Yes, it’s possible to have Hashimoto’s disease even after your thyroid gland has been surgically removed. Hashimoto’s is an autoimmune condition, which means the immune system keeps producing thyroid antibodies (like TPO antibodies) as part of its ongoing attack, and that immune activity doesn’t automatically stop just because the gland itself is gone.

After a thyroidectomy, thyroid antibody levels typically drop significantly, and many people notice their Hashimoto’s symptoms improve. But in some cases, antibody levels stay elevated, which is a sign the autoimmune process is still active. Some patients continue to notice symptoms like fatigue, joint and muscle tenderness, dry mouth and eyes, weight gain, or depression even without a thyroid.

Either way, removing the thyroid gland always causes hypothyroidism, since the body can no longer make its own thyroid hormone. That means lifelong thyroid hormone replacement medication is needed, along with supportive lifestyle steps like correcting nutrient deficiencies, following anti-inflammatory habits, and prioritizing sleep and stress management, to help keep symptoms under control.

In Hashimoto’s disease, the immune system produces antibodies that attack your thyroid gland, usually resulting in hypothyroidism. But if you’ve had your thyroid surgically removed, does that eliminate or cure Hashimoto’s disease? Can you still have Hashimoto’s thyroiditis after surgically removing your thyroid gland? Ahead, we’ll explore the answers to this intriguing question.

What is Hashimoto’s disease?

Your thyroid gland is the sole organ responsible for making and producing thyroid hormones. Thyroid hormones are essential, helping regulate many of your body’s functions, including metabolism. When your thyroid gland doesn’t produce enough thyroid hormone, it is considered underactive, and an underactive thyroid causes a medical condition called hypothyroidism.

One of the most common causes of hypothyroidism is Hashimoto’s disease, an autoimmune disorder. When you have Hashimoto’s, your immune system produces antibodies that attack the thyroid gland, leading to the death of the thyroid’s hormone-producing cells. This process usually results in a decline in hormone production and damage to the gland, leading to hypothyroidism.

Hashimoto’s disease is also known as Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, and chronic autoimmune thyroiditis.

While the exact cause of Hashimoto’s disease and other autoimmune diseases is unknown, it’s thought that genetics, viruses, and environmental factors play vital roles.

Women are more likely to develop Hashimoto’s disease than men, and it’s most common among middle-aged women.

Hashimoto’s disease can, in some cases, progress slowly, but eventually, the decline in thyroid hormone production can result in the common symptoms of hypothyroidism, including:

Brain fog
Coarse hair
Hair loss
Cold intolerance
Constipation
Dry skin
Fatigue
Infertility
Joint and muscle aches
Memory impairment
Weight gain
Depression

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How is Hashimoto’s diagnosed and treated?

Hashimoto’s is primarily diagnosed with the Thyroid Peroxidase (TPO) antibodies test. Elevated levels are indicative of an autoimmune attack on the thyroid gland.

In some cases, Hashimoto’s can be detected during a thyroid nodule biopsy or pathology assessment of a surgically-removed thyroid gland.

The primary treatment for Hashimoto’s disease is taking thyroid hormone replacement medication to replace the hormone that the thyroid gland can no longer produce and restore thyroid hormone levels to normal.

Is surgery a treatment for Hashimoto’s?

In some cases of Hashimoto’s, the thyroid becomes so painful, an enlarged thyroid impairs swallowing or breathing, or the damage to the thyroid gland is so severe that thyroidectomy – surgery to remove the thyroid gland -- has emerged as a potential treatment option.

A 2019 study compared symptom relief from thyroid hormone replacement medications versus a thyroidectomy. Patients in this study had persistent Hashimoto symptoms with high thyroid peroxidase (TPO) antibodies. The immune system makes TPO antibodies to identify thyroid cells for destruction.

After thyroidectomy, TPO antibodies dropped significantly, with most patients reporting the resolution of their symptoms. In contrast, those taking thyroid hormone replacement medication, who did not undergo thyroidectomy, saw a slight decline in TPO antibodies. This group also reported no change in their health survey or fatigue scores.

A small 2020 study reinforced these results. Participants had normal thyroid levels while taking thyroid medication but still had persistent Hashimoto symptoms, affecting their quality of life. Like the above 2019 study, participants had a very high TPO antibody level.

After the thyroidectomy, over 60% of the participants reported improved health. Most even reported an increase in their energy levels. The majority, over 80%, were pleased with their decision to undergo a thyroidectomy, with half reporting fewer:

Doctor’s appointments
Thyroid medication changes
Days with concentration problems, low mood, and intrusive pain

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Can you have Hashimoto’s after thyroid surgery?

After removing your thyroid gland, your body doesn’t have any way of making thyroid hormones on its own. Therefore, surgery to remove the entire thyroid gland always results in hypothyroidism and requires lifelong treatment with thyroid hormone replacement. But thyroid patients often wonder if it’s possible to have autoimmune Hashimoto’s disease after the thyroid has been surgically removed.

The answer is yes. Even after the thyroid gland is removed, the immune system can still produce antibodies that attack the thyroid gland.

While antibody levels typically drop significantly after thyroid surgery, they can remain elevated, indicating that the autoimmune Hashimoto’s is still active.

Some Hashimoto’s patients who have had their thyroid removed report continued symptoms after thyroidectomy, including fatigue, joint and muscle tenderness, dry mouth, and dry eyes, weight gain, and depression.

How is post-thyroidectomy Hashimoto’s treated?

Patients with Hashimoto’s post-surgery receive the same treatment as Hashimoto’s patients with a thyroid gland. Hypothyroidism requires thyroid hormone replacement therapy to optimize thyroid function.

Comprehensive management of Hashimoto’s hypothyroidism also benefits from lifestyle changes, including:

Correcting underlying vitamin and nutrient deficiencies
Incorporating anti-inflammatory and Autoimmune Protocol (AIP) principles
Prioritizing your sleep, hydration, activity, and stress management

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A note from Paloma Health

A comprehensive approach to treating Hashimoto’s and hypothyroidism – even after surgical thyroid removal – can help improve your symptoms and quality of life.

Our experienced thyroid practitioners at Paloma Health take a personalized approach to managing hypothyroidism. So, if you live with Hashimoto’s and an underactive thyroid and are wondering about your treatment options, schedule a free consultation with one of our care team members.

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Frequently asked questions

Can you have Hashimoto’s disease without a thyroid gland?

Yes. Even after your thyroid gland is surgically removed, your immune system can still produce antibodies that attack thyroid tissue. This means the autoimmune Hashimoto’s process can remain active even though the gland itself is gone.

What happens to thyroid antibodies after a thyroidectomy?

Thyroid antibody (TPO antibody) levels typically drop significantly after the thyroid gland is removed, and many people see their symptoms improve. In some people, though, antibody levels remain elevated, which is a sign that the autoimmune Hashimoto’s activity is still ongoing.

Does removing the thyroid gland cure Hashimoto’s disease?

Not necessarily. While thyroidectomy often lowers antibody levels and eases symptoms for many patients, it doesn’t guarantee the autoimmune process stops completely. Some people continue to have symptoms like fatigue, joint and muscle tenderness, dry mouth and eyes, weight gain, or depression after surgery.

Do you still need thyroid medication after a thyroidectomy?

Yes. Once the thyroid gland is removed, your body can no longer make thyroid hormone on its own, so surgery always results in hypothyroidism. This means lifelong thyroid hormone replacement therapy is needed to restore and optimize thyroid hormone levels.

Can thyroid surgery help relieve Hashimoto’s symptoms?

For some patients, yes. Studies described in this article found that people with persistent Hashimoto’s symptoms and very high TPO antibody levels often saw their antibody levels drop and their symptoms improve after thyroidectomy, with many reporting more energy, fewer medication changes, and better overall health. That said, this benefit needs to be weighed against the certainty of lifelong hypothyroidism after surgery.

References:

Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550-1562. doi:https://doi.org/10.1016/s0140-6736(17)30703-1

Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism. Thyroid. 2014; 24(12): 1670 - 1751. doi:https://doi.org/10.1089/thy.2014.0028

Sharma V. Thyroid Surgery for patients with Hashimoto’s disease. American Thyroid Association - Clinical Thyroidology for the Public. 2019;7:8-9. https://www.thyroid.org/patient-thyroid-information/ct-for-patients/july-2019/vol-12-issue-7-p-8-9/

Thatipamala P, Noel JE, Orloff L. Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms. Ear, Nose & Throat Journal. 2020;101:7. doi:https://doi.org/10.1177/0145561320967332

Wartofsky L. Hashimoto’s Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published April 5, 2019. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

Vol 12 Issue 7 p.8-9. American Thyroid Association. https://www.thyroid.org/patient-thyroid-information/ct-for-patients/july-2019/vol-12-issue-7-p-8-9/

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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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