Hashimoto’s is a lifelong autoimmune disease of the thyroid gland: the immune system mistakenly attacks its own thyroid cells. With timely diagnosis and proper treatment it can be fully controlled.
What is Hashimoto’s?
In Hashimoto’s thyroiditis the body treats thyroid tissue as “foreign” and produces antibodies against it – anti-TPO and anti-thyroglobulin (anti-TG). These antibodies damage the gland’s cells. As the number of hormone-producing cells falls, thyroid hormone production gradually declines and hypothyroidism develops.
The disease progresses slowly over the years, often silently. It is 5–10 times more common in women than in men, especially between the ages of 30 and 50. It can run in families, particularly in mothers and daughters.
Hashimoto’s is a chronic disease that requires lifelong monitoring. Diagnosis, treatment and lifestyle should be planned individually for each patient – if you have been diagnosed with Hashimoto’s, see an endocrinologist even if your TSH is normal.
What symptoms can occur?
Many patients have no complaints at all. As thyroid function declines, however, the following may appear:
- weakness, persistent fatigue and difficulty waking up in the morning;
- unexplained weight gain;
- dry skin and hair loss;
- constipation, muscle aches;
- low mood, sleep problems, poor memory;
- menstrual irregularities, a slow pulse.
Is TSH enough for the diagnosis?
No. Even if TSH is normal, anti-TPO and anti-TG antibodies must be checked to confirm Hashimoto’s. A full assessment also requires free T4, free T3, a neck examination and a thyroid ultrasound.
If anti-TPO is very high but TSH is normal or only slightly raised, it is not right to start treatment without a period of follow-up. TSH can, for example, rise temporarily during an infection.
If you feel constantly tired despite treatment, the adequacy of the dose, iron deficiency, vitamin B12 and D levels and cortisol should be checked – and make sure you drink enough water.
Does every Hashimoto’s patient need medication?
No. The decision is based not only on blood tests but on ultrasound findings and your symptoms taken together. If TSH and T4 are normal and the gland’s function and structure are not yet affected, regular monitoring may be enough.
If TSH is high, there are signs of hypothyroidism or the ultrasound shows damaged thyroid tissue, hormone treatment (levothyroxine) is recommended. The dose is set individually by the doctor: too much can cause hormone excess, too little leaves symptoms unresolved. In older people and heart patients treatment starts with a low dose. Treatment must also be continued during pregnancy.
If you are taking medication, pay attention to the following:
- take the thyroid hormone in the morning on an empty stomach, with water only;
- do not drink tea or coffee or eat for at least 30–45 minutes after the tablet;
- do not take calcium, iron or stomach-protecting medicines at the same time as the thyroid tablet;
- for monitoring, check not only TSH but also free T3, free T4, anti-TPO and anti-TG regularly.
A high anti-TPO is not just a number – it is a signal from your body.
Dr. Samir Shukurov
Nutrition: facts and myths
A balanced diet – rich in protein, fibre, healthy fats, vitamins and minerals – helps manage inflammation and supports overall health. Gut flora, stress and antibiotic use can also affect the course of the disease, so managing stress and protecting gut health matter.
Cutting down on packaged foods and sugar benefits gut health; in some patients limiting gluten may also be considered together with the doctor.
At the same time, some widespread beliefs are wrong:
- “Thyroid medication makes you gain weight” – wrong. Weight gain is caused by the hormone deficiency itself, often by an insufficient dose;
- “Frog treatment”, an open jar of iodine left in the room, amber or walnuts steeped in alcohol do not treat Hashimoto’s;
- “One pill is enough” – alongside medication, diet and lifestyle need to change too.
This article is for general information only and does not replace a medical examination.