Hashimoto's thyroiditis is the most common autoimmune disease in the world, and it disproportionately affects women - we're 7-10 times more likely to develop it than men. Yet many women with Hashimoto's go undiagnosed for years, being told their thyroid is "normal."
Here's what you need to know about this condition that may be silently attacking your thyroid.
What Is Hashimoto's Thyroiditis?
Hashimoto's is an autoimmune condition where your immune system mistakenly attacks your thyroid gland. Over time, this chronic attack damages the thyroid, leading to hypothyroidism (underactive thyroid).
The hallmark of Hashimoto's is the presence of thyroid antibodies - specifically TPO antibodies (anti-thyroid peroxidase) and/or TgAb (anti-thyroglobulin antibodies).
Why Standard Testing Misses Hashimoto's
Most doctors only check TSH when evaluating thyroid function. Here's the problem:
- Antibodies can be elevated for years before TSH becomes abnormal
- During this time, your thyroid is being damaged, and you may already have symptoms
- TSH can fluctuate, appearing "normal" one month and abnormal the next
- Some people have Hashimoto's with completely normal TSH throughout
Testing only TSH is like checking if your house is on fire by looking at the smoke detector after the fire is out. Antibody testing catches the problem at the source.
Symptoms of Hashimoto's
Symptoms can vary widely and often overlap with other conditions:
- Fatigue - often crushing, unrelieved by sleep
- Weight gain or difficulty losing weight
- Brain fog and difficulty concentrating
- Hair loss - including eyebrow thinning
- Cold intolerance
- Constipation
- Depression and anxiety
- Muscle aches and joint pain
- Dry skin
- Irregular or heavy periods
- Goiter (enlarged thyroid)
Some people also experience periods of hyperthyroid symptoms (racing heart, anxiety, weight loss) as damaged thyroid tissue releases stored hormone - this is sometimes called "Hashitoxicosis."
The Tests You Need
Thyroid Antibodies
- TPO Antibodies (Anti-TPO): Elevated in about 90% of Hashimoto's cases
- Thyroglobulin Antibodies (TgAb): Elevated in about 80% of cases; some people have only TgAb elevated
Complete Thyroid Panel
- TSH: May be normal, elevated, or fluctuating
- Free T4: May be low or low-normal
- Free T3: Often low even when T4 is normal (conversion issue)
- Reverse T3: May be elevated in Hashimoto's, especially with stress
Risk Factors for Hashimoto's
- Being female - women are 7-10x more likely to develop it
- Family history of thyroid disease or autoimmune conditions
- Having another autoimmune condition (celiac, type 1 diabetes, rheumatoid arthritis)
- Pregnancy or postpartum - often triggers onset
- Excessive iodine intake
- Chronic stress
- Viral infections (Epstein-Barr has been linked)
- Nutrient deficiencies (selenium, vitamin D, iron)
Living with Hashimoto's
Hashimoto's is a lifelong condition, but it can be managed effectively:
Medical Treatment
Once thyroid function declines enough, most people need thyroid hormone replacement (levothyroxine or natural desiccated thyroid). Some do better with combination T4/T3 therapy.
Lifestyle Factors
- Gluten: Many with Hashimoto's benefit from reducing or eliminating gluten due to molecular mimicry between gluten and thyroid tissue
- Selenium: Studies show selenium supplementation can reduce antibody levels
- Vitamin D: Deficiency is extremely common in Hashimoto's; optimizing levels may help
- Stress management: Stress can trigger flares and worsen autoimmunity
- Gut health: The gut-thyroid connection is significant; addressing gut issues may reduce antibodies
Tracking Your Hashimoto's
Once diagnosed, regular monitoring helps guide treatment:
- Track thyroid antibodies periodically - declining levels often correlate with feeling better
- Monitor TSH, Free T4, and Free T3 together - not just TSH
- Check related markers: vitamin D, B12, iron/ferritin, and inflammation markers
- Keep a symptom journal to correlate with lab values
Important: Some people feel terrible even with "normal" TSH. Optimal is not the same as normal. Advocate for treatment based on symptoms, not just lab values.
Get Tested, Get Answers
If you have unexplained fatigue, weight gain, brain fog, hair loss, or a family history of thyroid issues, request thyroid antibody testing. A simple blood test could reveal an autoimmune process that's been silently affecting your health.
Early detection allows for earlier intervention - and that can make a real difference in how you feel.
Don't wait for your thyroid to fail. Get your thyroid antibodies tested with EllaDx's comprehensive thyroid panel.