Hashimoto's: what is it, symptoms, what tests, how to treat?

Hashimoto's is often called a modern epidemic. Researchers have linked its onset to certain viral infections, including influenza. Women suffer from it 10 times more often than men. It affects up to 1-2% of children, and symptoms are easily overlooked or confused with other conditions.

Although untreated it leads to hypothyroidism and many people treat the diagnosis like a verdict, it is possible to live a normal life with Hashimoto's. How to do this?"

With Dr Witold Tomaszewski, MD, and clinical nutritionists Marta Kaczorek and Julia Skrajda, we tell you everything you need to know about it. Learn about the symptoms of Hashimoto's, its causes, as well as the tests and treatments and dietary indications to tame it and allow you to enjoy every day.

The thyroid gland - although a small gland - affects our body's most important functions. Find out more about the thyroid gland itself, the diseases that can affect it, and the tests you should have regularly:

• Thyroid gland - what it is, functions, tests, diseases and treatment
• Hypothyroidism: causes, symptoms, treatment [Doctor's advice]
.
• Hypothyroidism: symptoms, causes, treatment [Physician's advice]
.
• Psoriasis: symptoms, causes and treatment
.
• Thyroid tests - what to do and why are they so important?

Are you experiencing the symptoms described in the article? Get a thyroid test and consult an endocrinologist. Early diagnosis means a better chance of effective treatment!

What is Hashimoto's disease?

Hashimoto's is an autoimmune disease in which the body's own immune system attacks and gradually destroys thyroid cells. In developed countries, it is one of the most common causes of hypothyroidism.

Hashimoto's disease is one of the most common causes of hypothyroidism.

Hashimoto's disease is also known as chronic autoimmune thyroiditis, chronic lymphocytic thyroiditis (Autoimmune Thyroid Disorder, AITD). In the International Classification of Diseases and Health Problems and you will still find the following terms:

• Lymphoid goitre,
.
• Lymphocytic goitre,
.
• Lymphocytic thyroiditis,
.
• Hashimoto's thyrotoxicosis (transient),
.

Major symptoms of Hashimoto's

Hashimoto's disease in its early stages may not give you any worrying symptoms. As the disease progresses, you will begin to experience symptoms characteristic of hypothyroidism. Unfortunately, these can be easily confused with other diseases, ignored or blamed on daily stress and busyness.

Hashimoto's gives physical, mental and neurological symptoms. The main symptoms of Hashimoto's are primarily those encountered in hypothyroidism and:

• chronic fatigue,
.
• changes in appearance (facial swelling, hair loss, weakened and brittle nails, weight gain, pale and dry skin),
.
• muscle and joint pain,
.
• problems with bowel movements (constipation),
.
• menstrual disorders (irregular and heavy menstruation),
.
• problems with libido and fertility,
.
• low blood pressure,
.
• slow heart rate,
.
• lower mood,
.
• depression,
.

In Hashimoto's disease, the thyroid gland is mainly small and atrophic. However, there are rare cases where it enlarges, forming what is known as a thyroid goiter.

Regular check-ups will help detect possible abnormalities early and address them effectively.

See also:

• Cortisol testing
.
• Blood test
• Liver tests

What are the causes of Hashimoto's and who is at risk?

Although the first cases of Hashimoto's were described in 1912, the causes of the disease are still not fully known. However, there are several factors that increase the likelihood of developing the disease and:

• Genes: lymphocytic thyroiditis shows some genetic predisposition. If you have a family history of confirmed cases of Hashimoto's, hypothyroidism or other autoimmune diseases (e.g. Graves-Basedow), your risk increases;
• .
• Gender: women get the disease up to 10 times more often than men, and the risk of getting the disease is up to 4 times higher than for men and;
.
• Age: most cases in women are diagnosed between the ages of 30 and 50  ;
.
• Hormones: too high levels of oestrogens in the long term can increase a woman's susceptibility to the disease, by stimulating the immune system to produce antibodies, including TPO and TG;
.
• Different diseases and conditions: celiac disease, type I diabetes, lupus, rheumatoid arthritis (RA) or Sjögren's syndrome, vitamin B12 deficiency, Addison's syndrome or some liver conditions;
• Iodine excess;
.
• Radiotherapy and radiation exposure: an increase in thyroid disease was observed after the nuclear accidents at Fukushima and Chernobyl;
.
• Pregnancy: changes in immune function during pregnancy may be factors leading to Hashimoto's or hypothyroidism after the birth of the baby.

Hashimoto's and hypothyroidism

There is a common belief that Hashimoto's disease is synonymous with hypothyroidism. This is not true!"Hashimoto's disease can be asymptomatic and only when left untreated can it lead to hypothyroidism in the long term - it is one of its main causes.

Hashimoto's and thyroid cancer

The relationship between Hashimoto's disease and cancer formation (carcinogenesis) is not completely known. Scientists have several hypotheses that need to be carefully verified. However, numerous studies and show that people with Hashimoto's suffer from thyroid cancer more often than those without the condition. In addition, they are at increased risk of breast and lung cancer, as well as cancers of the blood, gastrointestinal tract and genitourinary tract.

Diagnosis of Hashimoto's disease - what tests need to be done?

Diagnosing using only the symptoms of Hashimoto's is difficult and risky. It is crucial to carry out blood tests for the thyroid gland.

Basic thyroid testsinclude determination of TSH, FT3 and FT4 concentrations. However, these may not be sufficient, so it is worthwhile to also do anti-TPO, anti-TG and TRAb tests, as well as complementary tests such as:

• ThyroidUSG - will help assess the size and structure of the thyroid gland, and detect any nodules or goitre;
.
• blood chemistry - any disorders of the thyroid gland may be responsible for the development of other dangerous conditions in the body, which can be more accurately diagnosed through blood tests;
.
• lipidogram - people with Hashimoto's and hypothyroidism as a result of slowed metabolism tend to have problems with cholesterol accumulation and are at risk of atherosclerosis and heart attack;
.
• Iron determination - a deficiency of iron can lead to, among other things, a decrease in thyroid hormones and anaemia, which often accompanies people with Hashimoto's.

When nodules on the thyroid gland are found, a so-called thyroid scintigraphy is performed. This is an isotopic study of the thyroid gland, which helps to determine the morphology of the gland, as well as the differentiation of the nodule tissue. However, it is rarely performed in cases of Hashimoto's.

A test often ordered by doctors is the determination of homocysteine. Its elevated concentration may accompany hypothyroidism, but Dr Witold Tomaszewski, M.D., admits that this test usually does not add anything to the diagnostic and therapeutic management.

Respectively, this test is not used in the case of Hashimoto's disease.

Reference values and interpretation

The reference values of TSH, fT3 and fT4 for adults are:

• TSH: 0.45-4.5 µU/ml
.
• fT3: 4.0-7.8 pmol/l
.
• fT4: 10-25 pmol/l
.

Each laboratory may have its own range of reference values, depending on the methods it uses. Therefore, consult your GP or endocrinologist for the interpretation of your test results.

Witold Tomaszewski

Different TSH and fT3 and fT4 results may suggest a different form of hypothyroidism.

Hashimoto's disease and high TSH

• If TSH is above the reference range and fT3 and fT4 are normal, the doctor will most likely diagnose subclinical primary hypothyroidism. If the TSH is below 10 mlU/l, it is necessary to repeat the test after about 15 weeks and refer to an endocrinologist. If the symptoms of hypothyroidism are not severe, it is worth having an ultrasound of the thyroid gland and going for a consultation with an endocrinologist.
.
• If TSH is elevated, fT4 is lowered and fT3 is within the reference range or lowered, probably there is primary clinically overt hypothyroidism. Depending on the symptoms, it will be necessary to consult an endocrinologist, have an ultrasound of the thyroid gland and start treatment with l-thyroxine.

Hashimoto's and normal TSH

• If all indicators are within normal limits, we speak of a state of so-called euthyroidism, i.e. hormonal balance. If a goiter is suspected, including with the presence of nodules, imaging studies should be performed.
• If the TSH and TSH are normal, the hormone balance is not normal.
• If TSH and fT3 are normal or below the reference range and fT4 below normal, it is likely to besecondary hypothyroidism. It is then necessary to rule out adrenal insufficiency and undertake appropriate treatment under the care of an endocrinologist.
.

Hashimoto's and low TSH

Testing for Hashimoto's - price

Hormone testing for thyroid disease is usually available in two packages: basic (TSH, FT3 and FT4) and extended, which includes anti-TPO, anti-TG and TRAb tests in addition to the basic tests. Costs depend on the specific laboratory and the choice of package.

The most cost-effective is the extended package, with prices starting at around £180. You can also choose a package with a doctor's consultation, which will be correspondingly more expensive.

To the full diagnostics, you should add the prices of any supplementary tests (e.g. thyroid ultrasound, morphology, lipidogram, as well as determination of the concentration of iron, homocysteine, vitamin D, glucose or tests for coeliac disease).

Hashimoto's in women

Thyroid problems are commonly regarded as typically female ailments. They affect virtually all spheres of life - including such intimate ones as sex life, fertility and motherhood and.

Hashimoto's and the menstrual cycle

Hashimoto's and hypothyroidism cause a disruption of the menstrual cycle. Menstruation is then more abundant, more painful and more irregular - in some cases it can even disappear for several months and.

Hashimoto's and libido and fertility

One of the key functions of the thyroid gland is hormone regulation. This has implications for sex life and fertility in both men and women and.

• Hypothyroidism-related dysfunctions occur less frequently in women (22-46%) than in men (59-63%);
.
• Women are more likely to report problems with desire, impaired arousal and sense of pleasure, and pain during intercourse;
• Women are more likely to report problems with desire, impaired arousal and sense of pleasure, and pain during intercourse.

Correct treatment most often leads to a definite improvement in sexual function and satisfaction.

See also:

• NAC for fertility, liver and detox
.

Hashimoto's and pregnancy

Stabilising Hashimoto's and hypothyroidism is a key issue for couples planning children and women who are already pregnant and.

Conception itself can be difficult, and untreated hypothyroidism during pregnancy increases the risk of premature birth, miscarriage or pre-eclampsia  .

What's more, for the first three months, the baby takes over the thyroid hormones from the mother. If it receives too few of these, this can result in, among other things, problems with normal growth or the development of the nervous system and brain  .

Hashimoto's and the menopause

Hashimoto's and hypothyroidism overlap in many ways with the symptoms of the menopause. Fatigue, sleep disturbances or mood swings - progressive hypothyroidism can increase both the number and severity of overlapping symptoms and.

Research shows that women with confirmed thyroid disease have experienced improvements in menopause-related symptoms following thyroid treatment and.

Does Hashimoto's occur in men?

Although Hashimoto's affects women 10 times more often, this does not mean that the disease completely bypasses men.

The most characteristic symptoms of Hashimoto's in men are and:

• weight gain unrelated to diet or lifestyle changes;
.
• pale and dry skin;
.
• metabolic problems (e.g. frequent constipation);
• fatigue.
• swollen face;
.
• weakness and pain in muscles and joints;
.
• increased sensitivity to cold;
.
• problems with libido, erectile dysfunction and sexual function;
.
• problems with fertility (poorer semen quality - fewer sperm, abnormal structure and reduced motility);
.
• concentration and memory problems;
.
• depressive states;
.

Hashimoto's disease in children

Hashimoto's disease is the most commonly diagnosed thyroid disease in children. It affects up to 1-2% of children regardless of age and.

The incidence of Hashimoto's in children depends on:

• gender,
.
• genetic predisposition,
.
• ethnic origin,
.
• exposure to iodine (diet, supplementation, radiotherapy),
.
• presence of other autoimmune diseases and genetic syndromes,
.

Hashimoto's disease is most commonly diagnosed in children aged 6-16 years, in Caucasians and in iodine-deficient countries. In addition, it is found in children with and:

• type I diabetes,
.
• celiac disease,
.
• addison's disease,
• diabetes,
and
• Bottom's syndrome,
• Down's syndrome
• Turner's syndrome,
• Turner's syndrome
• Klinefelter's syndrome,
.
• Noonan syndrome,
.

The symptoms of Hashimoto's in children are virtually identical to those in adults. In children, thyroid hormones are responsible for physical and mental development. Their deficiency may be responsible for, among other things, late teething, stunted or delayed puberty, slow growth or mental disorders and.

Children with Hashimoto's and developing hypothyroidism may underperform academically, be lethargic, apathetic and socially withdrawn.

Some parents blame such a condition on their child's humours or character. Unfortunately, the causes can be much deeper than just a weaker day. If this situation has been going on for a long time in your child and you don't see any change, consult your doctor and get tested for Hashimoto's and thyroid disease.

Hashimoto's: treatment, diet, activity and lifestyle changes

Some patients with Hashimoto's do not require drug treatment. As long as the TSH and fT4 values are within reference ranges and the thyroid gland is of normal size, constant monitoring of the situation will be necessary, as the disease can lie dormant for many years and not produce significant symptoms.

How is Hashimoto's treated?

It is not possible to halt or reverse the progression of Hashimoto's disease. Treatment boils down to therapy for hypothyroidism and hormone balance and. It mainly involves taking l-thyroxine, a synthetic version of the hormone produced by the thyroid gland. With a properly established dose, TSH will return to normal and the body will start to function better.

Consistent medical care and regular thyroid tests are necessary to help control symptoms and select the correct dose of medication.

Although treatment of Hashimoto's (like hypothyroidism) usually lasts a lifetime, appropriate therapy ensures that the disease does not affect length or quality of life.

Unmedicated Hashimoto's - effects and complications

Unmedicated Hashimoto's disease can result primarily in the development of phenomenal hypothyroidism.

Unmedicated Hashimoto's disease can result primarily in the development of phenomenal hypothyroidism.

Alongside this, the following can occur and:

.
• elevated cholesterol levels,
.
• hypertension and cardiovascular disease,
.
• anaemia,
• hypotension and cardiovascular disease,
• hypertension and cardiovascular disease,
• aemia
• hypometabolic coma - a life-threatening condition in which there is a decrease in vital functions, hypothermia, oedema or hypoglycaemia;
• Hashimoto's encephalopathy - a disorder that can manifest with stroke-like episodes, cognitive decline or neuropsychiatric symptoms. Although the first case was described in 1966, it has still not been thoroughly studied and the exact causes of its occurrence have not been determined. However, corticosteroid treatment is known to be effective  ;
.
• problems with fertility and getting pregnant;
.
• depression - Hashimoto's disease is often accompanied by psychiatric disorders, including anxiety and depression. The exact correlation is not yet known, but a very strong link between mental state and thyroid function has been confirmed so far;
.

Diet for Hashimoto's - what to eat and what not to eat?

A balanced diet and an active lifestyle play an important role in the treatment of Hashimoto's disease - especially as many people's symptoms persist even after taking medication. In addition, they reduce the risk of other conditions that people with Hashimoto's are at risk of (such as the development of autoimmune diseases, high cholesterol, obesity or diabetes).

There is no specific diet specifically recommended for people with Hashimoto's. It is recommended that menus should be well balanced and rich in nutrients and.

For Hashimoto's thyroiditis, it is worth including the following food groups in the diet:

• Fruits (e.g. berries, peaches, citrus, bananas, pineapple);
.
• Starchy vegetables (e.g. yams, potatoes, peas, squash);
• Healthy vegetables (e.g. yams, potatoes, peas, squash).
• Healthy fats (e.g. avocado, avocado oil, olive oil, coconut oil, natural yoghurt);
• Zoon protein (e.g. salmon, eggs, cod, turkey, prawns, chicken);
.
• Gluten-free grains (e.g. oatmeal, quinoa, brown rice);
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• Seeds and nuts (e.g. cashews, almonds, macadamia nuts, sunflower seeds, pumpkin seeds, peanut butter);
• Dairy and its substitutes enriched with calcium and vitamin D (e.g. coconut milk, cashew milk, goat cheese, almond milk, kefir);
• Beverages (e.g. water, unsweetened tea, yerba mate);
.
• Spices (e.g. curcumin, basil, black pepper and piperine, saffron, apple cider vinegar);
.

legumes (e.g. beans, lentils and chickpeas) are best eaten after heat treatment.

Additionally, after taking medication, avoid the following in particular:

• soy and soy products,
.
• coffee,
.
• grapefruit juice,
.
• substantial amounts of dietary fibre,
.
• nutrients and calcium-rich products,
• fiber foods and supplements.
• products and supplements rich in iron.
.

The absorption of levothyroxine may also be impaired by coeliac disease, gastrointestinal complaints and lactose intolerance and.

Eliminating or limiting certain food groups can help reduce Hashimoto's symptoms and improve overall health:

• sugar and sweetened products (e.g. fizzy and energy drinks, confectionery, breakfast cereals, ice cream, biscuits);
• highly processed foods.
• highly processed and fast food;
• pasta, pasta, bread and other foods.
• products with refined grains,
.
• grains and products containing gluten (especially for people with coeliac disease);
.

People with Hashimoto's need to watch out for so-called goitrogens, which are goitrogenic substances that interfere with the absorption of iodine. They can be found in brassica vegetables (e.g. cabbage and Brussels sprouts), cruciferous vegetables (e.g. cauliflower, kale or broccoli), legumes (beans, lentils or soya beans), turnips, swedes or mustard, among others.

Because of their goitrogen content, it is recommended to restrict the consumption of these foods raw. However, just cook them uncovered (goitrogens are volatile compounds, and heat treatment reduces their amount by 30%), and you can eat them without much concern and.

Supplementation in Hashimoto's disease - what can help?

People with Hashimoto's are more likely than others to be deficient in certain nutrients that can help fight inflammation in the body. Some of these you will supplement with your diet, others need to be supplemented additionally.

The most important ingredients to supplement for Hashimoto's are and:

• selenium - according to research, a dose of as little as 200 μg of selenium per day can help reduce TPO antibodies. You can find it in salmon, cereal products, dairy products or Brazil nuts, among others;
.
• Zinc - it is needed for the synthesis of thyroid hormones, and a deficiency of zinc can cause hypothyroidism. Zinc is also helpful in combating hair loss;
.
• vitamin D - vitamin D deficiency, according to research, often occurs in Hashimoto's disease. Zinc is present, for example, in wheat bran, flax seeds and pumpkin seeds:
.
• Omega-3 acids - one of the powerful antioxidants with tremendous anti-inflammatory potential. Omeega-3 acids can be found, for example, in avocados, olive oil, pumpkin seeds, nuts or oily fish;
• B vitamins - people with Hashimoto's are at risk of vitamin B12 deficiency. Taking a complex B vitamin raises levels of vitamin B12 and others in this group;
• magnesium - researchers have linked low magnesium levels to an increased risk of Hashimoto's. Magnesium-rich foods include wheat bran, pumpkin seeds, cocoa, chia seeds and almonds;
• Iron - is involved in the metabolism and synthesis of thyroid hormones. Iron deficiency consequently leads to anemia, which is one of the consequences of hypothyroidism. The best sources of iron are thyme, marjoram, dried seaweed or chicken liver.

Other substances that can help people with Hashimoto's include fish oil, alpha-lipoic acid and N-acetylcysteine.

Spices, plants and herbs for Hashimoto's - is it worth it?

Increasing interest in natural medicine means that more and more people are using plants and herbs recommended for Hashimoto's.

Here are the most popular ones:

• ashwagandha - as an adaptogen, it acts to normalise many of our body's functions, including the hypothalamic-pituitary-adrenal axis, which is important for proper thyroid function. There is a study that suggests that a daily dose of 600 mg of ashwagandha may help patients with subclinical hypothyroidism;
• Maca root - has widely documented supportive effects for symptoms experienced by people with thyroid disorders. It supports fertility and bone health. It helps us have more energy, the brain starts to function better, and libido and sex drive increase. Due to the presence of goitrogens, supplementation should be taken with caution;
.
• curcumin - regular use of curcumin can reduce the risk of and development of will;
.
• white quinine - quinine extract has a positive effect on the treatment of thyroid disease, both hypothyroidism and hyperthyroidism;
.
• garlic - helps fight inflammation and supports blood sugar metabolism;
.
• ginger - regular consumption of at least 1,000 mg of ginger per day can reduce such important symptoms of hypothyroidism as dry and pale skin, weight gain and reduced cold tolerance;
.
• Mountain rhodiola - extract from Rhiodola rosea stimulates the nervous system, helps to increase productivity and efficiency at work, supports the treatment of depression and helps to get rid of fatigue, which are important symptoms of the clinical form of hypothyroidism.

Hashimoto's and alcohol

The 'relationship' between alcohol and the thyroid gland, including Hashimoto's disease, is quite complicated and.

On the one hand, long-term alcohol drinking can damage thyroid cells and impair thyroid function, including the production of thyroid hormones. People with alcohol use disorders also often have lower TSH concentrations, which can lead to hypothyroidism.

These are the most common findings.

On the other hand, there are studies (from the Netherlands, Denmark or China) that suggest that moderate alcohol consumption may reduce the incidence of hypothyroidism and.

Scientists do not fully know how alcohol interacts with autoimmune thyroid disease. A common feature of these studies is that fewer TPO antibodies are involved in the development of these conditions.

This does not mean, however, that if you drink alcohol you will not develop Hashimoto's!

Alcohol has also so far not been shown to have negative interactions with levothyroxine, used in the treatment of Hashimoto's and.

Do not under any circumstances use alcohol as a preventative measure or treatment for Hashimoto's. It is the third biggest risk factor for diseases and disorders that affect the hypothalamic-pituitary-thyroid axis. Alcohol abuse can lead to dangerous consequences, including addiction, liver disease, high blood pressure or anxiety and.

How to lose weight with Hashimoto's? Activity and training with Hashimoto's

Thyroiditis is often accompanied by disturbances in carbohydrate metabolism or problems with the absorption of individual nutrients. In addition, there may be what is known as slowed metabolism, which means that some of the energy we provide with food is stored rather than processed.

This all comes with a significant risk of weight gain. If your BMI is greater than 24.9, it's worth following a slightly reductive diet to shed weight. Start by reducing your calorie supply by 200-300 kcal. Cutting calories too restrictively can take a toll on your wellbeing and health. It also increases the risk of yo-yo effect.

Daily diet should go hand in hand with physical activity. The World Health Organisation recommends at least 150 minutes of moderate physical activity or 75 minutes of intense exercise per week and.

We all know the legendary phrase that all movement counts. This is also confirmed by clinical nutritionist and personal trainer, Marta Kaczorek:

This includes any form of movement - cleaning, shopping, walking to work, marching during calli time or playing with your children.

You can train for anything you like - pool, cycling, jogging.

Both strength and cardio training should be tailored to your health and wellbeing. Observe your body and see how your body reacts. If you feel you can't do it today - do the workout tomorrow. Understanding and accepting yourself is really important.

Also make sure you get a good night's sleep and adequate regeneration.

And don't forget to get plenty of sleep.

Want to know more about thyroid health?

See also:

• Thyroid - what it is, functions, research, diseases, treatment
.
• Hypothyroidism: causes, symptoms, treatment
.
• Hypothyroidism: symptoms, causes, treatment

How to live with Hashimoto's? Find out Natalia's story

Although it doesn't make itself known too much for years, it causes many problems. It is difficult to diagnose quickly and effectively. Lack of support, anxiety, uncertainty - these are feelings that are compounded for many people with Hashimoto's who do not know it. This was also very much the case for Natalia Grajcar, one of the founders of Natu.Care.

Stabilising the disease and learning to live with it normally did not come immediately. "I'm still learning it, it's an ongoing process that requires work, effort. I had to completely re-evaluate my life and face my weaknesses". - recalls Natalia.

Choosing the right doctor proved to be crucial. "When I started my struggle with Hashimoto's and hypothyroidism knowledge and awareness of them was much less than it is today. I went from doctor to doctor until I finally came across an empathetic specialist with whom I felt really safe. His support both at the time of diagnosis and during treatment were really important to me. Without him, or the help of those closest to me, it would have been so much harder."

What was the most important thing about all this?"

Want to live a healthy and happy life? Do regular preventive checkups! Why are they so important? You can find out in our articles:

• Thyroid tests - symptoms, preparation, norms
.
• Blood tests: how to prepare, when and where to perform, how to interpret the results
.
• Cortisol testing - norms, price, symptoms and indications
• Hepatic tests - what are they and when to perform them?

Summary