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What lab tests for Hashimoto?

Hashimoto’s Disease

Hashimoto’s thyroiditis, also called Hashimoto’s disease, chronic autoimmune thyroiditis, or chronic lymphocytic thyroiditis, is an autoimmune disease. The disorder causes the body’s immune system to produce antibodies that attack thyroid tissue and eventually destroy the thyroid gland, leading to hypothyroidism, or the underproduction of thyroid hormone.

Hashimoto’s thyroiditis is the most common form of autoimmune thyroid disease. It can occur at any age, but is most often seen in women and older adults. The disease does not cause any pain and often goes unnoticed for years. This, and the fact that it can present with various combinations of symptoms, makes diagnosis difficult.

Although Hashimoto’s thyroiditis most commonly causes hypothyroidism, in some cases, it will first cause enlargement of the thyroid gland (goiter) and temporary thyroid gland overactivity (hyperthyroidism). This is called hashitoxicosis, and it is almost always followed by development of hypothyroidism.

Hashimoto’s thyroiditis is associated with other conditions, including diabetes, Addison’s disease, rheumatoid arthritis, pernicious anemia, and premature menopause. Currently, there is no cure for this disease.

What Are the Symptoms of Hashimoto’s Thyroiditis?

The symptoms of this disease can include those associated with hypothyroidism in general, for example:

  • Fatigue
  • Depression
  • Weight gain
  • Thinning scalp hair
  • Excessive dry skin
  • Brittle finger and toenails

How is Hashimoto’s Thyroiditis Diagnosed?

There are signs and symptoms of hypothyroidism that can be identified by a physician, though blood tests are often the most useful tools.

The best overall test to determine hypothyroidism is the thyroid stimulating hormone (TSH) level. TSH is produced in the brain and travels to the thyroid gland to stimulate the thyroid to produce and release more thyroid hormone. A high TSH level indicates that the body does not have enough thyroid hormone. If the TSH level is found to be too high, other tests are usually ordered to further investigate the problem.

Thyroid peroxidase antibodies and other anti-thyroid antibodies are also commonly tested for when confirming a diagnosis of Hashimoto’s.

How is Hashimoto’s Thyroiditis Treated?

Patients who are hypothyroid as a result of Hashimoto’s thyroiditis are treated with thyroid hormone replacement. Though there is no cure, the disease can be managed relatively easily. Thyroid hormone replacement medications come in pill form, and when taken daily as prescribed by your physician, can reverse all ill effects of hypothyroidism within weeks. Thyroid hormone replacement for Hashimoto’s thyroiditis is usually taken for the rest of a patient’s life.

Sometimes, in mild cases, no treatment is necessary and the physician will just follow the patient on a regular basis to see if their condition is worsening and if thyroid hormone replacement is required.

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Hashimoto’s Thyroiditis

Thyroiditis is when your thyroid gland becomes irritated. Hashimoto’s thyroiditis is the most common type of this health problem. It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid. The thyroid then can’t make enough of the thyroid hormone. Many people with this problem have an underactive thyroid gland. That’s also known as hypothyroidism. They have to take medicine to keep their thyroid hormone levels normal.

What is the cause of Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis is an autoimmune disorder. Normally, your autoimmune system protects your body by attacking bacteria and viruses. But with this disease, your immune system attacks your thyroid gland by mistake. Your thyroid then can’t make enough thyroid hormone, so your body can’t work as well.

Who is at risk for Hashimoto’s thyroiditis?

Things that may make it more likely to you for to get Hashimoto’s thyroiditis are:

  • Being a woman. Women are about 7 times more likely to have the disease. Hashimoto’s thyroiditis sometimes begins during pregnancy.
  • Middle age. Most cases happen between 40 to 60 years of age. But it has been seen in younger people.
  • Heredity. The disease tends to run in families. But no gene has been found that carries it.
  • Autoimmune diseases. These health problems raise a person’s risk. Some examples are rheumatoid arthritis and type 1 diabetes. Having this type of thyroiditis puts you at higher risk for other autoimmune illnesses.

What are the symptoms of Hashimoto’s thyroiditis?

Each person’s symptoms may vary. Symptoms may include:


This is an enlargement of your thyroid gland. It causes a bulge on your neck. It is not cancer. But it can cause problems like pain or trouble with swallowing, breathing, or speaking.

Underactive thyroid

When your thyroid doesn’t make enough thyroid hormone, it can cause these symptoms:

  • Tiredness
  • Muscle weakness
  • Weight gain
  • Being cold bothers you
  • Depression
  • Hair and skin changes

Overactive thyroid

When the thyroid is attacked by antibodies, it may at first make more thyroid hormone. This is called Hashitoxicosis. It does not happen to everyone. But it can cause these symptoms:

  • Being hot bothers you
  • Rapid heart rate
  • Sweating
  • Weight loss
  • Tremors
  • Anxiety

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is Hashimoto thyroiditis diagnosed?

Your healthcare provider will ask about your medical history and give you a physical exam. You will also have blood tests. These can measure your thyroid hormone levels and check for some antibodies to proteins in the thyroid.

Will I have Hashimotos forever?

How is Hashimoto’s thyroiditis treated?

Your healthcare provider will figure out the best treatment for you based on:

  • Your age, overall health, and medical history
  • How sick you are
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • Your opinion or preference

You will not need treatment if your thyroid hormone levels are normal. But Hashimoto’s thyroiditis often looks like an underactive thyroid gland. If so, it can be treated with medicine. The medicine replaces lost thyroid hormone. That should stop your symptoms. It can also ease a goiter if you have one. A goiter can cause problems like pain or trouble swallowing, breathing, or speaking. If these symptoms don’t get better, you may need surgery to remove the goiter.

When should I call my healthcare provider?

Tell your healthcare provider if your symptoms get worse or you have new symptoms.

Key points about Hashimoto’s thyroiditis

  • Hashimoto’s thyroiditis can cause your thyroid to not make enough thyroid hormone.
  • It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid.
  • Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness.
  • You don’t need treatment if your thyroid hormone levels are normal. If you have an underactive thyroid, medicine can help.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Seminar Webinar: Thyroid Disease, an Often Surprising Diagnosis

doctor examining patient's neck

Join endocrinologist Paul Ladenson, M.D., as he outlines the signs and symptoms of the various thyroid disorders and discusses the interplay among other diseases and the thyroid. The webinar recording is presented as part of A Woman’s Journey Conversations That Matter webinar series.

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Hashimoto’s Disease

Hashimoto’s disease can lead to hypothyroidism, when the thyroid gland is affected and gradually stops producing enough hormones to keep the body working properly. Hashimoto’s is more common in middle-aged women than men and can cause fatigue and weight gain.


The thyroid gland is a butterfly-shaped gland located in the front of the neck.

What is Hashimoto’s disease?

Hashimoto’s disease affects the thyroid gland. It’s also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis or autoimmune thyroiditis. The thyroid gland makes hormones that regulate virtually all of the body’s metabolic functions (how the body turns food into energy) and keep it working normally. Hashimoto’s thyroiditis is a type of autoimmune disease — your immune system doesn’t recognize your thyroid as your own and attacks it.

Hashimoto’s disease is common and affects about five people in 100 in the United States.

What is hypothyroidism?

Hashimoto’s hypothyroidism happens when the thyroid gland doesn’t make enough thyroid hormones to meet the body’s needs because its immune system has damaged it.

Thyroid hormones regulate metabolism, which is how you turn food into energy. Without enough energy, your body cannot operate normally and its functions begin to slow down.

How does hypothyroidism affect your body?

Hypothyroidism can affect you in ways that can be hard emotionally and physically. For example:

  • When your metabolism slows due to hypothyroidism, you eventually gain weight, feel tired more often and have little energy.
  • You can experience fuzzy thinking and memory problems (hypothyroidism is often misdiagnosed as depression).
  • Women can develop menstrual irregularity and change in flow, and find it harder to become pregnant.
  • You may be increasingly constipated (trouble having a bowel movement), have heartburn and other digestive problems.
  • Hypothyroidism can also lead to sexual dysfunction in both men and women.

A slow metabolism can affect almost every part of your body, with effects mild to severe.

Who is most likely to develop Hashimoto’s disease?

  • Is more common in women than men.
  • Commonly appears between the ages of 30 and 50.
  • Tends to run in families (hereditary).
  • Is more likely to develop in people who have other autoimmune diseases, like certain liver conditions, B12 deficiency, gluten sensitivity, rheumatoid arthritis, type 1 diabetes, lupus and Addison’s disease (an adrenal gland condition).

Symptoms and Causes

What causes Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disease, which means the body’s immune system is attacking its own cells and organs. Normally, the immune system protects the body against infections caused by bacteria, viruses and other harmful substances.

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In Hashimoto’s disease, the immune system makes antibodies that attack and damage the thyroid tissue. As a result, the thyroid gland becomes inflamed and the ability to make thyroid hormone becomes damaged, eventually leading to hypothyroidism.

What are the symptoms of Hashimoto’s disease?

Some people may not have any symptoms at first. As the disease slowly progresses, the thyroid gland becomes enlarged (a condition called a goiter). A goiter is a common first sign of Hashimoto’s disease. A goiter is painless, but can create a feeling of fullness in the throat, and can make the front of your neck look swollen.

Other symptoms of Hashimoto’s disease that develop over time include:

  • Tiredness (fatigue).
  • Weight gain.
  • Feeling cold.
  • Joint stiffness and muscle pain.
  • Constipation (trouble having a bowel movement).
  • Depression.
  • Puffy eyes/face.
  • Dry skin.
  • Thinning hair/hair loss.
  • Heavy or irregular periods.
  • Difficulty becoming pregnant.
  • Memory problems/difficulty thinking or concentrating.
  • Slow heartbeat.

Diagnosis and Tests

How is Hashimoto’s disease diagnosed?

First, your healthcare provider will take your medical history and perform a physical exam. He or she will feel your thyroid gland to determine if it is enlarged. Blood tests are also ordered. These include:

  • Thyroid stimulating hormone (TSH) test: A high TSH level most commonly means the thyroid gland is not producing enough T4 hormone. This lab is usually most consistent with a diagnosis of hypothyroidism or subclinical hypothyroidism.
  • Free T4 test: A low T4 level suggests that the person has hypothyroidism.
  • Antithyroid antibody test: Presence of antibodies indicates a higher risk of developing Hashimoto’s hypothyroidism.

The most common imaging test that may be ordered is an ultrasound of your thyroid gland. The ultrasound shows the size and appearance of the thyroid and if there are any nodules or growths in your neck area.

Management and Treatment

Does Hashimoto’s disease always need treatment?

Not everyone with Hashimoto’s disease develops hypothyroidism. Because having antibody levels that are consistent with Hashimoto’s incur a higher risk of developing hypothyroidism, healthcare providers generally choose to monitor your condition and watch for any changes in your thyroid health.

How is Hashimoto’s disease treated?

If Hashimoto’s disease does progress to hypothyroidism, usual treatment is a synthetic (man-made) form of thyroid hormone called levothyroxine (Synthroid®, Tirosint®, Levoxyl®, Levothroid®, Unithroid®).

This drug restores the normal function of the thyroid. You’ll need to take it every day for the rest of your life. Your providers and you will figure out how to adjust your dose to make sure that your hypothyroidism is well-managed.

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Will I need to have my thyroid removed for Hashimoto’s disease and hypothyroidism?

No. Because hypothyroidism and Hashimoto’s disease are managed by medications, surgery is not necessary.

Is there a special diet for people with Hashimoto’s disease?

There is no special diet for Hashimoto’s disease, but some foods, medicines or supplements may affect your ability to absorb levothyroxine, your thyroid medication. These include iron and calcium supplements, the ulcer medicine sucralfate, cholestyramine and aluminum hydroxide (found in some antacids). Taking these four hours before or after the levothyroxine may solve this problem.

Talk to your doctor about any dietary questions you have.

Eating well and a healthy lifestyle – exercising, sleeping well and managing stress – can help your immune system. No matter what, you’ll need to keep taking your medications if you are diagnosed with hypothyroidism.

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Outlook / Prognosis

Is Hashimoto’s disease dangerous or fatal?

If left untreated, hypothyroidism can lead to some serious complications and, in rare cases, death. These include:

  • Heart problems, such as enlarged heart or heart failure.
  • Mental health issues, including depression.
  • Myxedema coma, which needs immediate emergency care. Myxedema is a rare, life-threatening condition that can lead to heart failure, seizures, coma and death.

What happens if I have hypothyroidism during pregnancy?

For pregnant women, there is a different thyroid stimulating hormone (TSH) goal. If your TSH level is not at goal, your provider will likely offer you treatment with synthetic thyroid hormone to protect the safety of your pregnancy and your baby.

Untreated hypothyroidism during pregnancy can increase the risk of miscarriage, premature birth and stillbirth. Or it may cause a dangerous rise in blood pressure in late pregnancy (called preeclampsia). Untreated hypothyroidism can also affect your baby’s growth and brain development. Your providers will work with you to make sure your hypothyroidism is well-managed during your pregnancy.

Hypothyroidism during pregnancy is not common. But sometimes symptoms of hypothyroidism can be overlooked during pregnancy, with its fatigue and weight gain. Let your providers know right away if you notice any hypothyroidism symptoms, or feel like you’re developing a goiter.

A note from Cleveland Clinic

In most cases, hypothyroidism can be managed as long as you take your daily medication and get blood tests to adjust the dosage as instructed by your healthcare provider. Eating healthy and getting enough exercise can help you live a long, healthy life with the condition. Your healthcare providers can tell you what steps to take to feel better along the way.

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