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What is Hashimoto thyroiditis?

Hashimoto thyroiditis, also known as Hashimoto's disease or chronic lymphocytic thyroiditis, is an autoimmune condition that affects the thyroid gland. In this disorder, the immune system mistakenly identifies the thyroid gland as a threat and begins to attack it. This ongoing autoimmune attack can lead to inflammation and damage to the thyroid, ultimately interfering with its ability to produce essential hormones.

The thyroid gland plays a crucial role in regulating various bodily functions, including metabolism, energy production, and temperature regulation. When Hashimoto thyroiditis is present, the thyroid's ability to produce hormones, particularly thyroxine (T4) and triiodothyronine (T3), is compromised. This can result in an underactive thyroid, a condition known as hypothyroidism.

What are the symptoms of Hashimoto thyroiditis?

  • Fatigue

  • Weight gain

  • Sensitivity to cold

  • Dry skin and hair

  • Hair loss

  • Muscle weakness

  • Joint pain

  • Constipation

  • Irregular menstrual cycles

  • Depression

  • Memory issues

  • Swelling in the neck


Causes of Hashimoto thyroiditis

  • Genetics: Family history can play a significant role in Hashimoto thyroiditis. If a close relative has the condition or another autoimmune disorder, your risk may be higher.

  • Autoimmune factors: Hashimoto thyroiditis is classified as an autoimmune disease, meaning it occurs when the immune system mistakenly attacks healthy thyroid tissue. The precise trigger for this autoimmune response is still under investigation, but it's thought to involve a combination of genetic predisposition and environmental factors.

  • Hormonal changes: Changes in hormone levels, such as those that occur during pregnancy, postpartum, or menopause, may contribute to the development of Hashimoto thyroiditis.

  • Exposure to radiation: High levels of exposure to ionizing radiation, especially in the neck and throat area, have been associated with an increased risk of developing thyroid disorders, including Hashimoto thyroiditis.

  • Viral infections: Some viral infections, particularly those affecting the thyroid gland, have been studied in relation to the development of autoimmune thyroid diseases, including Hashimoto thyroiditis. However, the relationship is complex and not fully understood.

  • Iodine intake: Excessive or deficient iodine intake in the diet has been suggested as a potential trigger for Hashimoto thyroiditis, although this link is still debated among experts.


Diagnosing Hashimoto disease

  • The process often begins with a thorough medical history and physical examination by a healthcare provider. During the examination, the doctor may check for physical signs, such as an enlarged thyroid gland (goiter), which is a common feature of Hashimoto thyroiditis.

  • Blood tests are essential for diagnosing Hashimoto thyroiditis. The following blood tests are commonly used:

    • Thyroid function tests measure the levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH) in the blood. In Hashimoto thyroiditis, T3 and T4 levels are typically low, while TSH levels are high, indicating an underactive thyroid.

    • Anti-thyroid antibodies, such as anti-thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies, are often elevated in Hashimoto thyroiditis. These antibodies are indicative of an autoimmune response against the thyroid gland.

  • In some cases, an ultrasound of the thyroid gland may be performed to assess the size, shape, and structure of the thyroid. This can help confirm the presence of a goiter and assess the degree of inflammation and damage to the thyroid.

  • If a thyroid nodule is present, a fine-needle aspiration biopsy may be recommended. This involves using a thin needle to collect a tissue sample from the nodule to rule out other thyroid conditions, such as thyroid cancer.

  • In certain situations, additional tests, such as a radioactive iodine uptake test or a thyroid scan, may be necessary to assess thyroid function and confirm the diagnosis.


Once the diagnosis is confirmed, a St. Luke’s Health endocrinologist will work with you to develop an appropriate treatment plan. 

Hashimoto's thyroiditis treatment

The treatment for Hashimoto's thyroiditis primarily aims to manage the symptoms and address the underlying cause of the condition, which is an underactive thyroid (hypothyroidism) due to autoimmune inflammation. The primary treatment approaches for Hashimoto thyroiditis include:

  • Thyroid hormone replacement: The cornerstone of Hashimoto thyroiditis treatment is the use of synthetic thyroid hormones, such as levothyroxine (Synthroid). This medication effectively replaces the missing thyroid hormones (T3 and T4) in the body, helping to restore normal thyroid function. The dosage is adjusted based on regular monitoring of thyroid hormone levels in the blood.

  • Regular monitoring: It's crucial to monitor thyroid hormone levels regularly to ensure that the dosage of thyroid hormone replacement medication is appropriate. This typically involves periodic blood tests to check TSH, T3, and T4 levels.

  • Lifestyle management: Adopting a healthy lifestyle can complement treatment and improve overall well-being. This includes eating a balanced diet, getting regular exercise, and managing stress.

  • Dietary considerations: Some individuals find benefit from dietary modifications, particularly in cases of iodine deficiency or gluten sensitivity. Reducing iodine intake and, in some cases, following a gluten-free diet may be recommended.

  • Management of symptoms: Specific symptoms of Hashimoto thyroiditis, such as fatigue, weight gain, and depression, may be managed with appropriate treatments. For example, medications or therapy may be prescribed for depression if it's a significant concern.

  • Addressing other autoimmune conditions: Hashimoto thyroiditis is often associated with other autoimmune conditions, such as celiac disease or type 1 diabetes. Managing these co-existing conditions is an essential part of comprehensive care.

  • Supplements and natural remedies: Some individuals explore the use of supplements and natural remedies to alleviate symptoms, but it's crucial to discuss these with a healthcare provider to ensure they do not interfere with thyroid hormone replacement therapy.

  • Surgical intervention: In rare cases where a goiter (enlarged thyroid) becomes significantly large, surgery to remove part or all of the thyroid gland may be considered.


Tips for maintaining thyroid health with Hashimoto's disease

  • Medication adherence: If you have been prescribed thyroid hormone replacement medication, take it as directed by your healthcare provider. Consistency in medication is essential to maintain thyroid hormone levels within the optimal range.

  • Regular follow-up: Schedule regular check-ups with your healthcare provider to monitor your thyroid function. Adjustments to medication dosages may be needed over time, so monitoring is critical.

  • Balanced diet: Eat a well-balanced diet rich in whole grains, lean proteins, fruits, and vegetables. Limit processed foods, excessive iodine intake, and goitrogenic foods (e.g., soy, cruciferous vegetables) that may interfere with thyroid function.

  • Adequate iodine intake: Ensure you have an appropriate but not excessive intake of iodine. Iodine is essential for thyroid hormone production, but too much can worsen thyroid dysfunction.

  • Gluten sensitivity: Some individuals with Hashimoto's disease also have gluten sensitivity. If you suspect this, consider trying a gluten-free diet, as it may help reduce inflammation.

  • Stress management: Chronic stress can worsen thyroid symptoms. Incorporate stress-reduction techniques such as yoga, meditation, deep breathing exercises, or mindfulness into your daily routine.

  • Regular exercise: Engage in regular physical activity to support metabolism and overall health. Exercise can help combat fatigue and support weight management.

  • Adequate sleep: Ensure you get enough quality sleep each night, as sleep plays a crucial role in overall health and energy levels.

  • Hydration: Stay well-hydrated by drinking an adequate amount of water each day. Proper hydration supports various bodily functions.

  • Avoid smoking: If you smoke, consider quitting, as smoking can exacerbate thyroid-related issues.

  • Thyroid supplements: Consult your healthcare provider before taking any thyroid supplements or herbal remedies. They can guide you on what is safe and effective.

  • Thyroid self-checks: Periodically, check your neck for signs of a goiter or any unusual lumps. If you notice any changes, consult your healthcare provider.

Consult with your endocrinologist before making significant modifications to your diet or exercise routine, as they can provide personalized recommendations based on your specific condition and treatment plan.

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