Hashimoto’s disease

At a glance

  • Hashimoto’s disease is an inflammation of the thyroid gland.
  • It is caused by an abnormal reaction of the immune system.
  • The inflammation often leads to an underactive thyroid over time.
  • Then the person’s thyroid doesn’t produce enough hormones anymore.
  • If that happens, they have to take hormone replacement tablets.

Introduction

Photo of woman taking medication

The thyroid gland produces , including two types known as T3 and T4. These regulate a lot of processes in our bodies. Hashimoto’s disease is a chronic of the thyroid. It is caused by an autoimmune reaction. This often results in the gland not producing enough anymore. At the beginning of the illness, the can cause the thyroid to be overactive for a while. As the illness progresses, though, the thyroid becomes underactive. This can lead to various symptoms, such as tiredness or changes in the person’s skin.

The problem can be corrected by taking tablets containing thyroid every day. This usually makes the symptoms go away.

Symptoms

If the thyroid doesn’t make enough hormones, it has a negative effect on a number of body functions. This is reflected in the wide range of symptoms.

Many people feel generally weak, and often tired and cold too. There can be visible changes in the body. For example, the person’s neck might swell because the sometimes results in an enlarged thyroid (known as a “goiter”). Later, the thyroid can also shrink a lot. Their skin may become dry or thicker too, making their face look puffy. Some people put on weight.

Hoarseness, constipation, a slow heart rate, menstrual (period) problems and erection problems can also occur. Other possible symptoms of an underactive thyroid include mental health problems such as a low mood or lethargy.

Illustration: Hashimoto’s disease can cause a wide variety of symptoms

Causes

The thyroid that occurs in Hashimoto’s disease is caused by an autoimmune reaction: The person's attacks their own thyroid tissue, resulting in chronic . In some cases, this leads to more and more thyroid tissue being destroyed and replaced by connective tissue.

It is not clear why the makes this “mistake.” Genetic factors play a role: Experts assume that people with certain genes can develop these problems if too much iodine gets into their body. This might happen if they have to be injected with an iodine-containing contrast medium for a CT scan, for example. In day-to-day life, the iodine concentrations in our diets aren't high enough to cause these problems.

Prevalence

Hashimoto's disease affects an estimated 4 out of 1,000 women and 1 out of 1,000 men. It is the most common cause of an underactive thyroid in Germany and other countries. Most of those affected get it between the ages of 30 and 50. But it can occur in children and older people too.

Outlook

People with Hashimoto’s disease often still have normal levels of thyroid in their blood to start with, even though cells in the thyroid gland are dying. This is because the rest of the thyroid tissue can produce more . The tissue that’s still working properly grows in order to keep the hormone levels normal. As a result, the thyroid is often bigger than normal at the beginning of the disease (this swelling is called a “goiter”).

But sometimes too much of the thyroid tissue becomes damaged over time and the body can’t produce enough thyroid any more. This leads to symptoms that are typical of an underactive thyroid.

In rare cases, people with Hashimoto’s disease have an overactive thyroid for a short time at the beginning of the illness. The symptoms include a rapid heartbeat, agitation and increased sweating. This short period of overactivity happens because stored in the thyroid tissue are suddenly released into the body when the tissue dies.

Diagnosis

If your doctor thinks you might have an underactive thyroid, they will ask about your symptoms and examine the thyroid by feeling your neck. They might also do an ultrasound scan of your thyroid.

The only way to know for sure whether you have Hashimoto’s disease is by doing blood tests. The tests measure the levels of various hormones in your blood. These include the thyroid themselves and the thyroid-stimulating hormone (TSH). TSH is produced in the pituitary gland in the brain. It controls the function of the thyroid gland. The tests also show whether your blood contains antibodies that typically attack thyroid tissue. Your body makes these antibodies due to an abnormal reaction of the .

Because Hashimoto’s disease can occur in combination with other autoimmune diseases, further examinations are sometimes needed – for instance, to test for gluten intolerance (celiac disease) or diabetes. In type 1 diabetes, cells are attacked by the person’s own .

Effects

When Hashimoto’s disease leads to an underactive thyroid, it’s important to get treatment. If it’s left untreated, complications such as cardiovascular (heart and blood vessel) disease can arise over the long term. Seizures, difficulty concentrating, memory problems, confusion and even comas are also possible but extremely rare.

People with Hashimoto’s disease also have an increased risk of developing malignant tumors (cancer) in their thyroid, though this is also rare.

Treatment

It is not possible to treat the factors that caused the Hashimoto’s disease to develop. But if the results in an underactive thyroid, you can make up for the lack of T4 thyroid hormone (also known as “thyroxine”) by taking medication called levothyroxine or L-thyroxine. This medication keeps the hormone levels within the normal range and the symptoms typically go away completely. But it takes about two to three months for the hormone levels to return to normal.

People with Hashimoto’s disease take L-thyroxine once a day – usually for the rest of their life. Doctors often recommend taking the tablet with a glass of water half an hour before breakfast. The idea is that the body can absorb the medicine better on an empty stomach. But you can also take the tablet in the evening about two hours after your last meal before going to bed.

Taken at the right dose, side effects are very rare. The dose is determined based on the person’s exact hormone levels, their body weight and other factors. If the dose is too high, it can cause agitation. So the hormone levels are checked regularly during the first few weeks of treatment. If necessary, the dose is changed. After that, the hormone levels usually only have to be checked once a year.

Experts sometimes recommend treatment for Hashimoto’s disease even if the underactive thyroid is only “latent” – in other words, if the patient doesn’t have any noticeable symptoms. This is known as “subclinical hypothyroidism.” In these cases, the thyroid gland still manages to make enough , but only because the pituitary gland stimulates it to make more. The treatment is offered in order to prevent symptoms developing.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Akamizu T, Amino N. Hashimoto's Thyroiditis. Endotext 2017.

Chaker L, Bianco AC, Jonklaas J et al. Hypothyroidism. Lancet 2017; 390(10101): 1550-1562.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Erhöhter TSH-Wert in der Hausarztpraxis (S2k-Leitlinie). AWMF-Registernr.: 053-046. 2016.

Jameson JL, Mandel SJ, Weetman AP. Disorders of the Thyreoid Gland. In: D. L. Kaspers, S. L. Hauser, J. L. Jameson et al (Ed). Harrison's Principles of Internal Medicine. McGraw-Hill Education; 2015.

Jonklaas J, Bianco AC, Bauer AJ et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 2014; 24(12): 1670-1751.

Katagiri R, Yuan X, Kobayashi S et al. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS One 2017; 12(3): e0173722.

National Institute for Health and Care Excellence (NICE). Thyroid disease: assessment and management. 2019.

Pearce SH, Brabant G, Duntas LH et al. ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2(4): 215-228.

Schübel J, Feldkamp J, Bergmann A et al. Latente Hypothyreose des Erwachsenen. Dtsch Arztebl Int 2017; 114(25): 430-438.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on January 6, 2022

Next planned update: 2025

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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