Written by Farah Naz Khan, MD | Reviewed by Karla Robinson, MD
Updated on October 20, 2022
Key takeaways:
Hashimoto’s thyroiditis is an autoimmune attack on the thyroid gland, and it often leads to hypothyroidism. Although they can have similar features, Hashimoto’s and hypothyroidism are two different conditions.
Hashimoto’s disease and hypothyroidism often occur together. But not everyone with Hashimoto’s will develop hypothyroidism, and not all cases of hypothyroidism are due to Hashimoto’s.
Hashimoto’s doesn’t always need treatment. But the treatment for Hashimoto’s and hypothyroidism can be similar if there is a lot of damage to the thyroid gland.
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Hypothyroidism is the most common form of thyroid disease and one of the most common diseases in the world. And Hashimoto’s thyroiditis is the leading cause of hypothyroidism in the U.S. Because Hashimoto’s thyroiditis and hypothyroidism are linked, they are sometimes used interchangeably. But they are distinct conditions with different features.
What is Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis is an autoimmune disorder affecting the thyroid gland. In this condition, your immune system mistakenly attacks and destroys your thyroid gland cells. Most people with Hashimoto’s have created antibodies against the thyroid gland. These auto-antibodies can damage the thyroid and lead to hypothyroidism in many cases.
Hashimoto’s thyroiditis can affect anyone. But it’s much more likely if:
You’re born with female anatomy
You’re between 30 to 50 years old
You’re in a family with others who have Hashimoto’s
You’re diagnosed with autoimmune disorders (like lupus, Type 1 diabetes, or rheumatoid arthritis)
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What are the symptoms of Hashimoto’s thyroiditis?
Symptoms of Hashimoto’s thyroiditis can vary. Many times, symptoms of Hashimoto’s disease look like the symptoms of hypothyroidism. That’s because Hashimoto’s will often result in an underactive thyroid.
Some of the more common symptoms associated with hypothyroidism from Hashimoto’s include:
Fatigue
Weight gain
Cold intolerance (feeling cold when others are not)
Muscle aches
Constipation
A slower heartbeat than normal
Dry skin and hair
Chipped or peeling nails
SOMETIMES, YOU CAN DETECT HASHIMOTO’S VERY EARLY IN THE DISEASE PROCESS. IN THIS STAGE, THE ATTACK ON YOUR THYROID CAN LEAD TO AN OVERACTIVE THYROID (HYPERTHYROIDISM). IN THESE INSTANCES, SYMPTOMS OF HASHIMOTO’S THYROIDITIS CAN LOOK LIKE:
Tremors
Weight loss
Anxiety
Fast heart rate
Insomnia
Muscle weakness
Irritability
Less frequent periods
How do you know if you have Hashimoto’s thyroiditis?
Your provider will use your medical history and a series of tests to make the diagnosis of Hashimoto’s thyroiditis. If you have symptoms of thyroid disease or a goiter (swelling of the thyroid gland), you’ll likely need more tests. This may include blood work, imaging studies, or a combination of the two.
Common lab tests for Hashimoto’s disease include:
TSH (thyroid stimulating hormone)
T4 (thyroxine)
T3 (triiodothyronine)
TPO (thyroid peroxidase antibodies)
Thyroglobulin antibodies
TSH receptor antibodies
Many people with Hashimoto’s disease will test positive for TPO or thyroglobulin antibodies. But about 5% of people with Hashimoto’s thyroiditis will not have any antibodies detected.
Sometimes an ultrasound can help make the diagnosis of Hashimoto’s thyroiditis. The imaging may also include a fine-needle biopsy of thyroid tissue to confirm the diagnosis. This is often helpful when there’s a goiter or thyroid lab tests are normal.
Hashimoto’s vs. hypothyroidism: What’s the difference?
The main difference between Hashimoto’s and hypothyroidism is the cause of each condition. Hashimoto’s disease happens when your immune system attacks your thyroid gland. Hypothyroidism occurs when your thyroid is underactive and not producing enough thyroid hormone. And this can happen for many different reasons.
Hashimoto’s and hypothyroidism are closely linked. That’s because Hashimoto’s thyroiditis is the most common cause of hypothyroidism. But not all cases of Hashimoto’s disease lead to hypothyroidism, and not all hypothyroidism is due to Hashimoto’s.
Hashimoto’s disease is the result of your body making antibodies to the thyroid. This is what makes it an autoimmune disorder. Antibodies are an important part of the body’s immune system. They’re designed to fight off cells in the body that don’t belong.
But in Hashimoto’s, the body creates antibodies that mistakenly attack the thyroid. Sometimes this destruction is so widespread that it leads to hypothyroidism (but not always).
What causes Hashimoto’s hypothyroidism?
Scientists still aren’t exactly sure what triggers the immune system to attack the thyroid in Hashimoto’s disease. It seems that some people have a genetic tendency to develop Hashimoto’s. And it tends to run in families. There are also theories about other factors that might increase your risk of Hashimoto’s disease. These include:
Infection
Pregnancy
Change in iodine intake
Certain medications that trigger autoimmune responses
What can cause hypothyroidism?
It’s not just Hashimoto’s thyroiditis that causes hypothyroidism. Anything that prevents your thyroid from producing enough thyroid hormone can lead to hypothyroidism. Several other causes of hypothyroidism include:
Thyroid cancer
Thyroid surgery
Medications (like lithium and amiodarone)
Radiation treatment
Congenital hypothyroidism (from birth)
Are treatments for Hashimoto’s and hypothyroidism the same?
Treatment for Hashimoto’s thyroiditis and hypothyroidism can be the same in some cases. This depends on whether the damage to the thyroid gland from Hashimoto’s is severe enough to cause hypothyroidism. If so, treatment will typically include thyroid hormone replacement medication, like levothyroxine (Synthroid).
Treatment of hypothyroidism is necessary for the body to function normally.
Untreated hypothyroidism from any cause can lead to serious complications. This can include:
Mental health changes
Infertility
Heart disease
Nerve damage
Death (in severe cases)
If your Hashimoto’s disease isn’t advanced and hasn’t caused significant damage to your thyroid, you may not need any treatment. Your provider may choose to monitor your thyroid function regularly and check to see if you develop any symptoms.
The bottom line
Hashimoto’s disease often leads to hypothyroidism, but this can vary from person to person. Some people only have normal thyroid function early on in Hashimoto’s, while others never progress to hypothyroidism at all. Your provider will check you regularly for symptoms and any changes in your lab tests. This will give them clues about your thyroid function and help them develop a treatment plan that’s best for you.
References
American Thyroid Association. (n.d.). Goiter.
American Thyroid Association. (n.d.). Hashimoto’s thyroiditis (lymphocytic thyroiditis).
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