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What Does A Hashimoto's Attack Feel Like?

Learn what a Hashimoto's attack feels like, why it happens, and how to take action when you have a flare-up.
What Does A Hashimoto's Attack Feel Like?
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Hashimoto's thyroiditis is the leading cause of hypothyroidism in the United States. Historically, a lack of dietary iodine caused people to have an underactive thyroid, but this is not the case in countries with access to food products like iodized salt. Instead, most cases of hypothyroidism in the United States are due to an inflammatory process where the immune system attacks the thyroid gland, called Hashimoto's. Sometimes, people with Hashimoto's can experience an influx of their symptoms, called a flare-up or attack.

Ahead, what a Hashimoto's attack feels like, why it happens, and how you can take action when you have a Hashimoto's flare-up.

What does a Hashimoto's attack feel like?

A Hashimoto's attack is when your hypothyroid symptoms flare up or intensify. This complication can happen even when you are getting treatment for hypothyroidism. Usually, an attack occurs in response to some added stressor in your life or on your body. This stressor can be large or small—but the effects are often the same.

People experiencing an attack often describe the following symptoms:

  • "I feel sore and beat up." 
  • "I am completely exhausted."  
  • "My fatigue is crippling."
  • "My muscles and joints ache terribly."
  • "I feel weak and unable to do much at all."
  • "I feel very sad and low."

Of course, people may also find their other symptoms related to hypothyroidism worsen, including slower heart rate, weight gain, edema, and cold intolerance. 

Inflammation: the primary reason behind Hashimoto's attacks

Hashimoto's is one of at least 80 known autoimmune disorders. At the root of all autoimmune disorders is inflammation. In these types of conditions, a person's immune system mistakenly sends cells to attack their tissues. This constant attack leads to chronic inflammation, and in the case of the thyroid, eventual failure.

People who have an autoimmune flare-up like a Hashimoto's attack experience intense symptoms because the immune system goes into overdrive, mounting an even greater attack on the thyroid and causing even more inflammation. 

It is not clear why the immune system starts attacking healthy cells in the body. But, many researchers postulate that it is a combination of stress, genetics, and environmental factors that may lead to these diseases and that it likely stems from an early infection or injury. We also know that most people have more than one autoimmune disorder. Indeed, it appears they often travel in packs, where if you have Hashimoto's, you may also have another condition like rheumatoid arthritis.

Factors that cause a Hashimoto's attack

Several factors can send the immune system into overdrive, causing an attack on your thyroid. 

Poor thyroid function

People with hypothyroidism need to take thyroid hormone replacement medication because they cannot produce enough hormones to support their metabolic needs. Under normal conditions, the thyroid gland produces thyroxine (T4), which converts to the active form triiodothyronine (T3). But, because of chronic inflammation, the thyroid eventually stops making thyroid hormone.

One of the first things you may need to consider if you are having an attack is getting the proper thyroid medication dosage. Certain things can interfere with your medication, including taking it at the wrong time, not taking it on an empty stomach, or swallowing it with your morning coffee.

Physical stressors

Several physical factors are at play in many cases of Hashimoto's attacks:

  • Infection or illness due to a bacteria or virus
  • Nutrient deficiencies
  • Surgery
  • Sleep deprivation
  • Hormonal imbalance (like menopause or pregnancy)
  • Menstruation
  • Childbirth
  • Excessive physical exertion 
  • Other health conditions (like gastrointestinal problems, heart disease, or other autoimmune disorders)

Mental stressors

The mind and body are intricately connected, so it is no surprise that mental strain can also have physical consequences. The following mental and emotional stressors may cause a person to have a Hashimoto's attack:

  • Grief
  • Depression
  • Anxiety
  • Post-traumatic stress or a traumatic event such as a car accident or injury
  • Major life events, such as moving, marriage, divorce, career changes
  • Big decisions and times of transition

What to do if you are in the midst of a Hashimoto's attack

Figure out what is behind the attack

If you are experiencing an attack, step back and think about what may be causing the symptoms: are you grappling with a big decision, have you been ill, or are you feeling particularly low? Consider all of the factors that may cause an attack and see if any apply to your current situation.

Check your thyroid hormone levels

It is a good idea to have your thyroid checked to see if you are under or over-treating your hypothyroidism. Thyroid levels can remain stable during an attack. Still, your body also responds with crippling symptoms when your levels are off-balance. Therefore, it is crucial to ensure your thyroid hormones are stable to turn your attention to other factors.

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Get plenty of rest and sleep

Now is not the time to push it; a flare-up is a time to rest and let your body recover. Getting plenty of consistent sleep at night (at least eight hours) is critical, as is allowing your body and mind to recuperate. 

Practice gentle movement

Avoid intense workouts and physical strain during an attack. Instead, opt for gentle activities that keep your body moving to reduce muscle and joint pain. For example, walking, swimming, and gentle yoga are excellent low-impact options for your body during a Hashimoto's attack.

Eat a nutrient-dense diet

Nutrient deficiency is one of the causes of a Hashimoto's attack. When you are in the midst of an attack, make sure you eat foods with high-nutritional values (foods that often do not have a food label like vegetables, fruits, and some meats). In addition, ensure your diet includes plenty of vitamin Dseleniumironiodine, and zinc. These nutrients help support your thyroid health and can prevent flare-ups. 

If you have Hashimoto's, you will also want to get acquainted with an anti-inflammatory diet, which excludes the following pro-inflammatory foods:

  • Processed foods
  • Grains
  • Legumes
  • Dairy products
  • Refined sugar


12 Week Hashimoto's
Health Plan


Want to learn more about how to avoid a flare-up? Get our Stress 101 Thyroid Guide sent directly to your inbox. And, if you struggle with intense thyroid symptoms or suspect your thyroid is not working correctly, test your thyroid with a comprehensive at-home thyroid test kit. 


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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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