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Hashimoto's disease. Symptoms, Causes, Laboratory Tests, Treatment

Hashimoto's disease, also known as Hashimoto's thyroiditis or chronic lymphocytic thyroiditis, is an autoimmune disorder that primarily affects the thyroid gland. It is the most common cause of hypothyroidism (underactive thyroid). The main characteristics of Hashimoto’s disease are:

  • Autoimmune nature: Hashimoto's disease occurs when the body's immune system mistakenly attacks and damages the thyroid gland. The exact cause of this autoimmune response is not fully understood, but a combination of genetic predisposition and environmental triggers is thought to be involved.
  • Thyroid inflammation and damage: In Hashimoto's disease, the immune system produces antibodies (thyroid peroxidase antibodies or TPOAb and thyroglobulin antibodies or TgAb) that target and attack the thyroid gland. This leads to chronic inflammation and progressive destruction of thyroid tissue over time.
  • Hypothyroidism: As the thyroid gland is damaged, it becomes less able to produce sufficient amounts of thyroid hormones—triiodothyronine (T3) and thyroxine (T4). This results in hypothyroidism, where the body's thyroid hormone levels are lower than normal. Hypothyroidism can cause a wide range of symptoms, including fatigue, weight gain, sensitivity to cold, depression, and cognitive difficulties.
  • Goiter formation: In response to the inflammation and destruction of thyroid tissue, the thyroid gland may enlarge and form a goiter. A goiter is a visible or palpable swelling in the front of the neck. However, not all individuals with Hashimoto's disease develop a goiter.
  • Prevalence and demographics: Hashimoto's disease is more common in women than in men, with a female-to-male ratio of about 10:1. It typically affects middle-aged individuals, although it can occur at any age. The disease can run in families, suggesting a genetic component.
  • Diagnosis: Hashimoto's disease is diagnosed through a combination of medical history, physical examination, blood tests, and imaging studies. Blood tests can reveal elevated levels of TPOAb and TgAb, as well as decreased levels of thyroid hormones (T3 and T4) and increased levels of thyroid-stimulating hormone (TSH).
  • Treatment: The primary treatment for Hashimoto's disease is thyroid hormone replacement therapy. Synthetic thyroid hormones, such as levothyroxine, are prescribed to replace the deficient thyroid hormones and restore normal thyroid function. Regular monitoring of thyroid hormone levels is important to ensure the proper dosage of medication.
  • Lifestyle management: In addition to medication, certain lifestyle measures can help manage Hashimoto's disease. These may include maintaining a balanced diet, managing stress levels, getting regular exercise, and ensuring adequate sleep.
Causes of Hashimoto's Disease

The exact cause of Hashimoto's thyroiditis is not fully understood, but a combination of genetic and environmental factors is believed to play a role. Factors that may contribute to the development of Hashimoto's thyroiditis:

  • Genetic predisposition: Certain genetic variations (genes FOXP3, HLA-DRB1, PTPN22, SLC26A4, TG) can increase the risk of developing autoimmune diseases like Hashimoto's thyroiditis. Having a family history of autoimmune diseases, including Hashimoto's, can increase susceptibility.
  • Hormonal factors: Women are more likely to develop Hashimoto's thyroiditis than men, suggesting that hormonal factors may play a role. It is particularly common during the postpartum period and perimenopause.
  • Imbalance in the immune system: Hashimoto's thyroiditis is caused by an immune system dysfunction in which the body's immune cells mistakenly attack the thyroid gland. This can be triggered by an imbalance in the immune response, possibly influenced by environmental factors.
  • Environmental triggers: Certain environmental factors and triggers have been associated with the development of Hashimoto's thyroiditis. These may include viral infections, exposure to excessive iodine, radiation exposure, and certain medications.
  • Other autoimmune conditions: Individuals with other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, or lupus, have an increased risk of developing Hashimoto's thyroiditis. There may be a shared underlying mechanism that leads to the development of multiple autoimmune conditions.
Symptoms of Hashimoto's disease

Hashimoto's thyroiditis is the most common cause of hypothyroidism (underactive thyroid). Signs and symptoms commonly associated with Hashimoto's thyroiditis include:

  • Fatigue: Feeling constantly tired and lacking energy is a common symptom of Hashimoto's thyroiditis.
  • Weight gain: Unexplained weight gain or difficulty losing weight despite efforts can be a sign of an underactive thyroid.
  • Sensitivity to cold: Feeling unusually sensitive to cold temperatures, even when others are comfortable, is a common symptom of hypothyroidism.
  • Constipation: Sluggish bowel movements and difficulty passing stools can occur in individuals with an underactive thyroid.
  • Muscle and joint pain: Hashimoto's thyroiditis can cause muscle and joint pain, often accompanied by stiffness.
  • Depression and mood changes: Changes in mood, such as depression, irritability, and anxiety, can be associated with an underactive thyroid.
  • Dry skin and hair: The skin may become dry, rough, and pale, while the hair may become thin, brittle, and prone to breakage.
  • Swelling in the neck: Some individuals with Hashimoto's thyroiditis may develop a goiter, which is an enlargement of the thyroid gland that can cause visible swelling in the neck.
  • Menstrual irregularities: Women with Hashimoto's thyroiditis may experience irregular menstrual cycles or heavy periods.
  • Cognitive difficulties: Some individuals may experience difficulty concentrating, memory problems, and brain fog.

Not everyone with Hashimoto's thyroiditis will experience all of these symptoms, and the severity of symptoms can vary from person to person.

Laboratory tests for Hashimoto's disease

To diagnose Hashimoto's disease and monitor its progression and treatment, several laboratory tests are commonly used. Here are the key lab tests typically performed for Hashimoto's disease:

  • Thyroid-stimulating hormone (TSH): This test measures the level of TSH in the blood. Elevated TSH levels indicate an underactive thyroid (hypothyroidism), which is a common feature of Hashimoto's disease.
  • Free thyroxine (FT4): FT4 measures the amount of free thyroxine, the active form of thyroid hormone, in the blood. In Hashimoto's disease, FT4 levels may be decreased due to impaired thyroid function.
  • Thyroid peroxidase antibody (TPOAb): This test detects the presence of antibodies against thyroid peroxidase, an enzyme involved in the production of thyroid hormones. Most individuals with Hashimoto's disease have elevated levels of TPOAb, confirming the autoimmune nature of the condition.
  • Thyroglobulin antibody (TgAb): TgAb is another antibody test that measures the presence of antibodies against thyroglobulin, a protein involved in thyroid hormone production. Elevated TgAb levels can further support the diagnosis of Hashimoto's disease.
  • Total triiodothyronine (T3): T3 is another thyroid hormone, but its measurement may not be routinely done in the diagnosis of Hashimoto's disease. However, in some cases, it may be used to evaluate thyroid function more comprehensively.

These laboratory tests help confirm the diagnosis of Hashimoto's disease and determine the severity of thyroid dysfunction. They also aid in monitoring the effectiveness of thyroid hormone replacement therapy and adjusting medication dosage as needed. Regular monitoring of these lab tests is essential to ensure appropriate management of Hashimoto's disease and to optimize thyroid hormone levels.

Functional Medicine Laboratory tests for Hashimoto's disease

Functional medicine practitioners may utilize additional laboratory tests to provide a more comprehensive assessment of Hashimoto's disease and underlying factors that may be contributing to the condition. Examples of functional medicine lab tests that may be considered:

  • Reverse T3 (rT3): Reverse T3 is a biologically inactive form of T3. Elevated levels of rT3 may indicate a disruption in the conversion of T4 to active T3, which can affect thyroid function.
  • Thyroid antibodies panel: In addition to TPOAb and TgAb, functional medicine practitioners may assess other thyroid antibodies, such as thyroglobulin blocking antibodies (TBAbs), and thyrotropin receptor antibodies (TRAbs). These antibodies can provide further insight into the immune response and thyroid gland dysfunction.
  • Adrenal function tests: The adrenal glands play a role in regulating stress response and may interact with thyroid function. Tests such as cortisol and DHEA-S levels, and adrenal hormone profiles (AdrenalScan®), may be used to evaluate adrenal gland function and assess any potential impact on thyroid health.
  • Nutritional and micronutrient tests: Nutrient deficiencies or imbalances can impact thyroid health. Tests such as vitamin D, selenium, zinc, iron, iodine, and B complex vitamin levels may be performed to evaluate nutritional status.
  • Comprehensive stool analysis (EnteroScan®): This test assesses the health and balance of the gut microbiome, which can influence immune function and contribute to autoimmune conditions. Imbalances in gut bacteria and the presence of intestinal infections or dysbiosis may be identified.
  • Food intolerance testing (TrophoScan®): Using food sensitivity testing identifies specific foods that may be triggering an immune response and exacerbating Hashimoto's symptoms. Elimination diets or other personalized approaches may be recommended based on these results.
  • Heavy metal testing: Exposure to heavy metals, such as mercury or lead, may contribute to immune dysfunction and thyroid disruption. Testing for heavy metal toxicity and appropriate detoxification recommendations may be beneficial.

The tests mentioned above are just examples, and the specific tests ordered will depend on the patient's unique needs.

Hashimoto's Disease Treatment

The primary treatment for Hashimoto's disease is thyroid hormone replacement therapy, typically with synthetic thyroxine (T4) hormone. The medication is commonly known as levothyroxine and is taken orally.

  • Medication: Thyroid hormone replacement therapy aims to replace the deficient thyroid hormones (T3 and T4) and restore normal thyroid function. Levothyroxine is the standard treatment and is usually taken once daily in the morning on an empty stomach. The dosage is determined based on individual needs and is adjusted over time through monitoring of thyroid hormone levels.
  • Regular monitoring: It's important to have regular follow-up appointments to monitor thyroid hormone levels. Blood tests, including TSH, free T4, and sometimes T3, are typically used to assess thyroid function. The goal is to achieve optimal hormone levels within the normal range.
  • Individualized approach: Treatment is individualized based on the severity of symptoms, age, other medical conditions, and individual response to medication. The dosage may need to be adjusted periodically to ensure proper hormone levels and symptom management.
  • Lifestyle modifications: In addition to medication, certain lifestyle modifications may be beneficial in managing Hashimoto's disease. These may include eating a balanced diet, managing stress, getting regular exercise, and ensuring adequate sleep.
  • Ongoing care: Hashimoto's disease is a chronic condition that requires ongoing management. Regular monitoring of thyroid function and symptoms is important to ensure the effectiveness of treatment and make any necessary adjustments.
Natural Treatments for Hashimoto's Disease

While thyroid hormone replacement therapy with synthetic hormones is the primary treatment for Hashimoto's disease, some individuals may consider incorporating natural therapies or complementary approaches to support their overall well-being. It's important to note that natural therapies should not be used as a substitute for prescribed medications.

  • Diet: Eating a balanced diet that supports thyroid health may be beneficial. This includes consuming foods rich in iodine (such as seaweed, seafood, and iodized salt) and selenium (such as Brazil nuts, sardines, and organ meats), as these nutrients play a role in thyroid function. Some individuals may also consider eliminating potential food triggers, such as gluten or dairy, as they may contribute to inflammation in some cases.
  • Stress management: Chronic stress can impact immune function and worsen autoimmune conditions. Engaging in stress-reducing techniques like meditation, deep breathing exercises, yoga, or mindfulness practices may be helpful in managing stress levels.
  • Exercise: Regular physical activity can support overall well-being and may help alleviate some symptoms associated with Hashimoto's disease, such as fatigue and weight gain.
  • Supplements: Some supplements that have been studied in relation to Hashimoto's disease include selenium, vitamin D, omega-3 fatty acids, and probiotics.
  • Herbal remedies: Some herbal remedies may have potential benefits for thyroid health and immune system support.
  1. Ashwagandha (Withania somnifera): Ashwagandha is an adaptogenic herb that may help support the immune system and reduce stress. Some preliminary studies suggest that it may have a positive effect on thyroid function.
  2. Turmeric (Curcuma longa): Turmeric contains a compound called curcumin, which has anti-inflammatory and antioxidant properties. Some research suggests that curcumin may help modulate the immune system and reduce inflammation, which could be beneficial for Hashimoto's disease.
  3. Ginger (Zingiber officinale): Ginger has anti-inflammatory properties and may help support immune function. It may also assist in reducing inflammation associated with Hashimoto's. However, scientific evidence specific to Hashimoto's is limited.
  4. Licorice root (Glycyrrhiza glabra): Licorice root has been used traditionally to support adrenal function and balance hormone levels. It may help reduce inflammation and support the immune system. However, it's important to use licorice root cautiously, as excessive use can lead to side effects.
  5. Fucus vesiculosus, commonly known as bladderwrack or seaweed, is a type of brown algae that has been used in traditional medicine for various purposes, including thyroid conditions like Hashimoto's. However, it's important to note that the use of Fucus vesiculosus for Hashimoto's thyroiditis is controversial, and scientific evidence supporting its effectiveness is limited.


Vasilis J. Sideris
Medical Doctor, Biopathologist (Microbiologist)
Certified Functional Medicine Practitioner, CFMP®

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