormone replacement.
Be wary of supplements that claim to support thyroid function such as kelp, bovine thyroid extracts, and herbal preparations, as these can interact with your medication.
Though selenium deficiency is rare in the United States due to our selenium-rich soil, it's a possibility, especially if you have digestive issues, human immunodeficiency virus (HIV), are undergoing kidney dialysis, or have had gastric bypass surgery.
Selenium deficiency can make some autoimmune thyroid diseases worse, so your healthcare provider may check your level if you are at risk.
What is Selenium and How Does It Work?
There's no official recommendation for selenium supplementation with autoimmune thyroid disease, but research has shown that it lowers TPO antibody levels.
Selenium supplements may be helpful when your selenium level is low. An excess could lead to toxicity.
Selenium toxicity has a whole host of unpleasant symptoms ranging from garlicky-smelling breath to hair and nail loss and skin lesions, which is why your healthcare provider would check your selenium level before recommending supplements.
Selenium and Your Thyroid
The majority of people living in the United States don't have an iodine deficiency. However, some may have low iodine levels due to dietary restrictions or medication use.
If your healthcare provider thinks you may be iodine-deficient, you'll likely have a urine test to check it out. Since this deficiency causes thyroid dysfunction, your healthcare provider may start you on iodine supplements for a short period of time if you're found to have an iodine deficiency.
Make sure you talk to your healthcare provider before you take iodine supplements. Too much iodine in a short amount of time when you're hypothyroid can actually lead to an overactive thyroid (hyperthyroidism) and/or make your condition worse, so it's important that you only take these with your healthcare provider's approval.
Scientific studies have found that lower iron levels are linked to an increased prevalence of subclinical hypothyroidism and lower levels of T4 and T3.
Hashimoto's disease is associated with a higher risk of developing other autoimmune conditions, including celiac disease and autoimmune gastritis, which can impair iron absorption.
Low iron levelsare associated with persistent symptoms in people who are being treated for hypothyroidism, and several studies have shown that adding iron supplementation to levothyroxine treatment can more effectively help relieve symptoms. Iron supplements should be taken at least 4 hours away from thyroid medication to avoid interactions. Talk to your healthcare provider about testing your iron level if it hasn't been checked already.
Iron and Your Thyroid
Research has shown that vitamin D deficiency is more common in people who have autoimmune thyroid disease—Hashimoto's disease or Graves' disease—and may even contribute to the development of these diseases. Studies have also found that vitamin D supplements may significantly reduce TPO antibodies and thyroglobulin (Tg) antibodies.
The research regarding vitamin D's effect on the thyroid isn't definitive, and an excess can lead to toxicity.
Vitamin D and Your Thyroid
There may be a link between vitamin B12 deficiency and autoimmune thyroid disease.
A note about taking multivitamins or B-complex supplements: Taking biotin supplements within three days before your thyroid tests test can interfere with the results.
Probiotics are found in food and supplements and contain a good type of bacteria or yeast that may help balance the digestive system and boost the immune system. Hypothyroidism slows down the digestive system, which can lead to constipation, diarrhea, gas, and bloating. Probiotics may help reduce these symptoms.
Probiotics don't affect thyroid hormone levels. Talk to your healthcare provider before you start using them to be on the safe side.
What Are Probiotics?
Complementary Alternative Medicine
Complementary alternative medicine (CAM) should never be used as the only means to treat an underactive thyroid, but it can be used in conjunction with your medication to help relieve symptoms.
Considered to be a safe procedure as long as you go to a trained professional, acupuncture may help with some symptoms of thyroid disease, like constipation, insomnia, and depression.
However, acupuncture is not associated with restoring thyroid levels to normal when you have hypothyroidism or hyperthyroidism.
A small 2016 study looked at 22 women taking levothyroxine for hypothyroidism who did yoga for an hour, four times a week, for six months. The researchers found that at the end of the trial period, the women's cholesterol levels were significantly lower, their TSH levels were slightly lower, and the practice may have reduced how much levothyroxine the women needed.
Though more research needs to be done on the effectiveness of yoga for hypothyroidism, it may boost your mood, improve your sleep, and help you relax.
Involve Your Healthcare Provider
It's important that you talk to your healthcare provider if you're using or considering using CAM or supplements.
Some of these methods interfere with the effectiveness of treatment, and many of them aren't regulated by the government like standard treatments are. Your healthcare provider can help you navigate the waters and answer questions you may have about CAM and supplements.
Home Remedies and Lifestyle
Along with taking your medication, you can implement some lifestyle changes that may help you prevent other medical conditions, reduce stress, lose or maintain weight, and feel your best.
Eating plenty of fruits, vegetables, and whole grains is recommended for just about everyone, and people with hypothyroidism are no exception.
However, you do need to be careful when it comes to foods that contain goitrogens, most of which are cruciferous vegetables like broccoli, cauliflower, cabbage, and kale. Ingesting large amounts of uncooked goitrogens regularly can slow down your thyroid and/or create swelling in your thyroid called a goiter.
Goitrogens, Thyroid Disease, and Your Diet
Regular exercise improves general health, and it can also help relieve hypothyroid symptoms like fatigue, lack of energy, sleep problems, low mood, sluggish metabolism, and bone loss. It can also lower your risk of developing heart disease.
Exercising With Thyroid Disease
Stress can exacerbate your hypothyroid symptoms, so it's important to find healthy ways to cope and to minimize your stress. Make time for doing activities that you enjoy. Ask for help if you need it. When you're feeling stressed, try meditation, journaling, painting, listening to music, deep breathing, taking a bubble bath, calling a friend, or going for a walk.
Stress Management Techniques
A Word From Verywell
Treatment of Hashimoto's hypothyroidism and the accompanying symptoms include medication and lifestyle measures. Be sure to talk to your healthcare provider about any supplementary treatments you're considering to make sure it's safe for you before you start.
Frequently Asked Questions
Are there foods you shouldn’t eat if you have Hashimoto disease?
Avoiding raw cruciferous vegetables and soybean-derived foods is often suggested because they contain goitrogens that interfere with the thyroid.
Do I need to take hormones for Hashimoto disease?
If your blood tests show that your thyroid hormones are deficient, your healthcare provider will recommend thyroid hormone replacement, usually levothyroxine taken daily. However, you may have Hashimoto and have normal hormone levels, which means you might not need medication.
Symptoms of a Hashimoto’s Flare-Up and What to Do About Them
Can Hashimoto's disease be cured? ›
Hashimoto's disease can't be cured or reversed. However, it can be treated and managed so that you have few or no symptoms and can lead a normal life. If you aren't showing signs of hypothyroidism, your doctor will most likely just check your thyroid levels regularly.How do you permanently treat Hashimoto's? ›
- Remove all potential food allergens from your diet. ...
- Supplements like iodine, probiotics, and curcumin can do wonders for your thyroid.
- Reduce daily stress.
If left untreated, hypothyroidism caused by Hashimoto disease can lead to serious complications: Goiter, which can interfere with swallowing or breathing. Heart problems such as enlarged heart or heart failure. Mental health issues such as depression, decreased sexual desire, slowed mental functioning.How serious is Hashimoto's disease? ›
If Hashimoto's is left untreated, complications can be life-threatening. Because the hormones produced by the thyroid are so vital to the body's functions, untreated Hashimoto's can lead to serious and even life-threatening complications.What is the root cause of Hashimoto's? ›
Hashimoto's thyroiditis, or inflammation of the thyroid gland, is an autoimmune disorder. That means it is caused by a malfunction in your immune system. Instead of protecting your thyroid tissue, your immune cells attack it.What can trigger Hashimoto's? ›
Too much iodine in the diet may function as a trigger among people already at risk for Hashimoto's disease. Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto's disease.What to avoid if you have Hashimoto's? ›
- Added sugars and sweets. Soda, energy drinks, cakes, cookies, ice cream, candy, sugary cereals, table sugar, etc.
- Fast food and fried foods. ...
- Refined grains. ...
- Highly processed foods and meats. ...
- Gluten-containing grains and foods. ...
- High-glycemic fruits. ...
- Nightshades. ...
- Dairy & eggs.
The 5 Stages of Hashimoto's Thyroiditis.How does Hashimoto's make you feel? ›
Hashimoto's thyroiditis can cause your thyroid to not make enough thyroid hormone. It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid. Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness.Should I be worried about Hashimoto's? ›
Is Hashimoto's disease dangerous or fatal? If left untreated, hypothyroidism can lead to some serious complications and, in rare cases, death. These include: Heart problems, such as enlarged heart or heart failure.
What is life like with Hashimoto's? ›
Symptoms of Hashimoto's can take a toll on your social life. Fatigue, depression, and anxiety can each make socializing a challenge. And, if other symptoms, like brain fog or pain, bring discomfort, social activities that aren't necessary may feel off the table. Addressing the root cause of these symptoms can help.Is Hashimoto's hard to live with? ›
Hashimoto's disease can be a difficult condition to live with, and getting diagnosed with this condition can be overwhelming. However, even though Hashimoto's disease and the hypothyroidism it causes can have widespread effects on your mind and body, it doesn't need to control your life.What test confirms Hashimoto's disease? ›
Anti-thyroid antibodies (ATA) tests, such as the microsomal antibody test (also known as thyroid peroxidase antibody test) and the anti-thyroglobulin antibody test, are commonly used to detect the presence of Hashimoto's thyroiditis.Does hashimotos get worse with age? ›
Hashimoto's disease tends to worsen with age because it is progressive. The disease generally progresses slowly over many years and can cause progressive damage to the thyroid glands. Additionally, it is expected that those with Hashimoto's disease will eventually get hypothyroidism, though this is not always the case.What happens if you don't treat Hashimoto's? ›
Untreated hypothyroidism can lead to serious complications, including heart disease and nerve damage. In rare cases, it can be fatal. Most people with hypothyroidism have to take thyroid hormone replacement long term. You will need ongoing thyroid level checks to ensure you are on the right dose.What diseases are common with Hashimoto's? ›
The main complication associated with Hashimoto's is that it greatly increases your risk of developing another autoimmune disorder, such as Addison's disease, Graves' disease, type 1 diabetes, lupus, or rheumatoid arthritis.Can you get Hashimoto's from stress? ›
Stress has been implicated in the pathogenesis of Hashimoto's thyroiditis (HT), nevertheless evidence is scarce regarding the effect of stress management on individuals suffering from HT.What deficiency causes Hashimoto's? ›
The thyroid gland houses more selenium than any other tissue in the body. Selenium is a critical component of "selenoproteins," enzymes involved in thyroid hormone metabolism and the thyroid gland's antioxidant defense. Research suggests that selenium deficiency may be an environmental trigger for Hashimoto's disease.What foods cause Hashimoto's flare up? ›
Sharma, many people find that grains (specifically gluten -containing grains, like wheat, barley, or rye), high sodium intake, as well as high iodine intake are common triggers for a Hashimoto's flare-up.What vitamins should I take for Hashimoto's? ›
Supplements containing vitamins D and B along with selenium, zinc, iron, curcumin, and magnesium are among the best supplements for Hashimoto's disease. Supplements may be beneficial for some patients with this condition but should be taken with your doctor's supervision as part of a treatment plan.
Do I need to see an endocrinologist for Hashimoto's? ›
Temple Simpson, MPAS, PA-C, an endocrinology PA at Magnolia Endocrinology, recommends seeing an endocrinology provider when you're first diagnosed with a thyroid disorder to review and understand your condition, your test results, and your treatment plan.What is the best food for Hashimoto? ›
- leafy greens, such as kale and spinach.
- fatty fish, including salmon.
- a variety of colored vegetables, such as brussels sprouts, broccoli, carrots, beets, and red, yellow, and orange peppers.
- fruits, including berries, apples, and bananas.
- healthful fats, including avocado and walnuts.
This study illustrates that individuals with a TSH above 2.5 should be screened for Hashimoto's disease as well as cardiovascular risk markers.Can you treat Hashimoto's without meds? ›
The best therapy for Hashimoto's thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto's, but a specific diet alone is unlikely to reverse the changes caused by the disease.At what age is Hashimoto's diagnosed? ›
Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50. Your chance of developing Hashimoto's disease increases if other family members have the disease.What happens during a Hashimoto's flare up? ›
A Hashimoto's disease flare-up may cause the pituitary gland to produce more TSH to rebalance hormone levels. Continued overproduction of TSH causes the thyroid to become enlarged, leading to a painless but uncomfortable condition called goiter.How does Hashimoto's affect the brain? ›
Summary. Hashimoto encephalopathy (HE) affects the brain and how the brain works. Symptoms of HE may include behavior changes, confusion, cognitive difficulty, and seizures. Psychosis, including visual hallucinations and paranoid delusions, has also been reported.Can Hashimoto's cause other problems? ›
Hashimoto's thyroiditis is a disorder characterized by inflammation of the thyroid gland. This condition can cause certain complications, including putting you at a higher risk for developing other autoimmune disorders and, to a lesser extent, thyroid lymphoma, a specific type of thyroid cancer.Are you born with Hashimoto's? ›
But kids can have it too. Some children are born with it — this is called congenital hypothyroidism. Others develop it later, usually late in childhood or as teens. The most common cause of hypothyroidism in kids and teens is the autoimmune disease Hashimoto's thyroiditis.Can your thyroid recover from Hashimoto's? ›
Over 20% of patients with hypothyroidism after Hashimoto's thyroiditis may recover satisfactory thyroid function, and can be identified during thyroxine treatment by their thyroid response to TSH in a TRH test.
What is the difference between hypothyroidism and Hashimoto's? ›
The main difference between Hashimoto's and hypothyroidism is the cause of each condition. Hashimoto's disease happens when your immune system attacks your thyroid gland. Hypothyroidism occurs when your thyroid is underactive and not producing enough thyroid hormone.What is normal TSH for Hashimoto's? ›
The upper limit of the normal range of TSH is 4.5 mIU/L. In people under the age of 65 whose TSH falls in this range, treatment with levothyroxine may be helpful if they have symptoms of hypothyroidism, an enlarged thyroid (goiter),14 and/or high levels of TPO antibodies.What are 4 common household substances attacking your thyroid? ›
While heavy metals are abundant in the environment, four specific heavy metals damage the thyroid the most. Those heavy metals are aluminum, cadmium, lead, and mercury.How long can you have Hashimoto's and not know it? ›
It's possible to have Hashimoto's thyroiditis for years without experiencing a single sign or symptom. But if you have symptoms, they will be associated with the disorder's 2 primary complications—goiter and hypothyroidism. Not all individuals will develop these complications.Will I have Hashimoto's forever? ›
Can Hashimoto's disease be cured? There is no cure for Hashimoto's disease and the damage done to your thyroid gland cannot be reversed. However, Hashimoto's can easily be managed. As long as you take your medication and have your hormone levels checked regularly, you can lead a completely normal life.Is Hashimoto's permanent? ›
In the case of Hashimoto's thyroiditis, the resulting hypothyroidism is generally permanent, but it's treatable with life-long thyroid hormone replacement therapy.Can Hashimoto's get worse over time? ›
Hashimoto's disease tends to worsen with age because it is progressive. The disease generally progresses slowly over many years and can cause progressive damage to the thyroid glands. Additionally, it is expected that those with Hashimoto's disease will eventually get hypothyroidism, though this is not always the case.What is the TSH level for Hashimoto's disease? ›
Typically, in Hashimoto's thyroiditis, the pituitary gland in the brain will make more TSH (your blood test for TSH comes back high) because it thinks the thyroid is not making enough thyroid hormone. (Your T4 blood test may be below normal or on the low end of normal).What is the best vitamin for Hashimoto's? ›
Supplements containing vitamins D and B along with selenium, zinc, iron, curcumin, and magnesium are among the best supplements for Hashimoto's disease. Supplements may be beneficial for some patients with this condition but should be taken with your doctor's supervision as part of a treatment plan.What does an endocrinologist do for Hashimoto's? ›
Your endocrinologist or thyroidologist may work with your primary care doctor to manage your condition. For example, if your primary care doctor refers you to an endocrinologist for a diagnosis of Hashimoto's disease, the endocrinologist may find the right dosage of thyroid hormone replacement for you.
How do you know if you've got Hashimoto's? ›
Your doctor will start by taking a medical history and performing a physical exam. In addition to asking about symptoms, the doctor will check your neck for a goiter, which some people with Hashimoto's disease can develop. You probably won't need other tests to confirm you have Hashimoto's disease.What does Hashimoto's flare feel like? ›
When Hashimoto's thyroiditis flares up, you may begin to feel some of the symptoms of hypothyroidism. These can include things like: fatigue. aches and pains in your muscles and joints.