What can trigger a Hashimotos flare up?
A Thyroid Flare Up or ‘Bad Thyroid Day’
I refer to days when my hypothyroid or Hashimoto’s symptoms are particularly bad as a ‘bad thyroid day’. Also called ‘flare ups’, I’ve had these days when my thyroid condition hasn’t been under control and when it has.
My Hashimoto’s is currently in remission, yet I can still experience them from time to time.
Even now, with optimal TSH, Free T3 and Free T4 levels, as well as low thyroid antibody levels, I can still have flare ups.
What Is a ‘Flare Up’?
A Hashimoto’s or thyroid flare up is defined by an increase in symptoms of these conditions. A flare usually occurs for a few days but up to a few weeks.
However, if you’re feeling that they’re going on much longer than this, it could actually not be a flare up, but a permanent dropping of your thyroid hormone levels. After all, flare ups are not associated with a drop in thyroid hormone levels, but are more a reaction to overexertion which takes your body a day or two to recover from. Read more here.
Symptoms can differ from person to person, though the most commonly reported in a flare up are:
- Increased fatigue
- Heaviness (as if your body is being weighed down)
- Worsened mental health
- Brain fog
- Flu-like symptoms (aches and pains)
- Switching between feeling really cold and really hot
What Causes a Flare Up?
These are the most common triggers according to thyroid patients:
- Drinking alcohol
- Eating poorly (such as a lot of sugary or processed food, not giving your body good nutrition)
- Consuming a known food allergen or sensitivity (such as gluten, dairy, soy etc.)
- Overexertion (mentally and/or physically) – See the spoons post
- Not sticking to a good sleep routine
- Viral, bacterial, fungal etc. infections
- Being on your period or due to start on your period (hormone fluctuations)
If you’re stuck in flare up cycles, it may be because you’re doing something like this:
- Over exercising
- Doing all the things
- Running yourself in to the ground tired
- Forced to stop exercising and running around because your body collapses
- Forced to rest and recuperatet
- Repeat over and over again
So in order to prevent more flares, we need to break this cycle!
How Can I Avoid Flare Ups in Future?
Each time you experience one, try to pinpoint what things (such as those listed above) have contributed to it. Obviously the main thing to do here is then avoid them in future if possible, so as to reduce the chances of another flare.
Some people find relief from flare-ups when they eliminate a food allergy or sensitivity, such as gluten. Around 90% of people with hypothyroidism have the autoimmune disease Hashimoto’s, which is the cause for their hypothyroidism. 
Many don’t even know it, though, and for these people, cutting out gluten from their diet is often cited to help control thyroid antibodies and ease symptoms, helping them reduce the amount of future flare ups.
You can also look at quieting the immune response by lowing your thyroid antibodies if you have Hashimoto’s, which can even lead to the condition being in remission. By lowering thyroid antibodies, we’re told that this puts the condition under control and means it is better managed, reducing symptoms and flare ups. See this article for ways to do this.
Supporting your immune system and body as a whole with good nutrition, supplements such as Vitamin C, D and Selenium, adequate sleep and keeping stress levels low can also help.
Ensuring you are also addressing any adrenal dysfunction is also very key, as adrenal fatigue (though it is more accurately referred to as hypothalamic-pituitary axis dysfunction) often goes hand in hand with hypothyroidism and can cause many of the same symptoms.
Having your thyroid levels tested regularly and ensuring they are all optimised is also key to feeling well with thyroid disease.
What Should I Do in a Flare Up?
First and foremost, it is important to say that if you’re feeling incredibly unwell, then you should always see your doctor in case something more serious is going on. If what you initially think is a flare up actually carries on for weeks or months, it is probably more likely a sign of a thyroid medication dosage adjustment or need for other investigations.
How To Manage Flare Ups When They Happen
The bad thyroid days are a part of having hypothyroidism that I have learnt to accept with time, but I did, at one point, think I would be able to make a 100% recovery back to full health, without any flare ups ever again. But you know what? No one person is in perfect health every single day of their lives. And so it’s perfectly normal to expect flare ups in symptoms from time to time.
Now I realise it’s OK and normal to have bad health days. My health is always going to require close monitoring to try and keep it on track as much as possible.
As thyroid patients, we do often expect a bit too much from ourselves, too. And I’m very guilty of this!
On a bad thyroid day or flare up day, I like to rest, keep warm, put on some films or a TV boxset, and drink lots of warm drinks such as hot water and lemon, or herbal tea, keeping myself well hydrated. I eat nourishing food, enjoy bone broths and might even call a friend or two for some company. But if I don’t feel sociable, then that’s OK too.
I listen to my body and let it have whatever it needs to get over this flare. I often like to try and get in the bath (if I have the time) as this helps my body loosen up, but hot water bottles can also really help with this too.
On days where I have had to work or otherwise didn’t have the luxury of just resting in front of the TV or in bed, I have compromised. I can try to limit how much work or other commitments impede my recovery from a flare up. For example, seeking permission to work from home, working altered hours until the flare has passed, replacing walking to and from work with transport to save energy, or otherwise speaking to my line manager about suitable adjustments.
If making changes surrounding my work isn’t an option, at the very least I can support recuperating outside of work as much as possible. I limit how much unnecessary activity I do and maximise resting and recuperation time instead. Learn to say “no”. I avoid sugar and caffeine and other stimulants that place additional stress on the endocrine system, and eat nutrient dense food to nourish me and aid my recovery.
It’s OK to not be 100% well everyday. It’s OK to look after yourself.
If I can, I’ll take a bath and relax, listen to music… anything that helps me feel well cared for.
But most importantly: take it easy.
Don’t over-do anything, as you’ll just make it worse, so instead listen to your body and do not in anyway overexert it during a flare up. Don’t do anything requiring too much from you mentally, physically or emotionally. Just rest and look after your body. After all, you only get one.
What are thyroid flare ups like for you?
You can click on the hyperlinks in the above post to learn more and see references to information given.
Please remember that if you’re a thyroid patient living with poor mental health or lingering physical symptoms, that you don’t have to live this way. To address why you may still be feeling unwell (often despite being on thyroid medication too), please see this article and go through each suggestion, putting your thyroid jigsaw back together.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts and at events about the many aspects thyroid disease affects and how to overcome these. She is well-recognised as a crucial and influential contributor to the thyroid community and has a large social media presence. Her bestselling books include «Be Your Own Thyroid Advocate» and «You, Me and Hypothyroidism».
Can COVID-19 Trigger Hashimoto’s Disease?
We have known since the early 1970s that infections can trigger autoimmune diseases and now we have an interesting hypothesis on the potential triggering of Hashimoto’s disease by COVID-19 infection.
A recent case study out of Singapore published in the Singapore Medical Journal entitled, “COVID-19 complicated by Hashimoto’s thyroiditis” presents an individual who developed Hashimoto’s thyroiditis after contracting COVID-19.
COVID-19 can cause a hyperinflammatory state in the body which is a potential recipe for developing autoimmune disease. The authors begin by pointing out the most current literature on COVID-19 connections to the autoimmune diseases antiphospholipid syndrome, autoimmune thrombocytopenia, autoimmune hemolytic anemia, and Guillain-Barre syndrome.
This patient was a 45-year-old Chinese man who developed a non-productive cough and rhinorrhea for one day after exposure to COVID-19 in his dormitory. On the second day of his symptoms he was diagnosed with confirmed COVID-19 infection.
His symptoms went away after 7 days, but he reported new onset of severe generalized fatigue and muscle weakness. Before these symptoms happened, he was in good health, not taking any medications or supplements, working productively, and no history of smoking. He had no family history of autoimmune disease.
His physical examination was unremarkable and his thyroid was normal without goitre. However, his TSH level was high at 6.49 and his free T4 was low at 9.19 which is a classic presentation for hypothyroidism. His thyroid peroxidase antibody was extremely high at >2,000 confirming Hashimoto’s disease. His inflammatory markers were normal as well as electrolytes and other metabolic tests. Chest x-ray was completely normal.
He was prescribed 25mcg of levothyroxine once a day and five weeks later he reported increased energy, and he had started running again. His TSH was 6.59 and free T4 was 10.91 so those markers did not improve despite the medication and his energy improving.
The authors state that the onset of his symptoms from the time he first developed COVID-19 to the time he developed Hashimoto’s disease was similar to the onset of the other 4 autoimmune disease connections noted above in previous studies.
The authors conclude that the hyperinflammatory state triggered by COVID-19 also known as a “cytokine storm” can predispose patients to developing autoimmune diseases such as Hashimoto’s thyroiditis.
Dr. Hedberg’s Comments
Some patients will develop Hashimoto’s disease after getting the flu or other infections such as Epstein-Barr virus, H. pylori, Yersinia enterocolitica, Blastocystis hominis, Parvovirus-B19, Hepatitis C, and Herpes 6 to name some of the most common triggers.
Infections can cause abnormal shifts in the immune system thus triggering autoimmunity in predisposed individuals. Normally, it takes three important factors to trigger autoimmune disease:
1. A genetic predisposition.
2. A gut problem such as leaky gut or intestinal dysbiosis.
3. A triggering event such as infection, physical or emotional trauma, giving birth, mold exposure, medications, radiation exposure, excessive iodine exposure, or toxin exposure such as mercury.
What is interesting about this case is that he did not have a genetic predispostion at least not that we knew of or was stated in this paper. We also don’t know if he had any gut problems.
The cytokine storm caused by COVID-19 can be quite intense compared to other infections so perhaps any predisposing factors were overriden by the storm. This is just speculation on my part but with only a single study subject and not more data about this individual, there isn’t much more to go on other than what we know about how the immune system responds to infections and how autoimmune diseases are triggered.
Additional speculation on my part would be that if you have an autoimmune disease like Hashimoto’s disease, contracting COVID-19 could cause a major flare up of your symptoms.
This is all the more reason to wear a mask and practice all the recommended guidelines for minimizing exposure to this virus. Remember that if you have one autoimmune disease you have a greater chance of developing a second autoimmune disease. A COVID-19 infection may be a trigger for another autoimmune dsease which would be a tragedy for someone already dealing with one autoimmune disease.
We are still learning more and more each day about COVID-19 and based on the research cited in this paper we may be seeing increased rates of autoimmune disease or exacerbation of existing autoimmune disease symptoms due to this pandemic.