Hashimoto’s Disease and Hypothyroidism: Autoimmune Connection

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Thyroid disease is complex and highly impactful. Two of the most common forms of thyroid disease are hypothyroidism and Hashimoto’s thyroiditis. Hashimoto’s thyroiditis acts as a precursor to hypothyroidism. However, hypothyroidism may also develop without the influence of Hashimoto’s. Understanding the relationship between these two conditions is key to identifying and treating thyroid disease.

Hypothyroidism, Hashimoto’s, or Both?

Thyroid disease may manifest in a variety of ways. Hypothyroidism is the most common, followed closely by Hashimoto’s thyroiditis.

Hypothyroidism is a condition wherein the thyroid no longer produces the hormones necessary to maintain proper bodily function. This is typically accompanied by symptoms such as fatigue, poor cognitive function, weight gain, and depression.

Hashimoto’s thyroiditis is an autoimmune condition that triggers the release of antibodies that attack healthy thyroid tissue. This causes irreparable damage to the thyroid gland, often resulting in a decline of thyroid function and subsequent hypothyroidism. Even though Hashimoto’s frequently leads to the development of hypothyroidism, Hashimoto’s is not a prerequisite for it.


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Difficulties with Diagnosis

Sadly, many of those with thyroid disease are not aware of their condition until it becomes severe. In part, this is because of suboptimal testing. Current testing practices for thyroid disease rely heavily on TSH values. This is unfortunate as many studies have shown that TSH alone is not a sufficient metric for accurate diagnosis of thyroid disease.

Even if a person with hypothyroidism is fortunate enough to be diagnosed early, doctors often discount the possibility of underlying Hashimoto’s thyroiditis although Hashimoto’s is one of the leading causes of thyroid dysfunction. To accurately identify thyroid disease, including Hashimoto’s, more thorough testing must be done.

More Accurate Tests for Hashimoto’s

Hashimoto’s may be identified through assessing the values of specific antibodies. For example, thyroid peroxidase antibody (TPO) is present in up to 95% of those with Hashimoto’s. However, a patient may have Hashimoto’s even if they test negative for TPO antibodies. This goes against some standard dogma of conventional medicine, which claims that only those who have elevated TPO antibodies can be diagnosed with Hashimoto’s disease.

Thyroglobulin antibodies (TGA) are also frequently present in Hashimoto’s patients. Studies showing that about 80% of Hashimoto’s patients present elevated TGA values. However, much like TSH testing, reliance on antibodies alone, TPO or TGA, can be dangerous as about 5% of Hashimoto’s cases have no measurable thyroid antibodies.

The Importance of Choosing the Right Treatment at the Right Time

In the early stages of Hashimoto’s, the thyroid may still produce adequate thyroid hormone. Testing during this time can show “normal” thyroid function while in reality, the patient may be suffering from an autoimmune disease.

Studies show that overt hypothyroidism is more common in patients who test positive for thyroid antibodies. Subclinical hypothyroidism — mildly increased TSH — is more common among individuals who don’t test positive for antibodies.

Antibodies may appear decades before a change in TSH is detected. If recognized, this allows intervention before the thyroid gland is damaged to the point of complete dysfunction. The risk of developing overt hypothyroidism and autoimmune conditions increases as the number of thyroid antibodies rises.

Diligent Diagnosis is Critical

If thyroid malfunction is suspected, an integrative physician will use the correct thyroid and antibody-testing panel to detect possible autoimmune disease. They will probably use the opportunity to investigate and identify the underlying causes of immune malfunction that are contributing to thyroid malfunction.

Ideally, a patient suffering from thyroid dysfunction is diagnosed with Hashimoto’s before being diagnosed with hypothyroidism. This is because proactive early treatment of Hashimoto’s may halt progression of the disease, preventing further damage the thyroid, and limiting the risk of hypothyroidism. Unfortunately, often patients are diagnosed with Hashimoto’s after they have already developed hypothyroidism.

The Progression of Hashimoto’s

The early warning signs of autoimmune disease such as Hashimoto’s are often gut related, generating high inflammation in the body. This produces symptoms such as acid reflux, bloating, irritable bowel syndrome, diarrhea, and constipation. Patients may also experience severe fatigue and leaky gut, which can impede nutrient absorption. During this time there is potential for thyroid antibodies, but TSH value are likely to remain within “normal” ranges.

If autoimmune warning signs go undetected and unattended, the immune system will attack the thyroid more aggressively. This can trigger more severe symptoms such as anxiety, irritability, insomnia, and heart palpitations. Thyroid antibodies are likely to increase and a slight change in TSH may be seen.

Without intervention, the thyroid will incur damage limiting its ability to produce hormones. This can induce a severe case of hypothyroidism ushering in additional symptoms such as hair loss, intolerance to cold, depression, brain fog, and inability to lose weight. A change in TSH is likely to be seen along with a spike in antibody count. Unfortunately, because of reliance on TSH, often patients are diagnosed with an autoimmune thyroid disease only after reaching this severe point.

Treating Autoimmune Thyroid Disease

Conventional treatment of hypothyroidism usually includes synthetic thyroid hormones, regardless if the condition stems from an autoimmune disease or not. But, the first thing to understand about autoimmune diseases is that they are a disease of the immune system – not the thyroid or any other gland or organ. Therefore, in order to effectively treat, prevent, and reverse autoimmune disease, the immune system must be restored and controlled.

Get the Thyroid Support You Need

Thyroid conditions and autoimmune disease are woefully underdiagnosed and often poorly treated. For this reason, if you suspect that you have a thyroid condition, it is essential that you find an experienced integrative physician who will properly test thyroid function, assess for autoimmune disease, and provide the most effective treatments possible. You can get the quality care you need by contacting us at 877-508-1177.


1. Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).” National Academy of Hypothyroidism and Integrative Science.
2. Kent Holtorf, MD. “Thyroid Hormone Transport.” National Academy of Hypothyroidism and Integrative Science.

3. Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?” National Academy of Hypothyroidism and Integrative Science.

4. Kent Holtorf, MD. “Why Doesn’t My Endocrinologist Know All of This?” National Academy of Hypothyroidism and Integrative Science.

5. Dana L. Mincer; Ishwarlal Jialal. “Hashimoto Thyroiditis.” Treasure Island (FL): StatPearls Publishing; 2020 Jan.