What are the signs and symptoms of Hashimoto’s?

By Josh Redd, MS, DABFM, DAAIM, Chiropractic Physician

Hypothyroidism, or low thyroid function, is a common diagnosis these days. However, did you know that an autoimmune disease called Hashimoto’s causes more than 90 percent of hypothyroidism cases? In this article I’ll talk about the symptoms and lab markers that identify Hashimoto’s hypothyroidism.

Hashimoto’s is an autoimmune disease, meaning the immune system attacks and destroys the thyroid gland, gradually worsening its function.

However, most doctors won’t test you for Hashimoto’s because it doesn’t change how they treat you. The standard treatment is to prescribe thyroid hormone replacement medication.

But understanding the symptoms of Hashimoto’s, as well as which lab tests to order, can help you better manage your autoimmune condition.

You feel worse despite taking your thyroid medication

One of the most common signs of Hashimoto’s is that you continue to have thyroid symptoms despite taking your thyroid medication. Your doctor may also need to continually increase your dose over time. This is because the autoimmune attacks against your thyroid gland are gradually destroying its function.

In fact, you may not even notice if you accidentally skip a day of taking your meds because they are so ineffective in the face of ongoing autoimmune attacks.

Even though thyroid function is worsening, the medication produces normal thyroid lab results.

You swing back and forth between low thyroid symptoms and high thyroid symptoms

Bouncing back and forth between low thyroid symptoms and high thyroid symptoms is another common sign of Hashimoto’s.

One week you struggle with fatigue, headaches, constipation, depression, and low libido.

The next week you have insomnia, a racing heart, anxiety, tremors, and feel manic. This is because an autoimmune flare has damaged thyroid tissue, which spills excess thyroid hormone into the bloodstream.

Some people are even misdiagnosed with bipolar disorder because of this.

During a period of low thyroid activity, a blood test will show high TSH (thyroid stimulating hormone). During a period of excess thyroid hormone, TSH will be low.

Your TSH may even be normal during in-between periods. If you have your blood drawn during one of these “normal” periods, this can lead to a misdiagnosis and continuing worsening of your thyroid function.

This is why it’s important to test more often than once a year, such as quarterly.

You have other autoimmune diseases, such as pernicious anemia, celiac disease, multiple sclerosis, or vitiligo

Autoimmune diseases are partly the result of an imbalanced immune system that is chronically inflamed. If this imbalance goes unmanaged, people often develop more than one autoimmune disease.

This is because the hyper zealous immune system becomes overly sensitive to body tissue and starts attacking it instead of protecting it. Which tissues it attacks depends on genetic predisposition and other factors.

Common secondary autoimmune diseases we see in our Hashimoto’s patients include pernicious anemia (an autoimmune disease that causes B12 deficiency), celiac disease, or multiple sclerosis.

In fact, multiple sclerosis, a neurological disease that compromises muscle function, is the most common secondary autoimmune disease in our patients—and a good reason to manage your Hashimoto’s!

Symptoms of Hashimoto’s hypothyroidism

If you think you might have Hashimoto’s, see if any of these symptoms apply to you.

Low thyroid symptoms

  • Always tired or sluggish
  • Cold all the time; cold hands and feet
  • Require excessive amounts of sleep to function well
  • Weight gain despite low-calorie diet and exercise
  • Gain weight very easily
  • Constipation
  • Depression and lack of motivation
  • Morning headaches
  • Outer third of eyebrow thins
  • Thinning of hair on scalp, face, or genitals
  • Hair loss
  • Dry skin and/or scalp
  • Mental sluggishness
  • Brain fog

High thyroid symptoms

  • Heart palpitations
  • Inward trembling
  • Increased pulse rate, even at rest
  • Feeling nervous and emotional
  • Insomnia
  • Night sweats
  • Difficulty gaining weight

Lab tests to identify Hashimoto’s

Symptoms are important but a blood test provides proof of Hashimoto’s.

These are lab markers you want to run:

Thyroid peroxidase antibodies (TPO Ab)

In most cases of Hashimoto’s, the immune system attacks TPO, an enzyme that activates thyroid hormone production.

Thyroglobulin antibodies (TGB Ab)

You should also test for antibodies to TGB, which the thyroid uses to produce thyroid hormones.

Thyroid stimulating hormone antibodies (TSH Ab)

This test can identify Graves’ disease (hyperthyroidism), although sometimes TSH antibodies are elevated in Hashimoto’s. This marker is often labeled as thyroid stimulating immunoglobulin (TSI).

If your autoimmune thyroid condition is advanced or if you react to bioidentical thyroid meds but not synthetic, you may also have antibodies to the thyroid hormones T4 and T3.

When your test comes back negative despite Hashimoto’s hypothyroidism symptoms

Don’t despair if your test comes back negative even though you have all the symptoms of Hashimoto’s. The immune system constantly fluctuates, and lab values will too. You may have had your blood drawn during a time when the immune system was not flared up.

However, if your test is positive, this confirms Hashimoto’s hypothyroidism and that you urgently need to manage your autoimmune condition to avoid a worsening of health problems.

Non-autoimmune causes of low thyroid function

Although more than 90 percent of hypothyroidism cases in the US are caused by Hashimoto’s, other metabolic factors can cause low thyroid function.

One of the most common is poor conversion of thyroid hormones. The thyroid gland predominantly produces a form of thyroid hormone called T4. In order for the cells to use it, the body must convert it to T3, an active form of thyroid. This conversion happens primarily in the gut and the liver.

Poor liver function, poor gut function, chronic stress, and chronic inflammation are factors that prevent the conversion of T4 to T3, thus causing hypothyroid symptoms.

Think you might have hypothyroidism?

To learn more about Hashimoto’s and other factors that can cause hypothyroidism, read my book The Truth About Low Thyroid or contact one of our wellness centers for more information.

About Dr. Redd

Josh Redd, MS, DABFM, DAAIM, is a chiropractic physician and author of the Amazon bestselling book The Truth About Low Thyroid. Dr. Redd owns seven functional medicine clinics in the western United States and sees patients from across the country and around the world who are suffering from challenging autoimmune, endocrine and neurological disorders. Dr. Redd also teaches thousands of health care practitioners about functional medicine and immunology, thyroid health, neurology, lab testing, and more.