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“Dr. Aviva, I’ve been given a Hashimoto’s diagnosis – what should I do?” is a question I hear often because it’s one that brings a lot of women to my website, social media pages, and to my medical practice, or it’s a diagnosis I sometimes give after a woman has struggled with symptoms and no answers often for months or even years. In this blog and episode of my podcast you'll learn exactly what I tell my patients, so you can take control of your thyroid diagnosis, put together a supportive healthcare team, and take not only a conventional medical approach, but an integrative approach, which gives you the best of convention plus the best of natural medicine.
For many women, the diagnosis of hypothyroidism (or Hashimoto’s, the autoimmune form), is a relief because it explains a whole lot about the symptoms or struggles they’ve been having. There’s Molly, 34, who’d been trying to get pregnant, to no avail, for two years, who had irregular and often skipped periods; Tanya, 38, who was exhausted and experiencing postpartum depression, and still hadn’t lost any baby weight by the time her little one was 6 months old, and who had struggled to produce enough breastmilk; and Liz, 52, who’d been feeling exhausted, depressed, and had gained 35 pounds in 4 months without changing her diet or exercise one single bit. These women welcomed hearing that it wasn’t just their imagination or something they were doing ‘wrong’. It wasn’t ‘just stress’ as more than one doctor had told Tanya, ‘nothing we can do about it other than fertility treatment’ as Molly’s gynecologist had told her, or “it’s menopause, so just eat less and exercise more” as an unsympathetic physician told Liz.
But once the relief is over, some anxiety usually sets in about whether having a slow functioning thyroid is dangerous, and there are a lot of questions about whether it can be healed, whether to take medication and what, and whether they’ll always have to be on it, and overall, what to do next in their diet and lifestyle to support thyroid health.
Not all women feel this sense of relief, however. You might feel overwhelmed, frustrated, or sad, especially if you view yourself as an otherwise healthy gal and now see yourself with a future that includes dependence on a medication. If you’re feeling that way, it’s totally normal. Anytime we have a change in self-perception, we might need to grieve for a minute.
But don’t panic! While nobody wants to ever have a medical diagnosis, this one, which is now so common that 1 in 8 women can expect to receive a diagnosis in her lifetime, is readily ‘figureouttable” and with the right approach, generally very straightforward to manage and live with. Having Hashimoto’s doesn’t mean you’re not healthy, it’s definitely not a death sentence, nor does it automatically relegate you to a life of medications, frequent medical appointments, or ongoing testing. I’m going to walk you through the answers to the most common questions women have after getting a thyroid diagnosis – just as I do for patients in my practice.
Let’s Start with Terminology
Chances are you were diagnosed with Hashimoto’s, especially if the diagnosis came from a functional medicine practitioner, as this is often the catch-all term used for a slow functioning thyroid. But not all hypothyroidism is Hashimoto’s. Hypothyroidism refers to decreased thyroid function, and it can lead to a host of symptoms which I talk about here. Most of the time, you get a diagnosis because you’ve been having symptoms and your medical provider runs tests that then confirm why you’re feeling the way you do. Hypothyroidism is demonstrated by symptoms + lab results, or on some occasions lab results alone, and is by far the most prevalent form of thyroid disease in the U.S., accounting for 80% of thyroid problems.
Hypothyroidism comes in two main forms: non-autoimmune thyroid disease, simply called hypothyroidism, and the autoimmune form called Hashimoto’s thyroiditis, or more commonly Hashimoto’s. Hashimoto’s disease is the most common form of all thyroid disease in the U.S. (in many places in the world the non-autoimmune type is more common due to iodine deficiency), accounting for 90% of all hypothyroidism. It is differentiated from non-autoimmune hypothyroidism by the presence of thyroid-attacking antibodies in your blood, identified by a comprehensive set of thyroid labs.
Let’s Make Sure You Were Properly Diagnosed
It’s really important to make sure that you actually have one of these conditions before assuming the diagnosis is correct, because as often as the diagnosis is missed by conventional doctors, as I talk about in this article, there’s a surprising amount of overdiagnosis in the integrative and functional medicine worlds. I’ve even had patients come to me who were previously told they had a thyroid problem and were put on thyroid hormone medication – without even having a lab test! And sometimes, when I tested them, it turned out they didn’t have a problem at all – their symptoms were due to another diagnosis, often missed, of iron deficiency anemia, a different autoimmune condition, or another medical condition. Additionally, functional and integrative practitioners, including me, use a narrower range of normal for assessing thyroid labs. I talk about that here. But being above that range, if you don’t have any symptoms related to hypothyroidism, should not constitute a diagnosis.
To be diagnosed properly, you should have received proper testing of at least your TSH, the hormone produced in your pituitary gland that stimulates your thyroid to produce thyroid hormones. If you had absolutely no symptoms and your TSH is normal, then it’s very unlikely that you have hypothyroidism. You should also have thyroid antibodies checked – if those are normal, then you don’t have Hashimoto’s.
If you have either elevated TSH, suggesting that your pituitary is having to work hard to get a sluggish thyroid to respond, you could have hypothyroidism; you also want to get your antibodies checked at this time to determine whether it’s Hashimoto’s or not; normal antibodies and it’s likely not Hashimoto’s. It’s also very common to have transiently abnormal TSH, so even if you do test ‘positive’ for hypothyroidism, it’s appropriate to recheck in a few weeks before assigning a diagnosis unless your labs are far outside of the normal ranges and you’re obviously having symptoms, in which case the diagnosis is likely.
One time you might be appropriately told you have a low functioning thyroid, even when your thyroid labs are in the normal range, even if you don’t have any obvious thyroid symptoms, is if you’re trying to conceive. A slightly lower TSH of 1.5 to 2.5 is preferable to optimizing your likelihood of pregnancy – with or without reproductive assistance, and many reproductive endocrinologists will suggest medication to bring your TSH to that range.
Now, Get the Right Support
Once you know that you do have hypothyroidism or Hashimoto’s, you’ll want to make sure you have great support from your medical care provider. While, as we’ll discuss in a minute, you may need medication, in my opinion that should never be the sole answer – it’s important to dig a little deeper and get a comprehensive lab panel if you haven’t already, to include thyroid antibody testing if a diagnosis of Hashimoto's remains unclear, and also to test for possible underlying causes as relevant to you: low iodine and low vitamin D, for example, have been associated with hypothyroidism, while celiac disease and leaky gut have been associated with Hashimoto’s. Beyond nutritional and dietary factors, stress, for example, particularly elevated cortisol can contribute to hypothyroidism and Hashimoto’s, while certain medications and environmental toxins can reduce thyroid function and should be looked into. Postpartum moms are especially vulnerable to developing hypothyroidism, and this should not be overlooked if you have unusual fatigue, depression, anxiety, or symptoms of postpartum depression. I talk about postpartum thyroid health in this article.
A skilled healthcare provider will test for and/or explore these various underlying causes with you, and help you to address them, as well as encouraging a holistic approach, along with any conventional testing and treatment needed. This is especially important because our bodies are an interconnected whole – it’s rare that just one system is affected, and having Hashimoto’s, for example, increases your risk of developing another autoimmune disease, which getting to the Root Causes of Hashimoto’s may help prevent. Additionally, a skilled health practitioner can help you determine the next steps, for example whether medication is needed, and if so what type is best for you, as well as being someone who can offer you the latest in integrative options, for example, taking myo inositol and selenium, for example, to support thyroid function and reduce antibodies – which can be done prior to starting medication in some cases, and can be used in conjunction with medication.
Answers to “Scary” Questions About a Hashimoto's Diagnosis
If you do, in fact, have hypothyroidism or Hashimoto’s, you’ll likely have some concerns; hopefully the answers below to the most common ones I hear, will be reassuring for you.
Is Having a Slow Functioning Thyroid Dangerous?
It’s true, untreated, a slow functioning thyroid can have a major deleterious impact on well-being and health. You can feel fatigued, struggle with your weight, experience chronic constipation, hair thinning, brain fog, depression, and more. It can also affect your menstrual cycles, fertility, have harmful impacts on pregnancy, and long-term can affect your cognitive function and heart health. But that’s ONLY when it’s untreated. When hypothyroidism – including Hashimoto’s – are properly treated, your health risks are not increased at all; you can live an absolutely healthy, happy, and normal life.
Can Hypothyroidism be Healed? What about Hashimoto’s?
The answer is yes, sometimes, and other times it is a chronic condition, but one in which you can become entirely symptom-free. It all depends on what’s causing the problem, for how long you’ve had it, and in cases of Hashimoto’s, the extent of the thyroid damage.
- If you have non-autoimmune hypothyroidism due to nutritional deficiency, then replacing missing nutrients can sometimes restore/improve thyroid function.
- My experience is that women with celiac disease may have a reversal of Hashimoto's after gluten is removed from the diet, if the thyroid diagnosis is caught very early.
- Most women will recover from postpartum thyroid problems within 6-12 months, at which time medication can be weaned by half for a couple of weeks, and then discontinued. If symptoms persist beyond 18 months after onset, it is more likely that you’ve developed permanent hypothyroidism, and long-term medication might be needed. About 30% of women who develop postpartum thyroiditis develop permanent thyroid problems (but 70% don't!). For women who have fully recovered from postpartum thyroiditis, repeat thyroid testing within 5 to 10 years after the initial diagnosis, or if you develop symptoms of thyroid problems, is important e, as it's usually in that timeframe that it recurs becomes chronic.
- A small percentage of individuals do have a genetic predisposition to Hashimoto’s; in this case, if you develop Hashimoto’s, it’s likely that lifelong medication will be needed to maintain optimal thyroid function.
But again, don’t fear: no matter what, you can become 100% symptom-free and live your life without worrying about it causing any harm to you.
Getting on the Road to Treatment
Do I Need to Take Medication?
Not everyone with hypothyroidism needs thyroid medication, particularly if your thyroid labs aren’t significantly out of the normal range or your symptoms aren’t debilitating. With many patients, I spend at least 6, and often up to 12 weeks helping them to identify reversible causes (i.e., low iodine, celiac disease).
However, if your numbers are far out of the normal range or if your symptoms are seriously impacting your quality of life, unless you have an identifiable and readily reversible cause of hypothyroidism it’s very likely that thyroid hormone medication is in your future. In my book, The Adrenal Thyroid Revolution, I explain the various medication options, and their pros and cons.
This can come as disappointing news, especially if you’re trying to live as naturally as possible. Let me offer a word of reassurance: thyroid medication can be a game changer in how you feel, and thyroid medication is not a medication that is doing something foreign to your body – it is thyroid hormone replacement therapy, giving your body what you’d naturally produce but right now aren't because your thyroid function is suppressed.
The goal of thyroid medication is symptom resolution and normalization of thyroid labs: TSH, FT3, and FT4 will return to normal within 6 weeks; thyroid antibodies can take months to resolve. Once you’ve been feeling great for a number of months, you can work with your primary provider to see if you can reduce the dose, and at some point you may decide to try to go off of the medication. This is done by slightly lowering the dose, and then testing your TSH, FT3, and FT4; if they are out of range off the medication, you probably need to stay on it.
How Often Should I Follow Up on Testing?
If you have severe symptoms or lab results that are very far out of range, it’s common to start medication and retest in just 4 to 6 weeks in order to let a combination of your symptom improvements and test results guide the best medication dose (and choice) for you. This testing is commonly repeated in a few months to again assess treatment results and adjust medication dosing if necessary; after that, once you achieve steady labs and a steady medication dose, retesting may occur in a year, and then in my practice I typically retest annually, including thyroid antibodies, as sometimes those show up and a diagnosis of hypothyroidism may switch to Hashimoto’s. If you’re pregnant and have low thyroid function, you may be tested even just a couple of weeks after starting thyroid medication.
If a patient who is on medication in my practice experiences a recurrence of symptoms, I’ll retest to see if we need to adjust medication; similarly, if she seems to be experiencing symptoms of a hyperactive thyroid, I’ll retest to make sure she’s not getting too much thyroid medication, and will adjust her dose as needed.
What About Grave's Disease?
For those of you who have written to me about Grave’s disease, thank you for letting me know your need for information. The reason I have focused on hypothyroidism and Hashimoto’s is that it’s much more readily responsive to simple, safe pharmaceutical treatment, whereas the treatment options for Grave’s are more complex (the medications have more side effects, and treatment includes surgery and radiation), the risks of the condition are greater (arrhythmias, for example), and the condition is often quite labile (TSH can vary widely and often, for example, when getting onto medication). And while I treat women with Grave’s in my practice, it really does require specialist care beyond what most integrative practitioners provide. When it comes to root causes, though, the same approach is applicable, with the exception of giving iodine and other nutrients – these aren’t usually underlying causes. But food triggers, celiac, environmental triggers (including radiation exposure, a factor for 3 of my patients with Grave’s who grew up in Eastern Europe in the aftermath of Chernobyl), and viral infections can all play a role. Also, and importantly, most women with Grave’s ultimately face hypothyroidism as a result of ablation or surgery – so it’s still important to be knowledgeable about how to approach slow thyroid function.
What Can I Do to Support My Thyroid and My Health?
While we often don’t know exactly what ultimately causes any one person’s thyroid to slow down or an autoimmune disease to kick in, there are a set of factors known to adversely affect thyroid health and which can be linked with hypothyroidism and Hashimoto’s. Some of these include those I’ve mentioned: low iodine status, celiac disease, environmental toxin exposures (i.e, BPA, to which we’ve all been exposed, is known to adversely impact the thyroid), and stress, for example, and there are others, such as detrimental shifts in the gut microbiome, possibly an underlying viral infection, and more. I highly recommend a comprehensive integrative approach – one that includes conventional medicine when needed but that also nourishes the whole woman – to both trying to heal and to optimally live with hypothyroidism and Hashimoto’s.
That’s the new medicine for women, and I provide a complete guide to it for thyroid health in my book, The Adrenal Thyroid Revolution which you can get from major booksellers, or you can easily purchase here. It’s the approach that offers you the best chance of healing while also becoming more empowered about your total health, rather than just taking a pill and forgetting about it.
It’s the kind of medicine I practice and a path I hope you, too, will embrace.
