Hashimoto's Disease: The Top 12 Questions

1 Is Hashimoto's disease hypothyroidism or hyperthyroidism?

Hashimoto's disease is the most common cause of hypothyroidism. The thyroid’s ability to produce thyroid hormone is impaired when the thyroid gland is attacked by the body’s immune cells. With this, the body does not function properly, thus it can lead to hypothyroidism.

People with hypothyroidism caused by Hashimoto’s disease may experience symptoms such as fatigue, hypersensitivity to cold, dry skin, hair, and nails, drowsiness, increased menstrual flow, weight gain, difficulty concentrating, constipation, and sore muscles.

Hypothyroidism is not the only complication of Hashimoto’s disease. Some people may also develop goiter, a condition in which the thyroid becomes enlarged and inflamed. People who are diagnosed with Hashimoto’s disease and who have the symptoms of goiter and hypothyroidism need to undergo hormone therapy.

The cause of Hashimoto’s disease is not exactly known but it is linked to genetics and environmental factors.

2 Is Hashimoto's disease hereditary (genetic)?

Hashimoto’s disease is hereditary, but researchers are still working to identify the specific gene or group of genes that causes this condition to be passed from one generation to the next. A family member with an autoimmune disease such as rheumatoid arthritis, lupus, or Addison disease can also pass on the disease, which can also result in Hashimoto’s disease.

The inheritance pattern of the condition is not that clear yet, since there are many factors being considered.

3 Is Hashimoto's disease deadly?

Hashimoto’s disease can be deadly if left untreated, because the underactive thyroid can lead to muscle weakness, which can cause heart failure in the long run.

4 Is Hashimoto's disease an autoimmune disease?

Hashimoto’s disease is an autoimmune disease. In an autoimmune disease, the body’s immune cells attack, rather than protect, healthy cells and tissue. In Hashimoto's disease, the body's immune cells, lymphocytes, attack the thyroid's tissue by mistake, causing the inflammation of the thyroid and destroying its cells, blood vessels, and tissue. This is a slow process, which is why many individuals who have Hashimoto’s disease do not experience any symptoms until several years after its onset.

When the immune cells attack the thyroid, it cannot make adequate thyroid hormone for the body. Thus, an underactive thyroid (hypothyroidism), an enlarged thyroid (goiter), or both, may occur. If it is not detected and treated, Hashimoto’s disease can destroy the entire thyroid.

Health care professionals are not completely sure about how the process of autoimmune diseases works. However, what they do know is that there are certain factors that could contribute to the development of such diseases and make people susceptible to them.

Women are more likely to develop Hashimoto's disease. The condition is also called Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis.

5 Is Hashimoto's disease curable?

There is no cure for Hashimoto’s disease. However, treatment can help manage the condition and its symptoms. Treatment for Hashimoto’s disease depends on the severity of thyroid damage and whether it is already causing hypothyroidism. Meanwhile, if goiter is present, treatment will aim to decrease the size of the goiter, although some health care professionals choose to simply observe their patients for the disease's progression.

Hormone therapy is the treatment for Hashimoto’s disease. Hormone therapy involves replacing the hormones (T3 and T4) no longer adequately produced by the thyroid after having come under attack. When the hormones are replaced, symptoms are alleviated and the risk of complications is reduced.

Synthetic thyroxine is used to treat Hashimoto’s disease, whether with or without the presence of hypothyroidism. Synthetic thyroxine is a man-made T4 cell. It stays in the body long enough to ensure a balanced supply of thyroid hormone during the day. With this treatment, the success of controlling hypothyroidism is high as long as the hormone is taken according to the recommended dose and as instructed. Patients usually undergo a blood test before treatment is prescribed and commenced. The result of the test allows the doctor to determine the appropriate dose of synthetic thyroxine for the patient.

6 How does Hashimoto's cause infertility?

In a number of cases, there has been found a link between Hashimoto’s diseases and infertility. Hashimoto’s disease causes hypothyroidism, in which the thyroid gland does not produce enough thyroid hormones. Inadequate thyroid hormones can interfere with the release of eggs from the ovaries. Thus, hypothyroidism can result in infertility. 

Moreover, hypothyroidism in women can cause an increase in the level of the hormone prolactin. When this occurs, the amount of leutinizing hormone decreases, and the progesterone receptor sites are lost. Sensitivity to FSH (follicle-stimulating hormone) in the follicles is also lost. All of these can disrupt ovulation.

Incidentally, other causes of hypothyroidism, such as pituitary disorders and autoimmune diseases, can also impair fertility in women.

It is important to manage hypothyroidism in women so as to prevent or correct infertility. If infertility continues even after hypothyroidism has been treated, other treatments for infertility may be needed. Women who have hypothyroidism and wish to get pregnant have to seek medical treatment for hypothyroidism. Meanwhile, if you have hypothyroidism and are already pregnant, it is vital to monitor the thyroid hormone levels during the course of pregnancy to promote the normal development of the baby and decrease the chances of miscarriage or birth defects.

7 How does Hashimoto's affect pregnancy? Does it cause miscarriage?

Women may develop hypothyroidism caused by Hashimoto’s disease during the course of their pregnancy. There are about 3 to 5 cases of hypothyroidism out of 1,000 pregnant women. With uncontrolled hypothyroidism, the chances of a miscarriage, preeclampsia, premature birth, or stillbirth are high. The condition may also affect the growth as well as brain development of the baby.

There is an increased risk of birth defects in babies of mothers with uncontrolled hypothyroidism caused by Hashimoto’s disease. These children are also more susceptible to developmental and intellectual problems. Researchers have observed a link between birth defects like cleft palate and hypothyroidism in general. In addition, brain, heart, and kidney problems in babies are also more likely if their mothers had hypothyroidism during pregnancy.

To prevent these problems, checking one's thyroid hormone levels before getting pregnant is recommended. Women who have Hashimoto’s disease should discuss their condition with their doctors before planning to have a baby. There are thyroid medications that are safe for use during pregnancy and will help prevent future problems.

8 Can Hashimoto's cause anxiety?

When Hashimoto’s disease flares up, the thyroid gland is damaged, and thyroid cells are broken down and spill into the bloodstream. With this occurrence, there is a surge of thyroid hormones which can lead to transient hyperthyroidism. As a result, people may experience anxiety, palpitations, and insomnia. To manage anxiety caused by Hashimoto’s disease, proper treatment is needed.

9 Why does Hashimoto's cause weight gain?

Hashimoto’s disease is an autoimmune disorder that causes inflammation of the thyroid. With the thyroid's inflammation, one's metabolism and adipose tissue are affected, and this can lead to metabolic dysfunction and insulin resistance.

Inflammation of the thyroid causes an increase in fat tissue as well as adipokines – these are cytokines secreted by adipose tissue. Increased adipokines can lead to vascular and systemic inflammation. Therefore, with increased inflammation, fat tissue is also increased and when fat tissue is increased, there is more inflammation. As a result, more fat tissue is created.

10 Does Hashimoto's cause nodules?

Hashimoto’s disease can lead to the development of thyroid nodules. These nodules could develop into a type of cancer called thyroid lymphoma – a very rare complication of Hashimoto’s disease. Thyroid lymphoma is treatable when it is detected early. Thus, it is vital to pay attention to any nodules in the thyroid and get them examined.

11 What is a Hashimoto’s disease test?

Aside from a physical examination and the present symptoms of the patient, laboratory procedures are also important to confirm whether a person has Hashimoto’s disease. The most common laboratory tests that doctors have their patients to undergo are the thyroid-stimulating hormone test, free T4 hormone test, and anti-thyroid antibodies test.

The thyroid-stimulating hormone test or TSH is a type of blood test that is considered the go-to test for diagnosing hypothyroidism where Hashimoto’s disease is the most common cause. The goal of the thyroid-stimulating hormone test is to find out whether the TSH levels are within the normal range. A higher level of TSH may show Hashimoto’s disease and also, in turn, hypothyroidism. The normal level of thyroid stimulating hormone is different for each individual, thus the doctor specifies the appropriate normal range for each patient.

To help confirm a diagnosis of Hashimoto’s disease, doctors may require the free T4 hormone test to check on the level of free T4 in the bloodstream. T4 or thyroxine is the active thyroid hormone in the blood. Free T4 is a fraction of the total T4 thyroid hormone that is available in the body. When the T4 blood test is below normal level or at the low end of normal level, Hashimoto's disease is confirmed. Meanwhile, if the TSH test is normal but the symptoms resemble hypothyroidism, a free T4 test reveals any thyroid hormone problems. A low level of free T4 means that there is a deficiency in the production of thyroid hormone even if the TSH level is normal.

The anti-thyroid antibodies tests, meanwhile, are used to discover the presence of Hashimoto’s disease. They are commonly used to either confirm or rule out Hashimoto’s disease as the cause of hypothyroidism. The anti-thyroid antibodies tests include the anti-thyroglobulin antibody test and the microsomal antibody test (also called the thyroid peroxidase antibody test). These tests can measure and detect the presence of the antibodies produced when the immune cells attack the thyroid gland. 

12 What are the natural ways of treating Hashimoto’s disease?

Hashimoto’s disease can be managed successfully through hormonal therapy and other medications, but adopting a healthy diet and lifestyle also plays a big role.

A diet that is free from immune-reacting foods can help the body rest and the gut to heal, and thus promote the normal functioning of the immune system and thyroid gland. Among the first dietary changes one should consider is eliminating gluten, as it is a notorious allergen and often pointed to as one of the culprits behind many autoimmune disorders. Eliminating gluten may be tough, but it will prove rewarding in the end. One should also avoid fast food as well as food high in sugar content.

To start the healing process, people with Hashimoto’s disease would do well to eat more of the following:

• Fruits and vegetables – These are high in antioxidants, fiber, vitamins, and minerals. Antioxidants help fight inflammation, while fiber improves digestive health, supports a healthy weight, balances blood sugar, and improves heart health.
• Probiotic-rich food – Food such as kimchi, kefir, fermented vegetables, organic goat’s milk yogurt, natto, and sauerkraut are high in probiotics, which help support the healing of the immune system and gut. Probiotics also repopulate good bacteria in the gut.
• Coconut oil – This promotes a healthy metabolism, nourishes the gut, fights fatigue, and increases energy.
• Wild-caught fish – These fish are rich in anti-inflammatory omega-3 fatty acids, which are important for thyroid function and hormone balance.
• Seaweed – Seaweed is a natural source of iodine, which helps prevent problems that disrupt the function of the thyroid gland.
• Bone broth – This helps heal the intestinal lining by providing amino acids, collagen, calcium, phospshorus, and magnesium.