Hashimoto’s Disease

What is Hashimoto’s disease?

Hashimoto’s disease is an autoimmune condition that can cause hypothyroidism (underactive thyroid). It’s a lifelong (chronic) condition.

Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. It’s a part of your endocrine system and releases thyroid hormones.

Your thyroid’s main job is to control the speed of your metabolism. This is the process of how your body transforms the food you consume into energy. It’s common to mainly think of metabolism in terms of weight gain or weight loss. But this process affects every organ in your body, including your heart and brain.

In most cases of Hashimoto’s disease, your thyroid can’t produce enough thyroid hormone for your body. This slows down your metabolism and causes a range of symptoms.

The condition is named after Dr. Hakaru Hashimoto, who identified it in 1912. Other names for Hashimoto’s disease include:

• Hashimoto thyroiditis.
• Chronic autoimmune thyroiditis.
• Lymphocytic thyroiditis.

How common is Hashimoto’s disease?

Hashimoto’s disease is common. It affects about 5 in 100 people in the United States.

Hashimoto’s disease is the most common cause of hypothyroidism in countries with widely available iodized salt and other iodine-enriched foods. Iodine deficiency is the most common cause in other countries.

Who does Hashimoto’s disease affect?

Anyone at any age can develop Hashimoto’s disease. But women and people assigned female at birth (AFAB) are 10 times more likely to get it than men and people assigned male at birth (AMAB). Diagnosis most commonly occurs between the ages of 30 to 50 for people AFAB.

What are the symptoms of Hashimoto’s disease?

Some people with Hashimoto’s disease may not have any symptoms at first.

As the condition slowly progresses, your thyroid gland will sometimes become enlarged (a condition called goiter). Goiter is a common first sign of Hashimoto’s disease. It’s shouldn’t hurt, but it can create a feeling of fullness in your lower neck. It can make the front of your neck look swollen.

If Hashimoto’s disease leads to hypothyroidism, it can cause the following symptoms over time:

• Tiredness (fatigue), lethargy and excessive sleeping.
• Mild weight gain.
• Constipation.
• Dry skin.
• Feeling cold.
• Slower-than-normal heart rate (bradycardia).
• Joint stiffness and muscle pain.
• Dry, brittle hair; slow hair growth; or hair loss.
• Low or depressed mood.
• Puffy eyes and face.
• Memory problems or difficulty concentrating.
• Heavy or irregular periods.
• Decreased libido (sex drive).
• Female infertility or male infertility.

How do you feel when you have Hashimoto’s?

You might not feel different if you have Hashimoto’s disease without hypothyroidism.

However, if you develop hypothyroidism, it can make you feel “off.” “Hypo-” means “low” or “under.” So you can think of symptoms of hypothyroidism as a slowing down of various bodily functions.

You may have less energy than you used to or can’t exercise as much or as long as you once did. If you have a fitness tracker, you may notice that your heart rate is slower than it used to be. You may have brain fog or problems remembering things. Hypothyroidism can also “slow down” your mood — you may feel sad or depressed. It can also lower your sex drive and your digestive system — you may not poop as frequently as before.

If your body and mind feel stuck in slow motion, talk to your healthcare provider.

What causes Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disease, which means your body’s immune system attacks your cells and organs.

Normally, your immune system protects your body against harmful outside invaders, like bacteria and viruses. But in Hashimoto’s disease, the following happens:

• Your immune system makes antibodies that attack your thyroid tissue for unknown reasons.
• Large numbers of white blood cells (specifically, lymphocytes), build up in your thyroid.
• This buildup causes inflammation (thyroiditis) and damages your thyroid.
• Over time, the damage can prevent your thyroid from making enough thyroid hormone that your body needs. This leads to hypothyroidism. However, not everyone with Hashimoto’s disease develops hypothyroidism.

What are the risk factors for Hashimoto’s disease?

Factors that may increase your risk of developing Hashimoto’s disease include your:

• Family history: Research suggests that your genetics account for about 80% of your likelihood of developing Hashimoto’s. If you have biological family members with Hashimoto’s disease or other thyroid diseases, you’re more likely to develop it.
• Sex: People assigned female at birth are 10 times more likely to get Hashimoto’s. This may be in part due to sex hormone influences.
• Age: Your risk of developing this condition (and other thyroid diseases) increases as you age.

You’re also more likely to get Hashimoto’s if you have other autoimmune conditions, like:

• Addison’s disease.
• Celiac disease.
• Lupus.
• Pernicious anemia.
• Rheumatoid arthritis.
• Sjögren’s syndrome.
• Type 1 diabetes.

How is Hashimoto’s disease diagnosed?

First, your healthcare provider will:

• Ask about your symptoms.
• Ask about your medical history.
• Perform a physical exam, including feeling your thyroid gland.

After this assessment, they’ll order blood tests to confirm the diagnosis, including:

• Thyroid-stimulating hormone (TSH) test: A high TSH level most often means your thyroid gland isn’t producing enough thyroxine (T4) hormone. This result usually means you have hypothyroidism or subclinical hypothyroidism.
• Free thyroxine (T4) test: A low T4 level suggests that you have hypothyroidism.
• Antithyroid antibody test: If you have certain autoantibodies in your blood, it usually points to Hashimoto’s disease as the cause of hypothyroidism, as opposed to something else, like iodine deficiency.

In some cases, your provider may recommend a thyroid ultrasound (imaging test) to check the size of your thyroid and to make sure you don’t have thyroid nodules (growths).

What is the treatment for Hashimoto’s disease?

Not everyone with Hashimoto’s disease develops hypothyroidism. If you have high antibody levels but don’t have clinical hypothyroidism, your healthcare provider will likely monitor your thyroid levels instead of starting treatment.

If Hashimoto’s disease leads to hypothyroidism, the go-to treatment is a medication called levothyroxine. It’s a synthetic (manufactured) form of the hormone T4 that your thyroid makes.

Brand names of levothyroxine include:

• Ermeza®.
• Euthyrox®.
• Levo-T®.
• Levolet®.
• Levoxyl®.
• Synthroid®.
• Thyro-tabs® (formerly known under the name Levothroid).
• Thyquidity®.
• Tirosint®.
• Unithroid®.

This medication helps restore the normal levels of thyroid hormone your body needs. You’ll need to take it every day for the rest of your life.

Over time, you may need a different dose of the medication. Your provider will know how to adjust your dose to make sure that your hypothyroidism is well-managed.

Side effects of levothyroxine

If you experience side effects from levothyroxine, it’s most likely because your dose is too high. This can cause thyrotoxicosis — too much thyroid hormone.

Symptoms of thyrotoxicosis include:

• Rapid heartbeat (tachycardia) — usually a heart rate higher than 100 beats per minute.
• Irregular heartbeat (arrhythmia).
• Unexplained weight loss.
• Feeling shaky.
• Feeling nervous, anxious and/or irritable.
• Increased sensitivity to heat and sweating more than usual.
• Changes in your period.

Is there a special diet for people with Hashimoto’s disease?

There’s no special diet for Hashimoto’s disease. But some foods, medicines or supplements may affect your ability to absorb levothyroxine. These include:

• Iron and calcium supplements.
• Sucralfate (stomach ulcer medication).
• Cholestyramine and aluminum hydroxide (found in some antacids).

Taking these four hours before or after you take levothyroxine may solve this problem.

Talk to your healthcare provider or a registered dietitian about any dietary questions you have.

Eating well and having a healthy lifestyle — exercising, sleeping well and managing stress — can help your immune system. But no matter what, you’ll need to keep taking your medications if you have hypothyroidism.

Can Hashimoto's disease be cured?

There’s no way to cure or reverse Hashimoto’s disease. But lifelong medication works well to manage hypothyroidism and your thyroid hormone levels.

Can I prevent Hashimoto’s disease?

Unfortunately, there’s nothing you can do to prevent Hashimoto’s disease. The risk factors for it — like your genetics and age — aren’t modifiable.

What is the prognosis for Hashimoto’s disease?

With lifelong monitoring and treatment, the prognosis (outlook) for people with Hashimoto’s disease is excellent.

If you have hypothyroidism from Hashimoto’s disease that’s untreated, it can lead to certain health problems, including:

• High cholesterol.
• Heart disease and heart failure.
• High blood pressure.
• Depression.
• Myxedema coma. This is a rare complication of severe hypothyroidism. Your body’s functions slow down so much that it can be deadly.

Without treatment, hypothyroidism can also cause problems during pregnancy.

Hashimoto’s disease during pregnancy

Untreated hypothyroidism during pregnancy can increase the risk of:

• Miscarriage.
• Premature birth.
• Stillbirth.

Or it may cause a dangerous rise in your blood pressure in late pregnancy called preeclampsia. Untreated hypothyroidism can also affect the fetus’s growth and brain development. Your providers will work with you to make sure your hypothyroidism is well-managed during pregnancy.

Hypothyroidism during pregnancy isn’t common. But it can be easy to miss its symptoms that are also common during pregnancy, like fatigue and weight gain. Let your providers know right away if you notice any hypothyroidism symptoms or feel like you’re developing a goiter.

When should I see my healthcare provider?

If you have Hashimoto’s disease, you’ll need to see your healthcare provider regularly. They’ll perform routine thyroid hormone blood tests to make sure your levels are in range and that the dose of medication you’re taking is right for you.

Otherwise, see your healthcare provider if you develop new or worsening symptoms or notice a change in your thyroid.

When should I go to the ER?

If you have symptoms of myxedema coma, call 911 or get to the emergency room as soon as possible. This complication of severe hypothyroidism is life-threatening.

Symptoms include:

• A body temperature below 95 degrees Fahrenheit or 35 degrees Celsius (hypothermia).
• Swelling (edema) in your body, especially your face, tongue and lower legs.
• A slow heart rate and faint pulse.
• Slowed breathing (bradypnea) and difficulty breathing (dyspnea).
• Confusion or loss of consciousness.

A note from Cleveland Clinic

Getting a new diagnosis can be stressful. The good news is that Hashimoto’s disease is a manageable and treatable condition. If you’re experiencing symptoms of Hashimoto’s or have certain risk factors, such as a family history of thyroid disease, be sure to contact your healthcare provider. They can run some simple tests to see if your thyroid isn’t making enough thyroid hormone.