Hashimoto’s Explained

Did you know that…?

One in eight women will develop thyroid disease during her lifetime.

Women are more prone to thyroid dysfunction than man and most women are diagnosed when they are between 30 and 50 years old. With such prevalence, it’s very important to understand its causes and effects as well as how you can effectively prevent or treat this common condition.

What is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis commonly known as just Hashimoto’s is an autoimmune condition that affects thyroid. It develops over time, usually it takes 3 to 10 years for the symptoms to show.  In Hashimoto’s, your immune system attacks the thyroid gland causing inflammation called chronic lymphocytic thyroiditis, which then leads to gradual damage of your thyroid tissue, under-production of thyroid hormones and a slower metabolism. That’s why many people with Hashimoto’s also experience variety of symptoms related to under-active thyroid or so-called hypothyroidism.

Signs and symptoms of Hashimoto’s:

  • Weight gain
  • Fatigue and tiredness even with sufficient sleep
  • Indigestion, constipation, bloating 
  • Hair loss & thinning eyebrows
  • Feeling cold
  • Having cold hands and feet
  • Cognitive changes, “brain fog”, memory problems, difficulties to focus or concentrare, forgetfulness.
  • Feeling low and depressed
  • Dry skin and hair
  • Skin problems like eczema, acne
  • PMS, Irregular or heavy periods
  • Low sex drive
  • Muscle weakness, stiff and tender joints particularly in the hands, feet and knees.
  • Infertility or miscarriage
  • Reduced exercise or activity tolerance
  • High cholesterol
  • More frequent cold
  • Fluid retention
  • Goiter, or swelling of the neck

This is by no means an exhaustive list, but it gives a good overview of how vast (and nonspecific) the symptoms can be.

How to diagnose Hashimoto’s?

The most common diagnostic tests for Hashimoto’s are thyroid antibodies markers: thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TGB Ab). However, to get better picture of your thyroid health in general, it’s worth running a full thyroid panel that includes: TSH, Total T4, Free T4, Free T3, Reverse T3 and Thyroid Antibodies. 

Why Hashimoto’s is so commonly underdiagnosed?

Symptoms of Hashimoto’s are nonspecific and can seem unrelated. Also, the standard practice among GPs to screen for thyroid health is very limited and includes only TSH and Free T4 blood test. That unfortunately doesn’t even show your free T3 levels which is the active thyroid hormone. The one that are responsible for your metabolism and wellbeing. Additionally standard GP lab range is very wide and will show you that it’s abnormal when the disease process is already pretty advanced. That’s why many people are sent back home with “normal” blood results while feeling unwell with range of symptoms. To detect thyroid issues early which of course will give you better chances for quicker recovery you should be looking at the functional medicine lab ranges as they show the range for optimal health. I will get back to this in a moment.

What lab tests to run to detect Hashimoto’s and early thyroid dysfunction?

A comprehensive blood test can give you an insight into your current state of thyroid health and a clearer picture of what’s happening in your body. 

TSHthyroid stimulating hormone is produced by the pituitary to instruct your thyroid gland to produce thyroid hormones. 
Free T4T4 and T3 are your body’s main thyroid hormones. Free T4 measures the bioavailable (unbound) hormone produced by the thyroid gland. Low T4 is a marker of low thyroid function.
Free T3T4 is converted to T3 in the peripheral tissues like your gut and liver. Free T3 is also known as the “gas” that fuels all the processes performed in your body. It’s the active form of your thyroid hormones that you need the most at the end of the day. A low level of T3 can indicate low thyroid function, or just a problem with conversion
Reverse T3less known but useful if everything else looks “normal” and you still feeling unwell. Reverse T3 is also known as the “breaks” and it inactivates your active free T3. High levels of reverse T3 can be responsible for symptoms of hypothyroidism, since it competes with free T3 for cell receptor sites. This is an additional marker to help determine what’s going on and indicate the root cause of your thyroid problems
Thyroid Peroxidase (TPO) and Thyroglobulin (TG) antibodiesThese are two markers that will help you determine if you have autoimmune condition or not. The thing is that you don’t have to have abnormal basic thyroid markers to have Hashimoto’s. You may start seeing TSH, FT3 and FT4 outside the range once there is more severe thyroid damage. That’s why in my opinion it’s important to run full thyroid panel in terms of early detection and also prevention

The diagram below from the Institute for Functional Medicine is what I use to educate patients during a typical visit with me. It shows how T4 is converted into T3 or Reverse T3, as well as the nutritional and environmental influences that can affect this process.

Click here to get a sheet with your optimal ranges and how to interpret your results

Standard treatment for Hashimoto’s:

Conventional treatment for Hashimoto’s is very limited, the approach is to monitor it and if the Hashimoto’s progresses to hypothyroidism, synthetic hormones are usually recommended. The problem is that waiting till diseases develops to more serious stage doesn’t really solve the problem at all or make you feel better.

Moreover, synthetic T4 hormones (Levothyroxine or Synthroid are commonly prescribed) can only correct your T4 hormones levels but it does not address the autoimmune component of the disease and doesn’t address directly your T3 levels which are more needed for your overall wellbeing.

80% people on thyroid medication don’t feel any better for few reasons:
  • Synthetic thyroid hormones won’t fix your immune dysfunction (Hashimoto’s)
  • Most medication is synthetic T4 which is inactive form and your body to feel good, wake up refreshed in the morning, be full of energy, in a good mood, with glowing skin and hair needs active form which is T3
  • Moreover, your thyroid hormones need to enter the cell to do their job. If your cells receptors are unresponsive, you won’t see or feel any improvements
  • If you are undereating, under chronic stress or over exercising your body will produce more reverse T3 which will “steal” your active T3 leaving you with all the symptoms.
  • Also, if you have problem with converting T4 to T3m no matter how much synthetic T4 hormones you will be taking, you won’t feel any better either as your body needs T3, not T4.

The Functional medicine approach to treat Hashimoto’s:

Functional medicine offers holistic approach and addressed the root cause of an overactive immune system and related thyroid dysfunction, not only symptoms. As long as we don’t address underlying issues, the symptoms won’t resolve. It’s like just sticking a plaster on wound. You cover it up but once you take it out, it will start bleeding again.

Alternative medicine looks at the health of your gut, liver and adrenal glands; your level of exposure to toxins and excess oestrogen or hormonal balance in general; as well as the quality of your current diet and lifestyle. How it may contribute to nutrient deficiencies, blood sugar imbalance and stress on the body. 

In other words, you can reverse Hashimoto’s and correct your underactive thyroid once you find the root cause and apply appropriate protocol to correct existing imbalances that are causing dysfunction of your immune system and thyroid. 

Causes and risk factors:

Hashimoto’s doesn’t appear overnight. Some major event or stressors like emotional trauma, pregnancy or severe injury or infection can be a trigger but usually it’s a combination of multiple factors that have been an excess burden for your body for prolonged period of time. Overtime it will lead to immune system dysfunction and will cause your body not being able to recognise what is actual threat and what is not. As result it will start attacking your own’s body’s tissues. In Hashimoto’s it will be your thyroid.  

You may have some genetic predisposition but the major cause are environmental factors and poor gut health.

Hashimoto’s / Chronic disease = genetics + environment + nutrient deficiencies + leaky gut

Genetics:  There’s a saying that states “Genes load the gun, environment pulls the trigger.” Certain genes make you mor prone to certain diseases but not every person with a genetic predisposition will develop an autoimmune condition as our diet and lifestyle has powerful ability to switch off and on diseases genes.
Environment: That can be different for everyone and it’s not only air pollution or contaminated water. Environmental trigger also known as a “stressor” is everything harmful in your external surrounding or in other words “outside your body”. Most common ones are heavy metals from a dental procedure or certain foods, pesticides, infections food sensitivities i.e to gluten or dairy, radiation and electromagnetic field exposure, chronic stress, mold and many other triggers
Nutrient deficiencies: Most common in case of Hashimoto’s is vitamin D and selenium but of course it’s much more to it. The thing is once your body has all “essential materials“ to build and repair so it will heal itself. The problem starts when our body is deprived of key nutrients over prolonged period of time. Then environmental toxins and chronic stress only speeds up the process and can aggravate the severity of the disease.
Gut Health:Poor gut health is associated with Hashimoto’s and other autoimmune conditions for two reasons. 80% of your immune system is in your gut and if your gut lining is compromised it will allow infections, food particles leak to the blood stream causing inflammation and immune response. 

All of these risk factors create a vicious cycle of continually increasing stress on the body. Chronic and prolonged stress depletes nutrients and leads to imbalances and damage of adrenals, gut and liver as well as compromises blood sugar, hormonal balance and immunity. The cycle continues until the immune system spirals out of control creating chronic inflammation and an overactive immune system – the perfect storm leading to Hashimoto’s. 

To summarise, common causes and risk factors are:
  • Chronic stress (emotional, physical and social stress) and emotional trauma
  • Poor gut health (gut dysbiosis, leaky gut, SIBO)
  • Poor digestion and elimination
  • Nutrient deficiencies
  • Excess use of sugar and alcohol.
  • Food intolerances (gluten and dairy sensitivity are most common)
  • Menopause, pregnancy, hormonal imbalances
  • Heavy metal overload from food, water and environment
  • Infections (EBV, H. Pylori, parasites, yeast and fungi overgrowth like candida i.e)
  • Chronic blood sugar imbalance, insulin resistance and diabetes.
  • Impaired function of liver and adrenals
  • Birth control pills and excess use of antibiotics
  • Excess exposure to environmental toxins, fluoride and perchlorate in water, mercury and other heavy metals, lithium
  • Exposure to radiation/EMF
  • Overconsumption of soy products and uncooked “goitrogenic” foods.

Complications of Hashimoto’s:

  • Goitre – the thyroid gland enlarges. In severe cases, the throat looks as if a tennis ball is lodged under the skin. Occasionally, a large goitre can interfere with breathing or swallowing.
  • Emotional problems – low thyroid levels can increase the risk of depression and libido problems, such as reduced sex drive.
  • Heart conditions – low levels of thyroid hormones allow levels of the ‘bad’ cholesterol (low-density lipoprotein or LDL cholesterol) to rise. This can increase the risk of heart disease, including heart attack. In some cases, Hashimoto’s disease causes other cardiac conditions such as heart enlargement or heart failure.
  • Congenital defects – the unborn baby of a woman who has untreated Hashimoto’s disease risks various birth defects including cleft palate, and heart, kidney or brain malformations.
  • Myxoedema – this severe form of hypothyroidism produces symptoms and signs which may include unnatural sleepiness, extreme sensitivity to cool temperatures and coma. This condition may be fatal in severe cases. However, myxoedema is a very rare complication of untreated Hashimoto’s disease

5 steps to reverse Hashimoto’s:

  1. 1. Identify your major triggers and main stressors
  2. 2. Fix your gut
  3. 3. Correct nutritional deficiencies
  4. 4. Look for hidden infections, excess toxins, detoxification and elimination. 
  5. 5. Address your stress and support your adrenals

Dietary recommendation:

There is no one-size-fits-all diet, as each person is different with individual needs depending on lifestyle, personal story etc, however there are some basic principles to follow or at least to start with if you are just starting your healing journey:

  • Eliminate trigger foods, especially gluten and dairy
  • Reduce sugar, refined carbs and artificial sweeteners
  • Increase healthy fats intake including omega 3s and anti-inflammatory spices: ginger, turmeric, rosemary
  • Increase fermented foods (probiotics) like sauerkraut, kimchi, kefir.
  • Ensure enough fibre and variety of vegetables
  • Reduce soy and soy products like soy milk or soy yogurts.
  • Limit alcohol and caffeine intake

Lifestyle recommendation:

As long as reducing you stress exposure or your stress sources may not always be possible or very limited what you can do is to improve your reaction and stress response. How you react to stressful situation and how quickly are you able to return to relaxed state it’s absolutely fundamental.    

Apart from that there are few other lifestyle changes that can help you improve your symptoms and support your healing journey

  • Swap tap water or plastic bottle water to clean filtered water – tap water contains chlorine and fluoride that impair your thyroid function.
  • Ensure quality sleep, ideally 8h. During deep sleep your body detoxify and repair.
  • Spend at least 30min outdoors a day, best in nature if possible as it can calm your mind and increases your “happy” hormones that support healing.
  • Exercise (mix of cardio sessions and resistance training).
  • Journal, practice self-awareness, meditation and mindfulness. 


There are certain basic nutrients that low levels are linked with Hashimoto’s

  • Vitamin D
  • B complex
  • Zinc & Selenium
  • Magnesium

Additionally apoptogenic herbs may be beneficial if you struggle with high levels of stress

If you are interested in learning more or you have tried things already and it didn’t work, feel free to reach out to me and I would love to help you solve the mystery of your Hashimoto’s 🙂 Sometimes it may be just one missing bit that you have overlooked, sometimes it may be more complex. The thing is that with the right guidance you will get there faster than on your own.