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Hashimoto’s syndrome symptoms and treatment

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Hashimoto’s thyroiditis or Hashimoto’s syndrome. Did you get this diagnosis? Maybe someone in your environment has it? This article wants to offer you information about the causes, symptoms, and treatment options for Hashimoto’s syndrome. We believe that the best way to deal with the disease is to know a lot about it.

Hashimoto’s thyroiditis or Hashimoto’s syndrome is an autoimmune inflammation of the thyroid gland. This syndrome is known as chronic lymphocytic thyroiditis or autoimmune thyroiditis. The whole body is often affected. The disease progresses very differently from person to person. In addition to Hashimoto’s thyroiditis, autoimmune thyroiditis includes Graves’ disease. Transitions between the two diseases are possible – but rare.

What symptoms indicate Hashimoto’s syndrome?

People can have very different symptoms. In addition to mostly asymptomatic diseases, in which problems can be eliminated by regulating thyroid hormones, there are cases with numerous, different, and often confusing symptoms. The disease often starts slowly so that those affected find it difficult to notice the symptoms first.

In the beginning, the symptoms of hyperfunction are occasionally in the foreground. The so-called “hashitoxicosis” is the initial phase in which there is mostly mild hyperfunction, which then gradually turns into chronic hypofunction. Processes with fluctuating hormone values, in which the patient switches back and forth between overactive and insufficiently active, are rare, but they do occur.
In addition to symptoms of altered hormone levels, symptoms may occur that can be traced to the immune process and antibodies’ effects. These symptoms are summarized here as symptoms of immune disease. The possible separation of symptoms from a medical perspective is not entirely correct. I. It is still unclear which hormones cause symptoms and are specifically related to immune processes and antibodies outside—thyroid gland.

In general, hypofunction symptoms are in the foreground and should be balanced, which previously could not be done with appropriate amounts of thyroid hormones.

The symptoms of eye disease (endocrine orbitopathy), rare in Hashimoto’s syndrome, are listed separately on this page.
The symptoms caused by additional autoimmune diseases are summarized at the end of this page. Some of those affected by Hashimoto’s disease have other diseases as well. These diseases’ symptoms cannot be exhaustively stated here due to the amount of information. The sick person and his doctor need to consider another disease in case of atypical symptoms.

What is hashitoxicosis and what are the symptoms of hyperfunction?

At the beginning of the disease, some patients with Hashimoto go through a short hyperfunction phase. This phase can also go unnoticed or not happen. It is suspected that the cause is the immune destruction of the thyroid gland tissue that stores hormones. Antibodies that stimulate thyroid TSH receptors may also appear at this stage.

The symptoms of hyperfunction are different. Most of the symptoms are so-called general symptoms, such as nervousness, insomnia, and a tendency to sweat. Many symptoms appear slowly without feeling that we are actually sick. Only when nervousness, excessive sweating, diarrhea, trembling, and palpitations appear with insomnia, and they do not pass at all, only then a doctor is consulted.

Heart palpitations can also be perceived as a ringing in the ears. At the beginning of Hashimoto’s thyroiditis, symptoms of excessive function are often not very pronounced.

Treatment with thyroid medication is usually not necessary. If the hyperfunction is caused by the destruction of tissues that store hormones in the thyroid gland, thyroid medications that reduce thyroid hormone production may not be effective. Individual treatment should be performed by a hormone specialist (endocrinologist).

What are the symptoms that may indicate Hashimoto’s and hyperfunction?

Palpitations, palpitations
High blood pressure
Nervousness, irritability, restlessness
Muscle weakness, muscle aches
Shaking hands
Sleep disorders
Sweating, moist skin
Weight loss despite a good appetite

In women: menstrual disorders (irregular or heavy bleeding, lack of menstruation)

Patients notice internal restlessness and irritability. Sensory impressions can be perceived more intensely. Feelings are also experienced more intensely. Mood swings are greater in both positive and negative areas. Increased exhaustion is often noticed even after a little effort. Many affected people report insomnia, anxiety, and a feeling of panic.

Typical signs are an increased tendency to sweat and loose stools. If the hands and fingers are outstretched, subtle trembling is often visible.
Excessive activity of the thyroid gland in some cases leads to menstrual disorders. In addition to excessive bleeding, shortened or prolonged cycles may occur. The absence of menstruation is also possible.

In some cases, painful muscles and weaknesses occur, especially in the shoulder girdle and legs. Painful hardening of the muscles can also occur in the back muscles.

In most cases, palpitations can be followed up to hyperfunction and slowly subside as hyperfunction subsides. A change in heart rate can also be seen in an inactive thyroid gland. In scientific studies (Evangeloupoulou 1999), specific heart valves in Graves’ disease and Hashimoto thyroiditis (mitral valve prolapse). Therefore, the heart’s ultrasound examination is useful in people with autoimmune thyroid disease and heart problems.

What are the symptoms of underactive thyroid gland?

A gradually growing subfunction usually follows the phase of excessive function. Hashimoto’s thyroiditis can also start with an inactive condition. Symptoms of insufficient activity are also numerous.

What symptoms can occur?

Fatigue, general physical exhaustion, lack of body elasticity
Poor concentration, poor memory, difficulty finding words
High blood pressure with a heart rate below 70
Palpitations, palpitations
Depressed mood, anxiety and panic attacks, irritability, rarely suicidal thoughts
Dry, tousled hair
Hair loss
Dry skin
Prison, gas
Cold hands and feet
Weight gain, rarely weight loss
Menstrual disorders in women, unfulfilled desire to have children, the tendency to abortion in inactive conditions
Decreased sexual desire
Tingling in the hands and forearms at night (carpal tunnel syndrome)
Impaired hearing
Apathetic facial expression
Changes in character
Ringing in the ears
Night sweats
Pigment spots on the face, increased appearance of dark spots on the body
Neck tension, neck pain
Brittle nails
Inflammation of the eyelid margin, eyelid edema
Swollen nasal lining

Symptoms of dysfunction are mainly expressed by fatigue and poor concentration. Weight gain despite normal or reduced amounts of food.

Weight gain usually occurs with Hashimoto’s symptoms. Still, there are also known cases of the disease in which weight loss occurs despite insufficiently active and sufficient or increased food intake if weight loss is unclear, additional autoimmune diseases such as intestinal diseases (celiac disease, ulcerative colitis ), which may occur together with Hashimoto’s thyroiditis.

Even after the thyroid gland level in the blood normalizes, some patients still have constant problems with weight. The cause of the most existing inappropriate weight gain has not yet been clarified with certainty. In addition to thyroid hormones, other hormones also play a role (insulin, leptin, menopausal estrogen, and androgen deficiency and decreased basal metabolism). Some patients benefit from replacing thyroid hormone replacement with pure T4 with combination drugs that contain T3 as well as T4. Hypofunction rarely has serious weight loss.

People with a poorly active thyroid gland freeze more easily. With a reduced metabolic rate, the common cold is poorly tolerated.
Laxity of gastrointestinal activity occurs almost regularly, so some patients take laxatives. Nocturnal recurrence of “sleep” and tingling in the hands and forearms, the so-called carpal tunnel syndrome, can be caused by hypofunction. After the normalization of thyroid hormones, it generally declines. In addition to an underactive thyroid gland, there are other causes of carpal tunnel syndrome, which must be ruled out if symptoms persist despite normalized thyroid hormones.
Some patients notice a decrease in hearing, which normalizes when thyroid hormones are placed at the reference range.

Symptoms of the immune system Hashimoto’s syndrome

Hashimoto's syndrome

In addition to thyroid dysfunction symptoms, symptoms caused by the disorder can also appear immune system. It is not possible to determine whether altered thyroid hormones cause symptoms or immune disease in some cases.

You should note that most Hashimoto’s patients do not show symptoms of the immune disease after adjusting thyroid hormone replacement. Hashimoto’s syndrome can vary from asymptomatic form to form with differently expressed immune symptoms. They are listed below.

Symptoms of immune disease and Hashimoto

Joint pain

Muscle aches

Tendon and muscle hardening

Various skin changes (e.g., urticaria, rosacea)

Dryness of the mucous membranes (sicca syndrome)

Mood lability (both caused by immune diseases and hormonal changes)

Neurological symptoms (neuritis), dizziness, unsteady gait

Extremely rare seizures, hallucinations, psychiatric symptoms (Hashimoto’s encephalopathy)

General weakness, low elasticity

Nausea and gastrointestinal problems, digestive problems

Eye disease (endocrine orbitopathy)

Flu-like symptoms

Swelling of the lymph nodes


Increased liver values

White white dots on the forehead The immune disease can affect various organ systems and tissues outside the thyroid gland.

During Hashimoto’s thyroiditis, various skin changes can occur. Statistics on the frequency of skin changes that occur together with Hashimoto’s thyroiditis are not currently available.

Independent autoimmune skin diseases, such as white spot disease, vitiligo, rare blisters on the skin, pemphigus or circular hair loss, alopecia areata, must be distinguished.

Dryness of the mucous membranes (mouth, nose, eyes, etc.) is calsiccaicka syndrome. Until now, treatment was possible only symptomatically, e.g., Artificial saliva, eye drops, eye gel. Sjögren’s syndrome, which is an autoimmune disease in itself, must be distinguished from it.

Painful hardening of tendons and muscles has been reported. Muscles can be sensitive to pressure. Pain in the back and especially in the neck can be found in many patients. The cause of the pain is unclear. Some people have reported joint pain. Additional rheumatic diseases should be ruled out.

Gastrointestinal disorders and nausea are common. Here, too, additional autoimmune diseases (celiac disease, pernicious anemia, etc.) must be distinguished.

So-called Hashimoto’s encephalopathy, brain involvement is extremely rare and can exist even with normal levels of thyroid hormones in the blood. Epileptic seizures, shivering, hallucinations, and other psychiatric symptoms may occur. In most cases, strongly increased antibody levels to TPO can be detected. Cortisone treatment can make encephalopathy go away. Spontaneous cures have also been reported. However, due to rarity, little research has been conducted on this disease phenomenon.

The symptoms of immune disease are different. It is not clear how these symptoms occur due to the immune process and to what extent antibodies play a role. The multitude of possible different interpretations, which are only partially described in many medical textbooks, often leads to uncertainty in physicians and patients. When the immune process calms down, the symptoms often decrease.

Symptoms of eye disease

Eye involvement, so-called endocrine orbitopathy, is much less common in Hashimoto’s thyroiditis than in Graves’ disease. Transient forms of Graves’ disease and Hashimoto’s thyroiditis are possible. Endocrine orbitopathy symptoms range from mild symptoms such as tears, redness of the eyes, dry eyes, sensitivity to glare, and foreign body sensation to rare, severe forms with impaired or lost vision.

Endocrine orbitopathy is also an autoimmune reaction. Certain immune cells and antibodies directed against the thyroid gland also react with the eye tissue.

Endocrine orbitopathy usually progresses in strokes. Years of relapse are common. The prognosis of endocrine orbitopathy in individual cases is not possible. Orbitopathy can begin long after the onset of thyroid disease. In several cases, endocrine orbitopathy occurs before thyroid disease.

What symptoms of eye disease can occur?

Watery eyes, burning eyes, sensitivity to light, blurred vision

Feeling of a foreign body in the eyes, feeling of pressure behind the eye

Dry eyes, inflammation of the cornea, conjunctivitis

Protruding eyes (exophthalmos), poor eyelid closure


Double vision, eye muscle problems, vision disorders

Rare: severe visual impairment due to optic nerve damage


For eye disease, thyroid hormones must adapt optimally. Usually, the level of fT4 in the upper normal range or even slightly above is most favorable for the disease.

Symptoms that may indicate additional immune disorders

Ulcerative colitis and celiac disease

People with Hashimoto’s symptoms are more likely than healthy people to develop inflammatory bowel diseases such as ulcerative colitis or celiac disease . In case of chronic diarrhea, colonoscopy with tissue samples is necessary. Tests for specific antibodies are recommended. Indications for ulcerative colitis may be increased levels of inflammation in the blood.

Celiac disease can be noticed by gas and diarrhea. Detection can be performed by determining antibodies in the blood and small bowel biopsy (removal of tissue by colonoscopy). It is usually easy to treat with a gluten-free diet.

Pernicious anemia

Near anemia, stomach ups, et, and d burning sensation of the tongue may occur. Weakness, fatigue, diarrhea, ea, and difficulty breathing may occur and neurological disorders. Determination of antibodies against parietal cells and internal antibodies in the blood indicates diagnosis.


Autoimmune thyroid diseases are relatively common in adolescent diabetes ( type 1 diabetes ). In most cases, diabetes occurs first, and thyroid diseases appear after a few years. Women who developed childhood diabetes are particularly affected.

If there is already an autoimmune disease of the thyroid gland, later diabetes occurs less often.

Since about 10 to 15% of alTypepe 1 diabetics develop autoimmune thyroiditis that requires lifelong treatment, it seems advisable to routinely screen all type 1 diabetics for thyroid antibodies.

Specific antibodies are known for type 1 diabetes (GAD).

Some non-diabetic Hashimoto’s have reported additional disorders of sugar metabolism. Hypoglycemia often occurs after heavy meals due to excessive insulin release. Dextrose or fruit juices can return blood sugar levels too low to normal. In case of frequent hypoglycemia, the blood sugar level and HBA1c in the blood should be checked.

Insulin resistance occasionally occurs in people with Hashimoto’s disease. Although the amount of insulin in the body is normal, only the cells can no longer respond to insulin. The body tries to compensate by increasing insulin production. At the same time, there is often overweight and high cholesterol. Insulin resistance can turn into type 2 diabetes and be treated by an experienced physician. The goal must be weight loss; a customary thyroid hormone must support which in people with thyroid diseases. Insulin resistance in itself is not an autoimmune disease. It is capable of regression. A stress test of blood sugar and insulin determination should be performed to confirm the diagnosis.


Vitiligo, a white spot disease, often occurs in combination with Hashimoto’s thyroiditis dermatologist should also treat him. Occasionally, improvements have been reported after the r normalization of thyroid hormones. Vitiligo leads to the destruction of pigments in the skin. The skin becomes white and is no longer protected from sunlight.

Rheumatic diseases

Rheumatic diseases such as primary chronic polyarthritis and spondyloarthropathies can occur in combination with Hashimoto’s syndrome. A combination with lupus erythematosusSjogren’s syndrome, me, or other collagenosis is also possible.

Addison’s disease

Autoimmune disease of the adrenal gland (Addison’s disease) with reduced production of its own cortisol in the body occasionally occurs together with Hashimoto’s thyroiditis. This may indicate general weakness, salt cravings, low blood pressure, darkening of the skin, and abdominal pain. Before starting treatment with thyroid hormones, the level of cortisol in the blood must be normalized ( cortisone tablets ).


Sarcoid is a systemic disease that can lead to swollen lymph nodes with cough, fever, and difficulty breathing. Inflammation of the joints and bluish-red spots on the legs (erythema nodosum) can also occur. Spontaneous healings are common. Women between the ages of 20 and 40 are predominantly affected.


The simultaneous occurrence of several autoimmune diseases is called polyendocrinopathy or polyglandular autoimmune syndrome. In addition to autoimmune diseases of the thyroid gland, other autoimmune diseases can be found here. For those with polyendocrinopathies, first-degree relatives should check for signs of disease or antibodies, etc.

Therapy – combating symptoms

The most important therapeutic measure is the elimination of hypothyroidism through individually adjusted early replacement of thyroid hormones.
After using a supplement with thyroid hormones, many patients do not have any symptoms. Early treatment can in some cases lead to spontaneous healing. However, some of the patients show various symptoms that can last even after the normalization of hormone levels in the blood.

Surgical removal of the thyroid gland can be useful if the disease is severe.

Alternative treatment approaches have been shown to be effective. Relaxation techniques, acupuncture or psychotherapy can support the aforementioned treatment options.

Is there an alternative therapy?

Chinese plants

There is no known cure for Hashimoto’s thyroiditis with “natural” remedies.

Healing can be supported by relaxation exercises, acupuncture, and behavioral, psychological therapy.

To promote inner relaxation and recovery, each sick person must find their own personal path. Since various relaxation options are offered today, those affected should look for an option that suits them.

With additional muscle tension, good results were recorded in individual cases with craniosacral therapy, special physiotherapy treatment.

It is claimed that enzymatic treatments with Wobenzyme or Phlogenzyme have improved some cases.

If you, as a sick person, have had good experiences with other forms of therapy, we would be interested in contacting us.


Iodine promotes Hashimoto’s thyroiditis and is not suitable as a therapy. People with Hashimoto’s thyroiditis should avoid iodine-containing medications. On the other hand, small amounts of iodine, usually found in food, are not a problem.

Thyroid hormones combined with iodine, such as iodothyrox and thyroid iodine, do not make sense, but hormones without additional iodine such as L-thyroxine should be selected (see under hormones).

Therapies for Hashimoto’s syndrome

What does hormone therapy for Hashimoto’s syndrome contain?

All Hashimoto patients with symptoms or abnormal hormone levels should be treated. Unusual hormone levels occur when fT3 and fT4 decrease and the TSH value increases. Elevated TSH with normal values of fT3 and fT4 is also a reason for treatment. Indicates an already existing hidden (medical: latent) subfunction.
If the blood values are normal, and the symptoms of Hashimoto’s thyroiditis are normal, treatment can also be tried (starting with 25 µg of L-thyroxine per day).

Drugs used

T4 stuff

Euthirok® 25/50/75/88/100/112/137/150/175/200/300 consists of levothyroxine sodium
L-Thirokin® Henning® 25/50/75/100/150/175/200/300 consists of levothyroxine sodium
Berlthirok® 50/100/150 consists of levothyroxine sodium
Eferok® 25/50/75/100/125/150/175 consists of levothyroxine sodium
L-Thirokin® Henning® depot contains 1 mg of levothyroxine sodium
L-Thirok® Hekal® 25/50/75/88/100/112/125 / 137.5 / 150/175/200 consists of levothyroxine sodium
L-Thyroxine beta® 25/50/75/100/125/150/175 consists of levothyroxine sodium
L-Thyroquine HF® 50/75/100/125 consists of levothyroxine sodium
L-Thirokin Aristo® 25/50/75/100/125/150 consists of levothyroxine sodium
L-Thyroxine ratiopharm® 50/100 consists of levothyroxine sodium
L-Thyroquine Hekal® 88/112 consists of levothyroxine sodium
L-Thyroquine AL® 50/100 consists of levothyroxine sodium

T3 preparations

Euthirok® 25/50/75/88/100/112/137/150/175/200/300 consists of levothyroxine sodium
L-Thirokin® Henning® 25/50/75/100/150/175/200/300 consists of levothyroxine sodium
Berlthirok® 50/100/150 consists of levothyroxine sodium
T3 preparations
Thibon® 20/100 Henning consists of liothyronine HCL
Triiodothyronine® BC 50 consists of liothyronine HCL

T3 + T4 preparations

Novothiral® / Novothiral75® contains sodium levothyroxine and sodium liothyronine in a ratio of 5: 1, available in doses of 100 + 20/75 + 15
Prothirid® contains levothyroxine sodium and liothyronine sodium in a ratio of 10: 1, available in a dose of 100 + 10

What are immunosuppressants and their connection with hashimoto

Drugs that suppress the activity of the immune system can improve many autoimmune diseases. To date, no effective therapeutic approaches using immunosuppressants have been found in Hashimoto’s thyroiditis.


Cortisone treatment is not necessary for Hashimoto’s thyroiditis and has not brought any improvement. However, in combination with other autoimmune diseases, additional treatment with cortisone (rheumatic diseases, Addison’s disease, eye involvement in Hashimoto’s thyroiditis, etc.) may be needed.

Other drugs that suppress the immune system

Drugs that suppress the immune system (immunosuppressants such as methotrexate, cyclosporine, etc.) can theoretically reduce the activity of Hashimoto’s thyroiditis. So far, however, no convincing successes have been known. Further research is needed.

Hashimoto’s syndrome and antioxidants

Hashimoto’s syndrome occurs when the immune system is unbalanced due to stress, infection, or other factors with appropriate genetic sensitivity. Immune cells directed against your thyroid gland, which are usually under the control of other immune cells, get out of control and attack your thyroid gland.

Research and findings in recent years show that free radicals and oxidative processes heat the thyroid gland’s immune process and are responsible for a significant part of the symptoms. The supply of high doses of certain antioxidants is suitable for the best possible construction of protective systems against radical damage and the support of the body’s own defense mechanisms as much as possible.
The most important antioxidant substances include vitamins (C, E, B, flavinoids), grape and vegetable peel extracts, selenium, alpha-lipoic acid, N-acetyl-cysteine, nicotinamide, bioflavonoids, and omega-3 fatty acids (salmon oil). The combination of high doses of these natural substances that act together is intended to weaken the inflammatory process and restore the disturbed immune balance.


Selenium has an anti-inflammatory effect, neutralizing free radicals in numerous inflammatory processes. People who follow a vegetarian diet tend to be selenium deficient.

Selenium deficiency cannot be sufficiently proven by measuring the levels of selenium in the blood because the blood values are not representative of the thyroid gland. Therefore, it is unnecessary to measure the level of selenium in the blood before starting treatment.

In the thyroid gland, H2O2 is produced as a by-product during thyroid hormones T4 and T3. So that H2O2 would not have a harmful effect, the enzyme glutathione peroxidase must chemically convert it. The activity of the enzyme glutathione peroxidase depends on the presence of selenium. If the selenium content is too low, the tissue is damaged by H2O2.

T4 is converted to metabolically active T3 by other enzymes called deiodinases. Deiodase activity also depends on selenium. If the selenium supply is too low, not enough T3 can be produced from the available T4.
Selenium intake can also be useful for rheumatic diseases, inflammatory diseases, viral infections, and cancers. A dose of 200 µg of selenium has no side effects and makes sense. Only with doses of 3000 µg of selenium per day for 3 weeks can side effects such as liver damage, gray hair, and nail loss occur.

According to the study of prof. Gartner (Munich), taking 200 µg of selenium a day, could improve Hashimoto’s thyroiditis symptoms. When patients with Hashimoto’s thyroiditis were treated with 200 µg of selenium per day, TPO antibodies decreased by 36% after 3 months. Antibodies were taken as an indicator of disease activity.
The organism’s general condition has improved in terms of greater physical and mental resistance, ability to concentrate, mood, and, in some cases, joint problems and allergies. However, some patients do not respond to selenium treatment.

Recent research has shown that selenium can lead to sugar’s frequent occurrence (type 2 diabetes mellitus). Selenium treatment should then be avoided, especially for overweight or have a family history of sugar.


The intake of 20 mg of zinc per day has also been proven for some Hashimoto’s patients. Often, the higher susceptibility to infections and the organism’s general condition is improved by zinc intake. We need to wait for further scientific research. A zinc intake of 20 mg daily may be recommended.



Miko Lamberto

Ja sam nutricionista sa 10 godina iskustva, neke od svojih zapažanja sam preneo u naš blog. Za najnovije vesti i informacije o prirodi i pridonom lečenju nas pratite.

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