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How Long To Develop Hypothyroidism With Only A Hashimotos Diagnosis

Learn about the stages of Hashimoto’s and how long it takes to move from one stage to another.
How Long To Develop Hypothyroidism With Only A Hashimotos Diagnosis
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If you or someone you know lives with Hashimoto’s thyroiditis, you might be wondering what to expect.

Hashimoto’s is a common autoimmune disorder that affects the thyroid gland. It occurs when the immune system attacks your healthy thyroid cells. And the more healthy thyroid cells your immune system destroys, the worse your thyroid gland function becomes over time.

Hashimoto’s progresses through several key stages. Let’s look at these stages to help you better understand what to expect.

Before onset

At this point, your thyroid gland functions normally. It produces an appropriate amount of thyroid hormones- thyroxine (T4) and triiodothyronine (T3). In turn, body functions occur as they should.

That doesn’t mean things aren’t happening in the background, setting the stage for Hashimoto’s later. Some of these factors you can control; others you can’t.

Your genes play a significant role in the development of Hashimoto’s and are beyond your control. Specific genes associated with immune system function are linked to thyroid regulation. These genetic changes during development may increase the likelihood of an autoimmune disease like Hashimoto’s thyroiditis down the road.

If someone in your family has a medical history of thyroid issues, you have a higher risk of developing Hashimoto’s. And if you or another family member live with a different autoimmune disorder, your chances of developing autoimmune thyroiditis are higher. Other autoimmune disorders linked with the development of Hashimoto’s include celiac disease or rheumatoid arthritis. Having a genetic predisposition doesn’t mean you will definitely develop Hashimoto’s, though. And not having a family history doesn’t guarantee you will never develop Hashimoto’s.

Environmental factors, which you can control to a certain degree, can trigger the onset of thyroid disease, including Hashimoto’s. This is especially true in those with a genetic predisposition. Examples of environmental triggers include:

Experts believe that environmental factors trigger susceptible genes. As a result, the immune system gets confused and starts attacking healthy thyroid cells. With this, we move into the next stage.

Antibody elevation

At this point, you may still have normal thyroid function (euthyroid), and it’s making enough thyroid hormone to meet the body’s needs. But your immune system is starting to produce antibodies that attack your thyroid gland. The presence of thyroid antibodies makes a diagnosis of Hashimoto’s thyroiditis very likely.

Antibodies’ main job is to identify and attack foreign invaders that may harm your body. Generally, this means germs like bacteria or viruses. In Hashimoto’s, your immune system thinks your thyroid cells are foreign invaders. So, it makes antibodies against thyroid cells, causing a continued attack on them.

Specific thyroid antibodies include:

  • Thyroid peroxidase antibodies: These antibodies target an enzyme called thyroid peroxidase (TPO), which helps make thyroid hormones.
  • Thyroglobulin antibodies: These antibodies attack a protein called thyroglobulin (TG), which helps make and store thyroid hormones.

As these antibodies continue to attack your thyroid, chronic inflammation ensues. Over time, your thyroid’s ability to produce thyroid hormone will decline, but we aren’t there yet!

Since thyroid function is still normal at this stage, management focuses on lifestyle changes and avoiding worsening the autoimmune condition. Examples of lifestyle changes include:

## 5-day meal plan

Subclinical hypothyroidism

Your thyroid function will slowly decline due to the ongoing attack on your thyroid. In this stage, you may notice symptoms of an underactive thyroid (hypothyroidism). Symptoms are often non-specific, such as:

But, in most cases, those with subclinical hypothyroidism often don’t have symptoms. The best way to tell if you have entered this stage is by measuring your thyroid function. This requires a blood test. The three most commonly ordered thyroid biomarkers to check your thyroid function are:

  • Thyroid-stimulating hormone (TSH)
  • Free Thyroxine (Free T4)
  • Free Triiodothyronine (Free T3)

Those with subclinical hypothyroidism have a slight elevation in TSH levels with normal T4 and T3 levels. Your healthcare provider may recommend one or a combination of the following to manage subclinical hypothyroidism:

  • Starting thyroid hormone replacement medication
  • Lifestyle changes to manage inflammation
  • A watch-and-wait approach

Overt hypothyroidism

As your thyroid function continues to decline, your thyroid function moves from subclinical to overt hypothyroidism. Overt hypothyroidism means you have officially entered hypothyroidism. This means your thyroid no longer produces enough thyroid hormone to meet your body’s needs. Testing your thyroid biomarkers would reveal a high TSH level with low T4 and T3 levels.

Symptoms are generally more severe in this stage than in subclinical hypothyroidism. Besides the symptoms above, you may also have:

Your healthcare provider will likely prescribe a thyroid hormone medication at this stage. These medications give your body the essential thyroid hormone your thyroid can no longer make. As a result, thyroid hormone levels rise, restoring normal body processes and improving hypothyroid symptoms. Levothyroxine, a synthetic version of your T4 hormone, is the most commonly prescribed thyroid medication. But there are two others: desiccated thyroid (Armour thyroid) and liothyronine (Cytomel).

You and your provider will work together to determine which medication and dose is best for you.

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How long does it take to move between each stage?

The time of progression from Hashimoto’s to overt hypothyroidism varies from person to person. There isn’t a fixed timeline for how fast someone may move from one stage to another. Early stages of Hashimoto’s may not show noticeable symptoms. This makes it challenging to pinpoint when the condition initially developed.

Some move quickly and develop symptoms and overt hypothyroidism within months of a Hashimoto’s diagnosis. Others live with Hashmoto’s for years, even decades, before developing hypothyroidism.

As we learned, many factors influence disease progression. And how well you manage symptoms in the early stages may control your movement between the stages.

A note from Paloma Health

Through proactive management in the early stages of Hashimoto’s, you may be able to delay progression into overt hypothyroidism for many, many years. Here are some tips to get you started:

  • Make sure you have regular check-ups with your healthcare provider, especially if you have a family history of a thyroid disorder. Know the signs and symptoms of hypothyroidism, and if you have any of them, let your provider know.
  • Test your thyroid function every year. Regular testing makes it easier to notice small changes. Early detection of thyroid changes allows you to modify your lifestyle early on. An easy way to test your thyroid function is with Paloma’s at-home thyroid kit. This kit tests your TSH, free T4, and free T3 levels, as well as the presence of TPO antibodies.
  • Consider working with a nutritionist. They can help you find a diet that supports your thyroid and overall health. They may also recommend dietary supplements to help optimize your thyroid health.

And if you live with Hashimoto’s and are looking for a thyroid specialist, consider teaming up with ours here at Paloma Health. Our thyroid specialists focus on treating the individual and not just the disease. We use a combination of holistic and traditional approaches when it comes to managing hypothyroidism. Please set up a free consultation to learn more about our approach.


Klubo-Gwiezdzinska J, Wartofsky L. Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment. Pol Arch Intern Med. 2022 Mar 30;132(3):16222. doi:

MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2020 Jun 24]. Thyroid Antibodies; [updated 2023 Aug 7; cited 2024 Feb 26]. Available from:

American Thyroid Association. Thyroid Function Tests | American Thyroid Association. American Thyroid Association. Published 2019. Accessed February 26, 2024.

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Emilie White, PharmD

Clinical Pharmacist and Medical Blogger

Emilie White, PharmD is a clinical pharmacist with over a decade of providing direct patient care to those hospitalized. She received her Doctor of Pharmacy degree from Massachusetts College of Pharmacy and Health Sciences. After graduation, Emilie completed a postgraduate pharmacy residency at Bon Secours Memorial Regional Medical Center in Virginia. Her background includes caring for critical care, internal medicine, and surgical patients.

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