Which stage of Hashimoto’s are you in?
There are 7 stages of an underactive thyroid condition
Hashimoto’s is a lifelong and progressive autoimmune disease. It starts subtly — usually long before you were or will be diagnosed — and develops slowly.
This is the start of Hashimoto’s.
Your immune system starts making molecules that mistakenly recognize part of the thyroid gland as a foreign body and starts destroying it.
This occurs on a small scale, so you generally won’t feel any symptoms related to an underactive thyroid. You might experience problems with digestion because your gut is where most of immune cells are made.
At this stage, your thyroid is still close to fully functional. That means TSH blood tests won’t be sensitive enough to reveal Hashimoto’s.
If you’re tested positive for thyroid antibodies (TPO or TG), you should get a thyroid ultrasound or have a biopsy as your doctor might diagnose you with Hashimoto’s at this point.
This stage can last several years — it’s the best stage for receiving a diagnosis, because you can follow a healthy lifestyle and prevent Hashimoto’s from reaching stage 2.
Immune cells start increasing in number and efficiency, working faster to destroy bigger portions of your thyroid gland.
You might begin to feel a few early symptoms, such as fatigue, hair loss, or sensitivity to cold.
Some people experience goiter (swelling of the neck) during flare-ups and feel more symptoms — or symptoms at a higher intensity — after stress, colds, or certain foods.
At this point your TSH levels will most likely still be in a normal range, while your fT4 levels may be slightly lower.
This stage might last a few months or years, but in certain cases it might only last a few weeks.
If you’re diagnosed at this stage, you have a great chance to keep your thyroid gland sufficiently functional and avoid taking medications by following a healthy lifestyle.
3. Full-blown disease
This stage is usually the tipping point for your thyroid health.
You will likely start feeling increasingly tired and you might start experiencing many other symptoms with an increasing frequency and intensity.
A thyroid hormone blood test will show that your TSH is elevated. Depending on the country or lab where the test was done, your doctor might prescribe therapy with thyroid hormone replacement — the most common is T4 (Levothyroxine).
If your values are only slightly shifted, your doctor might prescribe expectant management. This means you will be regularly monitored for any changes in thyroid hormone levels and be prescribed medication once your thyroid blood values are clearly out of the “normal” zone.
If you’re diagnosed at this stage, you still have a very good chance to keep your thyroid gland highly functional with minimal medication or avoid taking medication by implementing and following a healthy lifestyle.
Certain symptoms might remain and you potentially need to work harder to get your hormones in balance again.
4. Medicated Hashimoto’s
Most Hashimoto’s diagnoses occur during this stage. At this point, the thyroid can’t produce enough daily T4 and T3 necessary for optimal health.
To compensate for the loss of thyroid function, your doctor will increase your dose of synthetic thyroid hormones. Most people usually start with the lowest dose of T4 — as you age, this dose increases.
It’s crucial to have enough thyroid hormones in the body to complete for some basic bodily functions, such as metabolism, brain function, and body temperature regulation.
This is why it’s important to take thyroid medication if your own thyroid can’t produce enough.
At the same time, balancing thyroid hormones won’t do much to prevent the immune system from further destroying the thyroid gland — this can be managed by maintaining a healthy lifestyle.
5. Medicated and lifestyle managed Hashimoto’s
At this stage, you’ll need to adjust your lifestyle in order to manage your weight and flare-ups. This helps to keep Hashimoto’s at bay.
Maintaining a healthy weight will help prevent heart and bone problems, as well as some other health issues.
6. Putting the brakes on the disease
It’s important to know that the autoimmune condition can be blocked, but it won’t go away. This means the moment you stop following a healthy lifestyle, the condition will be triggered again.
An underactive thyroid can be fixed to a certain extent. The thyroid gland has some regenerative potential, but it’s notoriously slow at regenerating (1, 2). It might take months or years, especially if large portions of your thyroid have already been destroyed.
7. Preventively managing Hashimoto’s
This stage is for life.
You need to avoid all triggers that work against your thyroid. Yet the immune system is a bit tricky — sometimes foods that previously weren’t problematic for you can start causing flare-ups.
The good news is that at this stage you will know your body so well that you will be able to recognize warning signs early on.
Hashimoto’s risks and flare-ups
Everybody is different, so triggers of flare-ups vary individually. However, there are some common triggers that might help you on your path to health.
According to BOOST Thyroid’s internal research, common food triggers include:
- Wheat (including gluten) (causes problems to 7 in 10 people)
- Dairy (milk, yogurt) (causes problems to 5 in 10 people)
- Soy (causes problems to 3 in 10 people)
- Alcohol (causes problems to 3 in 10 people)
And you’re at a higher risk of developing Hashimoto’s if you:
- Have low vitamin D levels before diagnosis (5 in 10 people)
- Have at least one family member diagnosed with Hashimoto’s (5 in 10 people)
- Have at least one family member diagnosed with any other autoimmune disease (6 in 10 people)
- Were born in a spring month (6 in 10 people)
Track your symptoms, medication, supplements, lab tests, and more in BOOST Thyroid.
1. Dumont JE, et al. Physiological and pathological regulation of thyroid cell proliferation and differentiation by thyrotropin and other factors, 1992
2. Coclet J, et al. Cell population kinetics in dog and human adult thyroid, 1989