Discussing Hashimoto's Disease

on Fri 11 Dec

Hashimoto’s disease is more correctly known as “Autoimmune Thyroiditis” (AT) because the immune system mistakenly attacks the thyroid gland as a threat to the body. This causes your immune system to produce special antibodies which inflame and destroy the thyroid cells.


This chronic disorder causes a slow failure of thyroid hormone production and often develops over many years. It can be tricky to diagnose since often Hashimoto’s disease sufferers will have blood test results that are within normal range or only just outside the laboratory reference range.


Possible symptoms in Hashimoto’s disease

  • Fatigued or run down
  • Depression
  • Unexplained or excessive weight gain
  • Constipation
  • Dry sometimes itchy skin
  • Dry, sometimes thinning hair
  • Difficulty in concentrating/thinking
  • Feeling cold
  • More frequent and heavy periods
  • Subfertility and miscarriage


 Hashimoto’s disease can occur at any age but is seen most frequently in middle aged women and in people with a family history of thyroid problems.


Although the symptoms are similar, Hashimoto’s disease is not always thyroid failure or hypothyroidism (although left untreated it can develop into this) and there is some controversy about treating the condition with Levothyroxine.


It is important to get an accurate diagnosis of the condition for three reasons:


  • Overall improved well-being
  • To make sure this is not symptom of a different challenge with an autoimmune condition
  • Awareness of the risk of progression to hypothyroidism
  • To ensure a successful thyroid environment pre-conception and in pregnancy


If you have the above symptoms but normal blood test results you might ask your GP to consider Hashimoto’s thyroiditis and request a blood test for TPO antibodies.  If this is high you may have Hashimoto’s disease but to be sure a TSH test should then be repeated 3 months later:


  • If a transient, modest elevation in TSH levels are found this may indicate recovery from non-thyroidal illness.


  • If the symptoms are consistent with hypothyroidism and the TSH elevation persists, then a 3-6 month therapeutic trial of levothyroxine may be a reasonable approach.


  • If the patient feels improved by therapy, as a minority will, it is reasonable to continue treatment.


  • If there are no symptoms and the TSH level appears stable with positive TPO antibodies, the risk of progression to overt hypothyroidism is a little less than 5% per year and so an annual TSH surveillance strategy is warranted.


  • If the TPO antibodies are negative, then 3-yearly TSH surveillance is the current recommendation, with the risk of progression to overt hypothyroidism being around 2% per year.


The exception to the above is in pregnancy, or in someone trying to conceive, when mild hypothyroidism should always be treated as it is associated with adverse outcomes for both mother and foetus.





Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.


As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link.


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