Hashimoto's Thyroiditis: Symptoms, Levothyroxine and What Really Helps

What is Hashimoto's thyroiditis?

Hashimoto's thyroiditis (also called autoimmune thyroiditis) is a chronic inflammation of the thyroid in which the immune system turns against the body's own thyroid tissue. Over time, this can make the thyroid produce fewer hormones. Hashimoto's is the most common cause of an underactive thyroid.

An important distinction: Hashimoto's and an underactive thyroid are not the same thing. Hashimoto's is the cause, the autoimmune inflammation. An underactive thyroid is a possible consequence. Many people carry the typical antibodies but still have normal thyroid function and no symptoms. You can read in detail how an underactive thyroid shows up under Underactive thyroid.

Symptoms

As long as the thyroid still produces enough hormones, Hashimoto's often causes no symptoms. Once an underactive thyroid develops, typical symptoms appear because the metabolism slows down:

• constant tiredness and lack of drive. More on this: Fatigue.
• feeling cold and being sensitive to cold. More on this: Feeling cold.
• weight gain despite an unchanged diet.
• dry skin and hair loss. More on this: Hair loss.
• constipation.
• low mood and trouble concentrating.
• in women, changes to the menstrual cycle.

The symptoms usually develop slowly and gradually. That is why they are often linked to the thyroid only late on.

How Hashimoto's progresses

Hashimoto's progresses a little differently in each person, but a slow course over years is typical:

• Early phase: the thyroid still works normally (euthyroid phase). Often only raised antibodies stand out.
• Possible brief overactivity: rarely, inflamed tissue releases stored hormones at the start. This can cause temporary overactivity (sometimes called Hashitoxicosis). More on this: Overactive thyroid.
• Underactive thyroid: over time, hormone production often declines. An underactive thyroid then develops and is treated.

The disease does not progress at the same speed in everyone. Some stay stable for a long time, others need hormones sooner.

Causes and risk factors

Why the immune system attacks the thyroid is not fully understood. A combination of several factors is known to play a role:

• a family tendency.
• sex: women are affected far more often than men.
• other autoimmune diseases such as type 1 diabetes or coeliac disease raise the risk.
• very high amounts of iodine can encourage or worsen autoimmune thyroiditis in those who are predisposed.

Triggers such as stress, infections or hormonal changes, for example after a pregnancy, can contribute to it appearing.

Diagnosis: blood values and ultrasound

The diagnosis is based on blood values and an ultrasound scan:

• TSH: the most important screening value. A raised TSH points to an underactive thyroid.
• free T4 (fT4): shows whether hormone production is already reduced.
• TPO antibodies (TPO-AB): raised in about 90 to 95 percent of those affected and the most important pointer to Hashimoto's. Sometimes Tg antibodies are measured as well.
• ultrasound: in Hashimoto's it often shows a typically altered, rather dark and irregular tissue pattern.

Treatment: when levothyroxine is needed

The autoimmune inflammation itself cannot be treated at its root. What is treated is the consequence, an underactive thyroid. The thyroid hormone levothyroxine then makes up for the missing hormone production.

When treatment is given:

• For a manifest underactive thyroid (raised TSH and low fT4), levothyroxine is usually given.
• For an early (subclinical) underactive thyroid or only raised antibodies without a functional problem, often only monitoring is done at first. Antibodies alone are not treated.

The aim is to bring the TSH back into the normal range and relieve the symptoms. The dose is set individually, depending on age, weight and other conditions. So-called natural desiccated thyroid (NDT) is not recommended in current guidelines because of a lack of evidence.

How to take levothyroxine correctly

For levothyroxine to work reliably, how you take it matters. The hormone is only absorbed well in the gut when the stomach is empty and nothing interfering is involved.

• Take it in the morning on an empty stomach, about 30 minutes before breakfast, with a glass of water (not with coffee, milk or juice).
• Every day at the same time if possible, so the hormone level stays steady.
• Leave several hours between it and calcium, magnesium or iron supplements, as they reduce absorption.
• Some foods (for example soya products) and medicines (for example acid blockers) can also affect absorption.
• As an alternative, taking it late in the evening works, at least 3 hours after the last meal.
• Do not change the dose on your own. It is adjusted according to the TSH value, usually rechecked after 6 to 8 weeks.
• Try not to switch the brand without checking first, as absorption can differ slightly.

Selenium: what does it really do?

Selenium is a trace element that the thyroid needs for its metabolism. With Hashimoto's it is often recommended as a supplement. The evidence, however, is mixed.

Several studies show that selenium can lower the amount of TPO antibodies in the blood. Whether this brings a noticeable benefit, that is, relieves symptoms or changes the course of the disease, is not proven. A large review (Cochrane) concluded that the evidence is not sufficient to recommend selenium in general. Among experts, a cautious stance therefore prevails.

If selenium is taken, then for a limited time, at a moderate dose and ideally after talking to your doctor. Because too much selenium can harm the body.

Hashimoto's and pregnancy

Hashimoto's and wanting children go together well, but they need special attention. An untreated underactive thyroid can raise the risk of complications and affect the development of the child. Worth knowing:

• The need for levothyroxine often rises clearly in pregnancy, frequently within the first weeks. The dose then usually has to be increased.
• The target values for TSH are lower in pregnancy than otherwise. That is why it is monitored closely.
• Women with thyroid antibodies have a higher risk of thyroid inflammation after birth (postpartum thyroiditis).

It is best to have the thyroid checked and well adjusted before a planned pregnancy. Anyone who is pregnant or planning to be should discuss this with a doctor early on.

Monitoring: when to see a doctor

Hashimoto's is very treatable, but it needs regular monitoring. A doctor's visit makes sense:

• when typical symptoms of an underactive thyroid appear, such as tiredness, feeling cold or weight gain.
• for regular checks of the TSH value, even when you feel well, usually once or twice a year or as advised.
• when you want children or are pregnant, then more closely.
• when your symptoms change while on levothyroxine, because a dose adjustment may then be needed.

Hashimoto's day to day: stay on top of it with brite

Levothyroxine only works with reliable, steady intake. brite helps you keep your routine and your values in view.

• Intake reminders: every morning on an empty stomach, at the same time.
• Readings diary: record your TSH value and how you feel, and spot trends.
• Interaction check: see at a glance what might interfere with absorption.
• Medication plan: always up to date and ready for your next appointment.

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