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What Is Hashimoto’s Disease?

Hashimoto’s Disease is the most common cause of hypothyroidism in the United States.
What Is Hashimoto’s Disease?

Hashimoto's thyroiditis is an autoimmune disorder that damages the thyroid gland. Autoimmunity occurs when immune cells attack healthy tissue instead of protecting it, leading to chronic inflammation.

In the case of Hashimoto's thyroiditis, immune cells mistakenly attack healthy thyroid tissue, causing inflammation of the thyroid. This damage can eventually lead to inadequate thyroid hormone production. Without enough thyroid hormones for your body to function correctly, you develop hypothyroidism. 

Hashimoto's thyroiditis is the leading cause of hypothyroidism in the United States, affecting roughly 5% of the population.

Causes of Hashimoto's disease

Doctors aren't entirely sure why the immune system, which is supposed to defend the body from harmful viruses and bacteria, sometimes turns against the body's healthy tissues.

Some scientists think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. A combination of factors — including heredity, sex, and age — may determine your likelihood of developing the disorder.

Hashimoto's thyroiditis is progressive

‍In the early stages, the body compensates and produces more hormone to keep your hormone levels within "normal" ranges. Here, your thyroid is still close to fully functional. While TPO antibodies may be present in the blood, marking the presence of an autoimmune condition, it could take several years before symptoms appear. 

Progressively, as more thyroid tissue is destroyed, the gland loses the ability to compensate, and you begin to become deficient in thyroid hormone. You might start to feel symptoms as your immune cells start working faster to destroy your thyroid gland.

Eventually, the gland completely loses its ability to produce thyroid hormone, considered the end-stage of Hashimoto's thyroiditis. 

Symptoms of Hashimoto's Disease

You might not notice signs or symptoms of Hashimoto's disease at first, or you may see a swelling at the front of your throat (goiter). Hashimoto's disease typically progresses slowly over the years. It causes chronic thyroid damage, leading to a drop in thyroid hormone levels in your blood.

The signs and symptoms are mainly those of hypothyroidism:

  • Enlarged thyroid gland (goiter)
  • Increased sensitivity to cold/inability to get warm
  • Fatigue
  • Hoarse voice
  • Sluggishness
  • Dry, pale skin
  • Constipation
  • Hair loss 
  • Brittle nails or hair
  • Difficulty getting pregnant
  • Puffy face
  • High cholesterol
  • Unexplained weight gain
  • Enlargement of the tongue
  • Slowed heart rate
  • Joint or muscle pain or stiffness
  • Muscle weakness or tenderness
  • Depression
  • Lapses in memory
  • Prolonged or excessive menstrual bleeding

Complications of Hashimoto's Disease


Pregnancy is identified as a trigger for Hashimoto's and can cause postpartum thyroiditis. Women with positive TPO antibodies have an increased risk of miscarriage. 


Polyautoimmunity is the condition in which one person has two or more autoimmune conditions. Hashimoto's may be associated with other autoimmune diseases such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis, celiac disease, lupus, or Addisons' disease. 

Genetic predisposition

Relatives of those who have Hashimoto's are at greater risk for developing Hashimoto's. Those who are genetically predisposed should be careful around environmental triggers like iodine intake, toxins, and certain medications. 

D‍iagnosis of Hashimoto's disease

If you experience symptoms of Hashimoto's, a simple blood test can help you understand how your thyroid is working.

Many labs look only at Thyroid Stimulating Hormone (TSH) to assess thyroid health. We believe it's critical to also measure Free Triiodothyronine (fT3), Free Thyroxine (fT4), and TPO antibodies. The antibody test is used to determine whether or not you are producing antibodies against thyroid peroxidase.‍

Many thyroid symptoms are nonspecific, often leading to a mis- or missed diagnosis. Often, patients receive a diagnosis of depression, anxiety, or stress. Doctors prescribe antidepressants or anti-anxiety medications without further evaluation of their thyroid function. For this reason, it is essential to take a complete blood panel to get the full picture.

Treatment for Hashimoto's thyroiditis


Most commonly, pure synthetic thyroxine (T4), taken once daily by mouth, fully replaces the thyroid gland and successfully treats the symptoms of hypothyroidism in most patients. For the few patients who do not feel completely normal taking a synthetic preparation of T4 alone, the addition of synthetic T3 may be of benefit.

Work with your doctor to find the right treatment for you. We are all unique with individual sensitivities, so our bodies will not all react the same way to a specific medication.

We advise a slow, step-by-step method of reaching your optimal dose, which is easier on the body than a sock-it-to-me approach. The goal is to get you feeling your best while managing symptoms.

Lifestyle modifications

Nutrition matters. What you eat may affect your thyroid disease, including the absorption of your thyroid medication. Nutrition, supplements, and lifestyle optimization have been shown to make a difference in some instances and are personal to each patient.

Talk to your Paloma practitioner for more details about how personalized dietary guidance and health coaching might benefit you.


While you cannot reverse autoimmune disease, you can stall progression. A healthy diet and exercise routine helps to limit the progress of the disease. There is no cure for Hashimoto's, so proactively monitoring and adjusting your treatment plan is critical to feeling your best each day.

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