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Can Hashimotos go in remission?

Reverse Hashimoto’s Disease by Addressing These Nine Underlying Triggers: A Functional Medicine Approach

If you have received a Hashimoto’s diagnosis, then you were probably told that you have a problem with your thyroid gland and the solution is to take a thyroid pill— for life. We look at this differently. Using a functional medicine perspective, we see Hashimoto’s not as a thyroid gland issue, but as an autoimmune disease. If we can address and turn off the underlying triggers of the autoimmune process, then we can reverse Hashimoto’s disease. Unfortunately, most doctors tell their patients, “you will be on this pill for the rest of your life” (and you still won’t feel yourself). But we tell patients we can turn around Hashimoto’s. We can help them get into remission. Hashimoto’s is a major area we focus on in our practice and we see people go into remission all the time. Keep reading to learn more about Hashimoto’s disease and the nine underlying triggers that we address to turn off the autoimmune attack.

What is Hashimoto’s Disease?

Your thyroid is a gland that is small and shaped like a butterfly in your neck. It is responsible for several hormones including thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). Brain and growth development, body temperature, metabolism, how fast your heart beats and other body functions are all influenced by thyroid hormones.

Hashimoto’s disease, a form of autoimmune hypothyroidism, is a condition that causes an underactive thyroid. When someone has Hashimoto’s, their immune system makes antibodies that attack the thyroid gland. The thyroid then doesn’t produce enough thyroid hormones, which results in hypothyroidism. Hashimoto’s disease often affects women between the ages of 40 and 60 years old; although it can affect women of other ages, and men, too.

Your risk of getting Hashimoto’s increases if you have:

  • A family history of someone with Hashimoto’s
  • Recently gave birth (postpartum thyroiditis)
  • Autoimmune diseases such as lupus, rheumatoid arthritis, celiac disease, pernicious anemia (a deficiency of vitamin B12) or type 1 diabetes

While you may not experience symptoms for years before a diagnosis of Hashimoto’s – eventually the damage to your thyroid will begin to exhibit physical symptoms such as:

  • A goiter (enlarged thyroid)
  • Fatigue
  • Joint pain
  • Muscle aches
  • Constipation
  • Pale, dry skin
  • Weight gain
  • Hair loss
  • Brittle nails
  • Enlarged tongue
  • Puffy face
  • Depression
  • Hoarseness
  • Issues with memory
  • Sensitivity to cold
  • Problems getting pregnant
  • Menstrual bleeding is longer than usual.

I Have Been Diagnosed with Hashimoto’s, What Now?

If you receive a diagnosis from a conventional doctor, you will then be prescribed a medication to replace your thyroid hormone. The #2 prescribed drug in the US, you will likely be given levothyroxine and you will be told you need to take it for the rest of your life. During this time your TSH (thyroid-stimulating hormone) levels will need to be consistently tested to see if the dosage is correct or needs to be changed. Side effects include hair loss, headache, hot flashes, insomnia, sweating, irritability, heartbeat issues, menstruation changes, and weight changes. You may notice that you still have hypothyroid symptoms and you and your doctor can’t get the dose right. This medicine also interacts with a range of other medications including antidepressants.

We feel that with functional medicine, there is a better way. Functional medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual. Untreated Hashimoto’s can lead to health issues including goiters, cardiovascular risks, mental health issues, myxedema, and birth defects. Conventional treatment doesn’t approach Hashimoto’s as an autoimmune disease, but as a thyroid gland problem. That means the autoimmune process is still underway, and will likely show up as additional autoimmune diagnoses over time. If you want to feel better, get into remission, and reduce or eliminate thyroid medications, continue reading.

Nine Underlying Triggers of Hashimoto’s Disease

In our practice, we have identified nine key areas that lead to Hashimoto’s thyroiditis, as well as other autoimmune diseases. Hashimoto’s disease can be reversed once these areas of health are addressed. When we help patients work on gut health, stress, nutrition, blood sugar balance, toxicity, hormonal balance, and chronic infections, the immune system calms down and it stops attacking the thyroid gland. When the autoimmune attack on the thyroid is turned off, the gland can start doing its job again. That means you don’t have to live with Hashimoto’s disease! You can turn it around.

Leaky Gut

An unhealthy gut barrier leads to overactivation of the immune system. Intestinal permeability, or leaky gut, occurs when your intestinal lining develops tiny holes in it and food, bacteria, and toxins pass from your gut into your bloodstream, where they don’t belong. Once in the bloodstream, they can spark inflammation and autoimmune attack. Also, nearly 80% of your immune system is in your gut as well as trillions of friendly microorganisms. This is the part of our body that helps us to digest the food we eat, absorb nutrients, and get rid of toxins. A healthy gut is vital to combat autoimmune disease.

Food Sensitivities, Celiac Disease, and Gluten Sensitivity

Food sensitivities can aggravate Hashimoto’s disease. Unlike food allergies, food sensitivities may be hidden for decades. We find that most people react to inflammatory foods such as grains, dairy, and sugar. Functional medicine doctors look at the diet for food triggers of autoimmune thyroiditis. These include rice, wheat, corn, eggs, dairy, nuts, seeds, and nightshade vegetables (tomatoes, peppers, and eggplants). In addition, sweeteners such as fruits and sugar can also trigger an autoimmune reaction.

Celiac disease is an autoimmune disease that damages the gut in response to a common protein in wheat, called gluten. Having celiac disease can increase your risk of Hashimoto’s. In celiac disease, or in gluten sensitivity, an overproduction of antibodies can attack your body and affect your thyroid gland. Making matters worse, consuming gluten can cause intestinal permeability or leaky gut syndrome (mentioned earlier).

Food sensitivities can be especially challenging to monitor, especially when travelling, attending social events, or going to resturants. These can all contribute to unknown exposures to foods that you are sensitive to and further exacerbate autoimmune diseases, including Hashimoto’s hypothyroidism.

Mental/Emotional Stress and Adrenal Fatigue

Our bodies encounter stress on a daily basis. The stress hormone, cortisol, can interfere with thyroid hormone production. Cortisol levels increase with stress and are produced and released by your adrenal glands. Chronic stress can lead to adrenal fatigue, which in turn leads to chronic inflammation and immune upregulation. This can include mental and emotional stress and trauma – which have been identified as common predisposing factors for developing autoimmunity. We have found that restoring adrenal health and reducing stress can be a game-changer in patients with Hashimoto’s disease.

Environmental Toxins and Chemicals

Since the 1950s, Hashimoto’s disease diagnosis has steadily inclined. While there are genetic and biologic reasons for this autoimmune disease – research indicates that other sources may be the culprit. Environmental exposures are often overlooked by conventional medicine as a contributor to autoimmune thyroid disease, but they have been shown to impact a variety of health conditions.

Environmental Factors in Hashimoto’s:

  • Those living near a petrochemical complex
  • Synthetic pesticides
  • Not enough sun exposure and Vitamin D deficiency
  • PCBs (polychlorinated biphenyls)
  • BPA (bisphenol-A)
  • Radiotherapy
  • Heavy metals

Nutrient Deficiencies

To calm the immune system and turn off autoimmune attack, we make sure every patient has optimum nutrition. Most people with autoimmunity are deficient in basic nutrients to regulate the immune system such as glutathione, omega 3s, and vitamin D3 can be a factor in autoimmunity. The thyroid gland needs good levels of nutrients in order to perform well, including iodine, zinc, selenium, tyrosine, and more.

Chronic Infections

You may have an infection and not realize it because symptoms haven’t been revealed to you yet. This can cause an autoimmune attack. If you have gastrointestinal symptoms like diarrhea, bloating, constipation, or heartburn, or even other non-gut related symptoms such as brain fog or depression, then you may have a chronic infection in the gut. Small intestinal bacteria overgrowth (SIBO) is an overgrowth of bacteria in the small intestine or bowel. Sometimes this is caused by antibiotics, maldigestion, or starchy foods. If gut infections are left untreated, they ramp up the immune system and even cause intestinal permeability as your body tries to expel the excess bacteria. In addition, mononucleosis (Epstein-Barr virus), mumps, and the flu have been linked to thyroid disease and may be dormant in your system for years before a flare-up.

Insulin Surges

Blood sugar balance is vital for healthy thyroid function and to reverse Hashimoto’s thyroiditis. Many patients with Hashimoto’s don’t do well with carbohydrates and sugar. After a carbohydrate-rich meal, insulin is released from the pancreas to help clear out the extra sugar from the bloodstream. Wild swings in blood sugar can magnify the symptoms of Hashimoto’s. Insulin surges counteract high blood sugar but they ramp up inflammation and irritate the immune system. You don’t have to have a diabetes diagnosis for this to occur. The harmful effects of imbalanced blood sugar can be worse if you have a history of stress or adrenal fatigue.

Estrogen Dominance

Hormones are the chemicals that tell our cells what to do and imbalances lead to the wrong signals. Both women and men can develop estrogen dominance, or excess levels of estrogen. This is a powerful hormone and if it isn’t counterbalanced, it can be very inflammatory and irritating to the immune system. If we expect the thyroid gland to properly produce thyroid hormone, then all hormones in the body need to be balanced and healthy.

What is the Functional Medicine Approach to Hashimoto’s?

A functional medicine doctor will likely need to see you and evaluate your health challenges on a personalized level. Functional medicine is focused on a systems biology-based approach – by examining the individual lifestyle, biochemical, and genetic factors that are unique to you, while looking for underlying triggers or root causes. Restoring health and wellness may mean a plan that consists of addressing you as a whole, and not just a set of symptoms.

Treatment Approaches for Hashimoto’s Disease May Include:

  • Identifying the foreign substance or infection that is permeating the gut and causing it to attack itself. After discovery, work on repairing intestinal damage and gut health will begin.
  • Trying an elimination diet that would eliminate the foods that may be causing sensitivity including dairy, gluten, or other grains.
  • Removing environmental toxins or chemicals that can be causing the issue.
  • Providing tools and resources including nutritional modifications to cope with stress and lower cortisol levels.
  • Helping you to figure out why you may be experiencing insulin surges and addressing them.

This whole care perspective empowers you to take a proactive and personalized approach to your health, especially when faced with a chronic condition such as Hashimoto’s disease. By making changes to your diet and lifestyle, you can begin to take an active role in your health guided by a doctor that is addressing the root causes of your chronic autoimmune hypothyroidism to get you into remission. In addition to your thyroid health – functional medicine has the potential to heal your immune system.

Why Your Thyroid Hormone Levels May Be Fluctuating

Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.

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​​If you have thyroid disease, your thyroid-stimulating hormone (TSH) levels can fluctuate from time to time. These fluctuations can occur as your thyroid disease progresses or from other factors such as your age, changes in weight, pregnancy, drug interactions, and even seasons.

This article describes eight different factors that can cause thyroid hormone fluctuations and what you can do about them.

why thyroid levels fluctuate

Thyroid Disease Progression

Fluctuations in TSH levels can occur as your thyroid disease progresses. The rate of progression is highly variable, with some people remaining stable for many years and others progressing relatively quickly. There may also be a pattern of worsening symptoms (exacerbations) followed by periods of low disease activity (remission).

This can occur in people with Hashimoto’s disease, a form of hypothyroidism (underactive thyroid), and Grave’s disease, a form of hyperthyroidism (overactive thyroid).

How the Thyroid Gland Works

Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis , the autoimmune form of hypothyroidism, tends to progress slowly over many years and often remains undiagnosed until the disease is advanced. Even when treatment is started, thyroid autoantibodies may continue to attack the thyroid gland.

In some cases, these attacks come in episodes known as flares. At other times, the assault may be persistent, progressively undermining the function of the thyroid gland.

If the latter happens and you maintain the same treatment dose, you might experience:

  • Falling thyroxine (T4) and triiodothyronine (T3) thyroid hormone levels
  • Rising TSH levels
  • Symptoms of hyperthyroidism

Graves’ Disease

Graves’ disease (an autoimmune form of hyperthyroidism) can also progress, especially in the first few years following the diagnosis. Even with treatment, a low-level autoimmune assault on the thyroid gland may persist.

If the same treatment dose is maintained, the progressive damage to the gland can manifest with:

  • Rising T3 and T4 levels
  • Falling TSH levels
  • Symptoms of hypothyroidism

The opposite can also happen. After years of taking antithyroid drugs, your condition can suddenly go into remission. When this happens, your T3 and T4 levels may drop while your TSH rises.


Pregnancy can affect thyroid hormones, whether you have thyroid disease or not. People who are pregnant often experience temporary thyroiditis (thyroid inflammation) that can cause T3 and T4 to increase and TSH levels to decrease.

Pregnancy can have the same effects on people with thyroid disease, albeit more extreme. Here is what commonly occurs in people with thyroid disease who become pregnant:

  • Hyperthyroidism: Increased T4 and T3 levels and decreased TSH levels
  • Hypothyroidism: Decreased T4 and T3 levels and increased TSH levels

The best way to deal with this is to ensure your thyroid hormones are regularly monitored during pregnancy. In this way, your medication doses can be adjusted to keep TSH levels within the optimal range.

Medication Potency

Sometimes when you are taking thyroid medications as directed, your hormone levels will change. This sometimes happens when you refill your thyroid medications and use a different pharmacy or receive a different generic.

Many people do not realize that within the U.S. Food and Drug Administration (FDA) guidelines, thyroid hormone replacement drugs can vary somewhat in their potency.

For example, with levothyroxine used in the treatment of hypothyroidism, the FDA allows the drug to be within 95% to 105% of the stated potency. What this means is that a 100-microgram (mcg) pill might actually deliver slightly higher or lower doses than advertised.

The best way to avoid this is to use the same pharmacy for all refills and to ensure the same brand of medication is dispensed with each visit.

Thyroid Disease Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

Doctor Discussion Guide Old Woman

Dosing Problems

If you do not take your thyroid medications consistently or correctly, the therapeutic drug level—meaning the concentration of medication in your body needed for the drug to work—can quickly drop. Without a consistent therapeutic drug level, your thyroid hormone levels can fluctuate, sometimes precipitously.

There are three common mistakes people make when taking thyroid drugs:

  • Dosing with food: Thyroid medications need to be taken on an empty stomach. Food can delay or reduce drug absorption by changing the rate at which it dissolves or by exposing it to excess stomach acid during digestion.
  • Inconsistent dosing: This is one of the main reasons for TSH fluctuations. You need to take your medications consistently, typically in the morning on an empty stomach an hour before breakfast. Alternatively, you can take it at bedtime at least three hours after your last meal.
  • Dosing with supplements: Certain supplements can reduce drug absorption. To avoid this, you need to separate your thyroid medication dose from any fiber, calcium, biotin, tyrosine, or iron supplement you take by at least three to four hours.

Taking your thyroid medications at the same time every day is essential. By doing so, you can quickly establish a habit and ensure consistent therapeutic drug levels in your body.

Changes in Weight

Another factor that can influence therapeutic drug levels is weight. Simply put, the more weight you put on, the lower the overall concentration of the drug will be. Conversely, the more weight you lose, the higher the overall concentration will be.

This may be more of a long-term concern since people don’t usually put on large amounts of weight all at once, but it can be an issue if you lose weight quickly (such as due to a rapid weight loss plan). In such cases, not only will your TSH levels fluctuate but so can estrogen levels which indirectly influence your thyroid hormones.

Drug Interactions

Some prescription drugs, over-the-counter medications, and herbal supplements can interact with your thyroid medications. In some cases, they can «compete» for the same enzymes used to break down your thyroid drug, causing levels of one drug to drop (reducing its effectiveness) and the other to rise (increasing the risk of side effects).

Drugs known to interact with thyroid medications include:

  • Aluminum-containing antacids
  • Beta-blockers
  • Cipro XR (ciprofloxacin)
  • Cholesterol-lowering drugs like cholestyramine
  • Corticosteroids (steroids)
  • Evista (raloxifene)
  • Human growth hormone (hGH)
  • Kelp supplements
  • Lithium
  • Pacerone (amiodarone)
  • Renvela (sevelamer)
  • Tyrosine
  • Xenical (orlistat)

To avoid interactions. advise your healthcare provider of any drugs you take or intend to take (including recreational drugs) if you are being treated for thyroid disease.

Change of Seasons

Thyroid levels and TSH, in particular, can change along with the seasons. For example, TSH naturally rises somewhat during colder months and drops back down in the warmest months.

Some healthcare providers adjust for these seasonal variations. For example, they may prescribe slightly higher thyroid replacement doses during colder months and higher doses during warmer months.

Older Age

Older age affects the function of the thyroid gland whether you have thyroid disease or not. If you have thyroid disease, your healthcare provider may adjust your dose to compensate for expected changes in your TSH levels (as described below).

Age rangeNormal TSHHigh TSH
18-50 years0.5–4.1 mU/LOver 4.1 mU/L
51-70 years0.5–4.5 mU/LOver 4.5 mU/L
71 years and older0.4–5.2 mU/LOver 4.5 mU/L

If you are getting older and have a harder time keeping your TSH levels within the optimal range, ask your endocrinologist if a dose adjustment is feasible.


For people with thyroid disease, certain things can cause fluctuations in TSH levels. These include disease progression, medication changes, pregnancy, inadequate dosing, changes in weight, seasonal variations, and age.

If you notice a change in your symptoms, be sure to tell your healthcare provider who can have your thyroid hormone levels tested. Depending on the results, your medication dosage may be changed.

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670-751. doi:10.1089/thy.2014.0028
  2. Weetman AP. An update on the pathogenesis of Hashimoto’s thyroiditis. J Endocrinol Invest. 2021;44(5):883–890. doi:10.1007/s40618-020-01477-1
  3. Wong M, Inder WJ. Alternating hyperthyroidism and hypothyroidism in Graves’ disease. Clin Case Rep. 2018;6(9):1684-1688. doi:10.1002/ccr3.1700
  4. National Institute of Diabetes and Digestive and Kidney Diseases. Thyroid disease and pregnancy.
  5. Harvard University. Drugs that interact with thyroid medication.
  6. Wang D, Cheng X, Yu S, et al. Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone. Clin Biochem. 2018;60:59-63. doi:10.1016/j.clinbiochem.2018.08.008

Additional Reading

  • Glynn N, Kenny H, Salim T, et al. Alternations in thyroid hormone levels following growth hormone replacement exert complex biological effects. Endocr Pract. 2018 Apr;24(4):342-350. doi:10.4158/EP-2017-0223
  • Wang QW, Yu B, Huang RP, et al. Assessment of thyroid function during pregnancy: the advantage of self-sequential longitudinal reference intervals.Arch Med Sci. 2011 Aug;7(4):679-84. doi:10.5114/aoms.2011.24139

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of «The Thyroid Diet Revolution.»

Can Hashimotos go in remission?

Donna Allgaier-Lamberti of Holland poses for a photograph with her granddaughter.

Wrestling with a health condition that another person walking down the street can’t see takes a mental toll on a person.

For close to a decade now, this has been the experience of Holland resident Donna Allgaier-Lamberti. Feeling poor physically but appearing fine to most people has been one of the many effects of Hashimoto’s Thyroiditis, which Allgaier-Lamberti was diagnosed with in 2015. Hashimoto’s is an autoimmune disorder in which the immune system attacks thyroid cells by mistake because it thinks they are bacteria.

“When you have an invisible condition, you look normal, you look fine, and you kind of rise to the occasion when you go out in public,” explained Allgaier-Lamberti. “With an autoimmune disease, because you mostly look normal, people might not think that you’re struggling.”

Come-and-go brain fog, sluggishness, and an overactive immune system plagued Allgaier-Lamberti for close to a decade before being diagnosed with Hashimoto’s at the age of 65.

“With Hashimoto’s, the immune system is on overdrive all the time,” she described. “It’s like you’re the Energizer Bunny all the time. The human body can only do that for so long before it breaks down. Your organs can’t take running on high-speed year after year after year. They break down and you get sicker and sicker and sicker.”

Visits with doctors and specialists led her to an elimination diet known as the autoimmune protocol (AIP).

Diet and lifestyle changes to combat Hashimoto’s

The idea behind the AIP diet is to eliminate certain foods that cause inflammation to the gut. Adopting this diet required Allgaier-Lamberti to be patient. Figuring out what to ditch and what to keep was a “slow process,” but she feels like she’s sleeping better, coming down with flu-like symptoms less often and is generally living a happier, healthier life.

“I tried to just start eating whole foods, cooked from scratch. No processed foods, no eating out, good oils, not bad oils,” she said. “That’s sort of the AIP in a nutshell. But it’s much more than diet.”

Nutrient-dense meats like grass-fed beef and organic chicken became mainstays in Allgaier-Lamberti’s diet. She has more or less said goodbye to these foods and food groups:

  • Cow’s dairy
  • Gluten
  • Nightshade fruits and vegetables like tomatoes, peppers, and eggplants
  • Russets/white potatoes
  • Sugar

“You decrease the inflammatory foods to decrease the inflammation in your body,” she said. “And you really focus on the nutrient-rich foods. Lots of greens, but not a lot of fruit, because fruits have a lot of natural sugars in them, and sugar is something we eliminate.”

The AIP also taught Allgaier-Lambertithat she wasn’t getting enough Vitamin D, zinc, and magnesium. She turned to supplements as part of her pursuit to soften the symptoms of Hashimoto’s.

“Everybody’s blood labs are different,” said Allgaier-Lamberti, a Blue Cross Blue Shield of Michigan member. “These are the things that mine showed. It’s really important to have your labs checked. And thank God for my insurance because it covers all my labs. And I have to have a lot of labs. So, I’m really grateful for that.”

Always talk to your doctor before taking a supplement, as they may interfere with health conditions and medications.»

Finding support for an ‘invisible condition’

Allgaier-Lamberti came to learn that being open and talkative about her Hashimoto’s diagnosis has been much better for her mental health than struggling in silence.

“I have found that the more that I share and give out, the more I give back,” she said. “I’ve come to learn that people who don’t have a thyroid disease or autoimmune disease aren’t going to understand it. So, I no longer have that expectation that they are going to get it.”

Some people who do get it, though, are the members of the private “Michigan Thyroid Support Group” on Facebook. Home to more than 2,000 members, no one’s condition is invisible there. Everyone knows what every other member is going through for the most part. It’s a place where Allgaier-Lamberti and others have become comfortable sharing symptoms, discussing solutions, finding physicians and more.

“It’s an amazing resource,” she said. “Sometimes, we feel really alone. When we don’t know other people who are going through the same thing, there’s nobody to bounce ideas off of. When you find a support group of people with a similar health condition you can ask things like, ‘Is this normal?’ or ‘I’m struggling with the AIP, how do you manage it?’ Whatever the questions are, it’s just really helpful to talk to someone in a similar situation.”

Allgaier-Lamberti said her Hashimoto’s Thyroiditis is currently in remission. For that, she’s grateful.

“Obviously, not everyone goes into remission,” she said. “I put in a lot of hard work when it came to dieting and being disciplined and just educating myself. But I’m also fortunate to have a good doctor, and fortunate to be able to pay for my medical expenses. So, I’m grateful but I’m also fortunate.”

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