Hashimoto’s 101: Everything You Should Know‍

Medically Reviewed by
Dr. Stacy Henigsman
Nutritionally Reviewed by
Felice Ramallo, RDN

If you’ve ever suffered from a thyroid problem before, you may have heard of the term Hashimoto’s Disease, which refers to an autoimmune condition that can cause an underactive thyroid (or in rare cases, an overactive thyroid). According to the National Institute of Diabetes and Digestive and Kidney Diseases (aka NIDDK), Hashimoto’s is one of the most common causes of a problematic thyroid, thought to affect approximately 5 in 100 Americans. As with anything thyroid related, when there is a problem, it can wreak havoc on your hormones and prompt a bunch of emotional and physical symptoms that can be extremely distressing, disruptive, and confusing to say the least. Luckily, there are treatment options available to manage and mitigate these symptoms if you experience thyroid problems as a result of Hashimoto’s (since not everyone with this condition does), so their impact on your daily life is lessened. 

In this article we’ll dive into:


  • Explaining the thyroid (and its role in the body)
  • What is Hashimoto’s?
  • Diagnosing Hashimoto’s
  • Symptoms
  • Risk factors
  • Treatment options

Explaining the thyroid 

The thyroid gland is a butterfly shaped gland that rests at the front of your neck, and it is a hormone gland. It produces two hormones, triiodothyronine (T3) and thyroxine (T4). These hormones play a key role in regulating blood pressure, body temperature, heart rate, and metabolism. The thyroid is also in charge of producing calcitonin, which helps bone cells use calcium to build and strengthen bones. 

It’s also helpful to point out that the thyroid works with help from something called the pituitary gland, which is located at the base of the brain. This gland helps monitor the amount of thyroid hormones in your bloodstream; if it senses a lack of thyroid hormones, it can adjust the amounts with its own hormone, thyroid stimulating hormone (TSH). TSH will communicate to the thyroid that more thyroid hormones (T3 and T4) are needed , and the thyroid can take this information and – in an ideal world – produce the right amount of hormones that keep your body’s many processes of metabolism running at the right rate. 

What is Hashimoto’s?

Hashimoto’s is an autoimmune disorder in which your immune system attacks your thyroid gland by mistake. This attack on your thyroid may impact your body’s ability to produce thyroid hormone, which has knock-on effects for the rest of your body. 

Most of the time, Hashimoto’s prompts hypothyroidism, which is an underactive thyroid, though in rare cases it can also cause hyperthyroidism, or an overactive thyroid. 

Symptoms of Hashimoto’s

Since Hashimoto’s is often linked to hypothyroidism, there is often a lot of crossover between symptoms of an underactive thyroid and Hashimoto’s. That being said, symptoms of both hyperthyroidism and hypothyroidism should be kept in mind, since rarely Hashimoto’s can trigger an overactive thyroid as well. 

Let’s take a look at symptoms of an underactive thyroid first, since these are more common in someone diagnosed with Hashimoto’s. ​​Symptoms can include:


  • Fatigue
  • Feeling cold
  • Hair loss
  • Hair dryness
  • Brittle nails
  • Constipation
  • Dry skin
  • Weight gain
  • High cholesterol
  • Irregular periods
  • Stiff joints
  • Puffy face 
  • Depression.

Symptoms of an overactive thyroid can include: 

  • Unintentional weight loss, 
  • Hair loss
  • Trouble falling or staying asleep
  • Irregular heartbeat
  • Rapid heartbeat
  • Nervousness
  • Anxiety
  • Tremor
  • Sweating
  • Increased sensitivity to heat
  • Increased appetite, and 
  • Changes to your menstrual cycle 

In some cases a goiter (irregular growth of the thyroid gland) can be present. In this circumstance, your immune system’s attack on the thyroid gland causes it to become enlarged. You may be able to see a slight bulge on your neck, and you can have problems swallowing or speaking.  

Diagnosing Hashimoto’s 

Hashimoto’s is diagnosed based on several things: 1) an evaluation of your medical history, 2) a physical exam (which will likely include checking your neck for the presence of goiter), 3) an inquiry into your symptoms, and 4) blood testing, in which your doctor may order more than one test to check for hypothyroidism. 

These tests will likely check your levels of: 

  • This test measures the level of thyroid stimulating hormone in your blood (this is the hormone that the pituitary gland produces to help regulate your thyroid). 
  • A high TSH level oftentimes indicates hypothyroidism (aka an underactive thyroid), since this means that your thyroid isn’t making enough hormone on its own. As a result, your pituitary gland steps in to release TSH into your blood. In order to understand the root cause, if your TSH test comes back as irregular, you will likely need at least one more thyroid test.
  • This test measures T3 uptake. T3 test results are often examined alongside T4 and TSH test results to help diagnose thyroid disease.
  • This looks at the level of anti-thyroid peroxidase antibodies and thyroglobulin antibodies in your blood (present in those with Hashimoto’s). 

Want to learn more about testing? Check out Allara’s guide to hormonal testing to read about the most common types of tests your doctor may order if they suspect a hormonal imbalance

Risk factors for Hashimoto’s 

Before we touch on the risk factors of Hashimoto’s, we should point out something important: it is quite common for people to blame themselves for health conditions that they have absolutely zero control over. If you suspect you have Hashimoto’s or you have been positively diagnosed, please refrain from blaming your body or yourself - our bodies are just that: bodies. Not perfect machines or robots. Unfortunately, sometimes our bodies think they are helping us (in the case of an autoimmune condition like Hashimoto’s), even though they are triggering negative symptoms. Even if this is the case for you, try to be mindful about speaking to yourself with kindness and not blaming yourself for something that is not your fault. 

Now let’s talk about factors that may put you at increased risk for Hashimoto’s, according to Johns Hopkins

  • Being female
  • Females are at 7x increased risk of having Hashimoto’s compared to men
  • Being aged between 40 and 60
  • Though Hashimoto’s is seen in younger and older people as well, this age bracket is statistically more likely to begin showing signs of Hashimoto’s
  • Heredity 
  • Though no gene has yet been linked to Hashimoto’s, it is thought to run in families

Treatment for Hashimoto’s 

Treatment for Hashimoto’s will depend on the individual and the path they decide to take with the help of their primary care physician. That being said, doctors will likely recommend different plans depending on your symptoms. 

If you have no symptoms of an over or underactive thyroid, but blood tests indicate you have Hashimoto’s: in this case, your doctor may choose to simply  check in with you about your symptoms and have your thyroid hormone levels tested regularly, but forego prescribing a medication or enacting a treatment plan in the way of lifestyle or dietary recommendations.

If you have hypothyroidism, this means your thyroid isn’t making enough thyroid hormone. To solve this, your doctor may prescribe levothyroxine to compensate, since it is “identical to the natural thyroid hormone thyroxine (T4).” This prescription is available as a liquid or as a capsule. Since the absorption of this medication is impacted by certain foods, multivitamins, and drinks, (grapefruit juice, espresso, soy, and iron are all examples of substances that negatively affect absorption) your doctor may recommend you take this medication in the morning before your first meal. Your doctor may also take another blood test a couple of months after you take this medication, adjusting the dose as needed; once you have a regular dose that works for you, you may have tests taken once or twice a year to check that levels of this medication are working for you. This is super important, since taking too much thyroid hormone can cause problems such as atrial fibrillation (rhythm of heartbeat) or osteoporosis (weak bones).

What to do if you think you have Hashimoto’s

First and foremost: if you suspect you may have Hashimoto’s, or any kind of thyroid problem, it is imperative you book an appointment with your primary care doctor to discuss your symptoms. 

Second, try researching hypothyroidism and hyperthyroidism, in order to understand how your symptoms may cross over with these two conditions. Do you notice similarities? Are there times when your symptoms flare worse than others? Try and think back to when your symptoms started: have they got worse over time, or did they arise one day and they’ve been consistent since then? Write down any information you think is relevant in advance of your appointment so you don’t forget. 

We recommend learning as much as you can, so you can go into your doctor’s appointment with increased knowledge to ask follow up questions and explain as in depth as possible your experience. The more information you can give your primary health provider, the better!

Third, take some time for yourself and try to reduce stress in your life (where possible) before your appointment. Exercise, meditation, and staying socially connected, are all ways you can “cope with stress,” according to Harvard Health. Also on their list of recommendations is getting at least 7 hours of sleep a night and eating a balanced predominantly plant-based diet to get plenty of antioxidants. You don’t have to stop here though, when it comes to paying extra attention to your emotional and mental health: hobbies like gardening, knitting, getting a coffee with friends, swimming, baking, and way more are all activities that you may find meditative and restorative. 

To learn more about the thyroid and the role it plays in our physical and mental health, check out our post on Thyroid Health 101. 

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.

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