Thyroid issues can have vague symptoms that make them difficult to self-diagnose and may make you less likely to talk to about them with your health care provider. Hashimoto’s disease is the most common cause of hypothyroidism.

Signs and symptoms

Hashimoto’s is an autoimmune disorder and involves chronic inflammation of the thyroid. Overtime, the ability of the thyroid gland to produce thyroid hormones becomes impaired. This leads to a gradual decline in function.

“Hashimoto’s is not life threatening,” said Nicole Schneider, F.N.P., endocrinologist at Marshfield Clinic Health System. “Thyroiditis refers to inflammation of the thyroid gland and leads to the thyroid gland enlargement found on physical exam, which can lead to neck discomfort or difficulty swallowing.”

Hashimoto’s symptoms may include:

• fatigue
• weight gain
• constipation
• increased sensitivity to cold
• dry skin
• depression
• muscle aches
• reduced exercise tolerance
• irregular or heavy menstrual cycle

How to diagnose?

As mentioned, Schneider said that Hashimoto’s is often first diagnosed during an annual wellness visit when a patient presents with symptoms and has an enlarged thyroid on physical examination.

To determine hypothyroidism, your provider will order a blood test to look for thyroid stimulating hormone (TSH) or a low thyroid hormone level (Free thyroxine – free T4). Once hypothyroidism is the concern, you will need an antibody test to determine if the Hashimoto’s is the cause. If TPO antibody is also elevated, Hashimoto’s thyroiditis is cause of the hypothyroidism.

Schneider explained that some patients may have TPO elevated, but the TSH and free T4 levels may be normal, or only have a mild elevation of TSH. Symptoms of hypothyroidism may also be absent if there is only a mild elevation of the TSH.

“The disease can be diagnosed early in those with a family history of Hashimoto’s thyroiditis,” she said. “Hashimoto’s thyroiditis occurs commonly in middle-aged women, but can be seen at any age, and can also affect men and children.”

Treatment differs depending on levels

Schneider said that if patients have elevated TPO antibodies, but normal TSH and T4, they don’t require treatment. Patients with mildly elevated TSH may not require treatment and should have repeat testing after three-to-six months.

If the patient has elevated TSH and low T4, treatment consists of synthetic levothyroxine (T4 replacement) taken orally.

“Most patients with Hashimoto’s thyroiditis require lifelong treatment with levothyroxine,” Schneider said. “Finding the appropriate dose may require testing with TSH every six-to-eight weeks after any dose adjustments until the correct dose is determined.”

After a levothyroxine dose is stabilized, testing annually is usually sufficient. Your symptoms of hypothyroidism improve once the TSH and free T4 are normal.

You and your provider will know if the medication dosage is excessive because you may develop symptoms of hyperthyroidism like nervousness, irritability, increased sweating, heart racing, hand tremors, weight loss, anxiety, difficulty sleeping, thinning of your skin, fine brittle hair and weakness in your muscles.

Other considerations

Schneider said there is no specific hypothyroidism diet. However, she mentioned that adequate dietary iodine is essential for normal thyroid function.

“In developed countries, thyroid disease from iodine deficiency has been nearly eliminated by iodine additives in salt and food,” she said.

Other supplements, such as soy, may have an impact on thyroid hormone production, and avoiding dietary extremes will ensure thyroid health.

Certain medications, supplements and foods may affect your ability to absorb levothyroxine. Schneider said it may be necessary to take levothyroxine at least four hours before these substances: soy products, high-fiber foods, iron supplements (including multivitamins with iron), Cholestyramine, antacids (that contain aluminum, magnesium or calcium), Sucralfate and calcium supplements.

Additionally, biotin supplements can interfere with the measurement of thyroid hormone.

“Biotin does not affect thyroid levels, but supplements should be stopped for 48-72 hours before measuring the thyroid function, so that the thyroid lab tests are adequately interpreted,” she said.

If you think you have any signs or symptoms of Hashimoto’s disease, talk to your provider to get the treatment you need.