Hashimoto’s thyroiditis is one the most common autoimmune diseases. It affects 1-2% of the US population but is more common in women, especially around middle age. But it can affect all age groups from children to elderly. In the US, it is the most common cause of hypothyroidism over the age of 6. It also has a very strong genetic predisposition so it often runs in families. 

What’s with the name? 

Hashimoto’s thyroiditis was described in 1912 by a Japanese surgeon named Dr. Hakaru Hashimoto. He wrote an article in a medical journal describing a set of symptoms in a small group of female patients who were all found to have intense infiltration of their thyroid gland with lymphocytes or immune cells. The thyroid glands were noted to be fibrosed or showed long term tissue degeneration. Another scientific name for Hashimoto’s disease is chronic lymphocytic thyroiditis or autoimmune-mediated inflammation of the thyroid gland. 

If I have Hashimoto’s, does that mean I also have hypothyroidism?

The terms Hashimoto’s and hypothyroidism are sometimes used interchangeably by the general population (“I am on Synthroid because I have Hashimoto’s”) but they are not the same thing. Many people with Hashimoto’s do not have hypothyroidism. And many people with hypothyroidism do not have Hashimoto’s. Have I confused you thoroughly?!

Hashimoto’s = evidence of chronic inflammation in the gland which is caused by the immune system. 

How to test for this: blood tests such as thyroid peroxidase (TPO) antibodies or thyroglobulin (Tg) antibodies. It may also be noted on thyroid ultrasound imaging. 

Hypothyroidism = lower than normal production of thyroid hormone within the thyroid gland. 

How to test for this: blood tests indicating the levels of thyroid hormone which include TSH, T4 and T3. 

What are the stages of Hashimoto’s?

Stage I: inflammation but normal gland function, no symptoms

Stage II: inflammation, normal gland function but the beginning of symptoms

Stage III: decreased gland function, more symptoms

Stage I is the subclinical stage. It is very hard to pick up on Hashimoto’s at this time because it is not a standard screening test included in your annual physical and you do not have any symptoms to suspect it. Typical thyroid screening tests such as TSH or T4 look normal as the thyroid gland is still functioning normally despite being attacked by your immune system. The inflammation has not yet caused permanent damage to the thyroid gland. 

Stage II: By now, there is actual damage to the thyroid tissue caused by antibodies from your own immune system. At this stage many people report the beginnings of hypothyroid symptoms. Those with family members with Hashimoto’s may request to be tested for it or your doctor may suspect it based on your family history. For others, it could still be easily missed as they have normal thyroid function tests such as TSH and T4. And many of the symptoms of hypothyroidism are vague and non-specific such as fatigue, brain fog, weight gain, constipation, heavy periods etc. 

Stage III: this is typically seen after chronic autoimmune inflammation in the thyroid gland, often stretching over years. The repeated cycles of inflammation cause destruction of the thyroid glandular tissue and fibrosis which in time leads to a decline in how much thyroid hormone your gland is able to produce. When this happens, lab tests reveal low levels of thyroid hormones, or hypothyroidism. 

If you have a diagnosis of Hashimoto’s and have been told, “there is nothing you can do about it” or “your TSH is normal so there is no reason for you to have any hypothyroid symptoms”, do not lose hope! There is much that can be done to lower inflammation in your thyroid in order to preserve the function of the gland as long as you can. And you can also work towards addressing your symptoms with diet modifications, natural supplements or in some cases, medications to boost thyroid hormone levels. 

In my upcoming posts, I will share some tips on how to live with Hashimoto’s and make healthy, proactive choices. I will also discuss when it warrants treatment with medications. 

Yours in good health, 

Ashita Gupta, MD