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5 Common Triggers of Hashimoto's Flare-Up

Five of the top triggers of autoimmune flare-ups, and how to avoid them.
5 Common Triggers of Hashimoto's Flare-Up
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Autoimmune disease happens when the body's defense system cannot tell the difference between its local cells and foreign cells. It begins to attack the body's healthy cells. Many researchers believe this response occurs after an infection or injury. 

Hashimoto's thyroiditis is an autoimmune disorder where the body produces antibodies that attack the thyroid. Thyroid autoimmunity is the leading cause of hypothyroidism in the United States. 

An autoimmune flare-up is a period of worsening and intensification of symptoms due to an added stressor (even something minor) on an already compromised immune system.

Ahead, five of the top triggers of autoimmune flare-ups, and how to avoid them.

Five triggers of autoimmune flare-ups


Gluten is a protein found in wheat, rye, barley, and other grains. 

There is an association between celiac disease and Hashimoto's disease. While the research is inconclusive, a gluten-free diet may benefit those with Hashimoto's. 

Gluten may irritate the small intestine, causing intestinal permeability (a.k.a leaky gut). Leaky gut weakens the junctions in the intestines, allowing toxins to escape from the gut into the bloodstream. Your immune system sees these as invaders and begins to attack the body, including the thyroid gland.

Many food items may contain gluten, often in hidden or unexpected ways: 

  • Wheat and derivatives of wheat
  • Rye, barley, triticale, or malt
  • Brewer's yeast
  • Pasta like ravioli, dumplings, couscous, and gnocchi
  • Noodles like ramen, udon, or egg noodles
  • Bread and pastries like croissants, bagels, muffins, donuts, etc.
  • Crackers like pretzels or graham crackers
  • Cereal and granola often made with regular oats (not gluten-free oats) 
  • Many sauces and gravies
  • Salad dressings may contain malt vinegar, soy sauce, or flour
  • Soy sauce
  • Most beer or any malt-beverages (note that distilled alcohol is gluten-free)
  • Energy or granola bars
  • Potato chip seasoning
  • Processed lunch meats
  • Candy and candy bars
  • Many meat substitutes made with seitan (wheat gluten)

This list is not exhaustive. You may choose to work work with a thyroid nutritionist to determine if gluten is a dietary trigger for you.

Other dietary triggers

Dietary stress can lead to increased gastrointestinal (GI) distress, chronic inflammation, and a possible elevation in thyroid antibodies that indicate the presence of Hashimoto's disease. Exposure to reactive food may cause symptoms like diarrhea, bloating, acid reflux, gas, or cramping in the GI tract. You may also experience respiratory, muscular, or skin symptoms.

A registered dietitian nutritionist can help you experiment with an elimination diet to identify your dietary triggers. 

Sustained stress

Stress affects your thyroid function. When your body is stressed, your adrenal glands produce cortisol. Studies suggest that elevated levels of thyroid-stimulating hormone are associated with high levels of cortisol. Managing stress is essential to protect or calm your body from an autoimmune flare-up.

To reduce stress:

  • Aim for seven to nine hours of sleep each night
  • Eat nutrient-dense foods to fuel your body
  • Move your body a little bit each day
  • Practice mindfulness or relaxation techniques
  • Connect with those who are important to you.

Viral infections

Viral infections (like rubella, mumps, or Epstein Barr virus) are one such environmental factor that may induce an autoimmune flare-up. This response happens because viruses cause inflammation as your body tries to fight.

Use these tips to prevent a virus:

  • Wash your hands frequently
  • Aim for seven to nine hours of sleep each night
  • Avoid touching your face
  • Clean and disinfect surfaces

Insufficient sleep

Getting enough sleep is vital to improving thyroid health. If you have a hard time falling asleep, staying asleep, or get low quality sleep, you could be setting yourself up for an autoimmune flare-up.

Use these tips to improve your sleep:

  • Plan for seven to nine hours of sleep each night
  • Do some form of physical activity every day
  • Do not bring technology into your bed or bedroom
  • Try a multivitamin in the morning and magnesium at night

Download our simple sleep guide here. 

A note from Paloma Health

Learning to recognize your triggers for an autoimmune flare-up will help you navigate Hashimoto's disease. Schedule a free call with a care advisor to determine if Paloma Health can help you identify and manage your condition. 


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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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