In general, your doctor may test for Hashimoto's disease if you're feeling increasingly tired or sluggish, have dry skin, constipation, and a hoarse voice, or have had previous thyroid problems or a goiter.
Diagnosis of Hashimoto's disease is based on your signs and symptoms and the results of blood tests that measure levels of thyroid hormone and thyroid-stimulating hormone (TSH) produced in the pituitary gland. These may include:
- A hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone is low. At the same time, the level of TSH is elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.
- An antibody test. Because Hashimoto's disease is an autoimmune disorder, the cause involves production of abnormal antibodies. A blood test may confirm the presence of antibodies against thyroid peroxidase (TPO antibodies), an enzyme normally found in the thyroid gland that plays an important role in the production of thyroid hormones. But the TPO antibody test isn't positive in everyone with Hashimoto's thyroiditis. Many people have TPO antibodies present, but don't have a goiter, hypothyroidism or other problems.
In the past, doctors weren't able to detect an underactive thyroid (hypothyroidism), the main indicator of Hashimoto's disease, until symptoms were fairly advanced. But by using the sensitive TSH test, doctors can diagnose thyroid disorders much earlier, often before you experience symptoms.
Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism. These tests also help your doctor determine the right dosage of medication, both initially and over time.
Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life.
If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others).
Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism.
Monitoring the dosage
To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after six to eight weeks of treatment and again after any dose changes. Once the dose that normalizes your thyroid tests is determined, your doctor is likely to check your TSH level about every 12 months as the dosage you need may change. Excessive amounts of thyroid hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine can also cause heart rhythm disorders (arrhythmias).
If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.
Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage.
Also, don't skip doses or stop taking the drug. If you do, signs and symptoms will gradually return.
Effects of other substances
Certain medications, supplements and some foods may affect your ability to absorb levothyroxine. However, taking levothyroxine four hours before or after other medications could remedy the problem. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or if you take any of the following:
- Iron supplements, including multivitamins that contain iron
- Cholestyramine (Prevalite), a medication used to lower blood cholesterol levels
- Aluminum hydroxide, which is found in some antacids
- Sucralfate, an ulcer medication
- Calcium supplements
Is a combination of hormones needed?
Levothyroxine is the synthetic form of the natural T-4. T-4 is converted into T-3 in the body. While most people are treated successfully with levothyroxine alone, some people don't feel completely normal on levothyroxine.
Researchers have investigated whether adjusting standard hypothyroidism treatment to replace some T-4 with small amounts of T-3 may offer benefit. But, the majority of studies have determined that the addition of T-3 does not offer any advantage over treatment with T-4 alone.
There is some evidence that T-3 may offer benefit to certain subsets of people, such as people who have had their thyroid surgically removed (thyroidectomy). Research is ongoing.
T-3 can be given alone as liothyronine (Cytomel) or in combination with T-4. Taking a combination T-4 and T-3 ends up producing higher than normal levels of T-3, especially soon after the medication is taken. This can cause a fast heart rate, anxiety and trouble sleeping.
But, for those who haven't gotten enough relief from T-4 alone, adding liothyronine to standard levothyroxine treatment for a three- to six-month trial is a long enough period to see if the combination helps you.
Standard treatment for Hashimoto's disease is levothyroxine, the synthetic form of thyroxine (T-4). However, extracts are available that contain thyroid hormone derived from the thyroid glands of pigs. These products — Armour Thyroid, for example — contain both levothyroxine and triiodothyronine (T-3).
Doctors have a number of concerns about thyroid hormone extracts such as Armour Thyroid, including:
- The balance of T-4 and T-3 in animals isn't the same as in humans.
- The exact amount of T-4 and T-3 in each batch of a natural extract product can vary, leading to unpredictable levels of these hormones in your blood.
Preparing for your appointment
You're likely to start by seeing your primary care doctor. Your doctor may refer you to a specialist called an endocrinologist.
Here's some information to help you prepare for your appointment and to know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. When you make your appointment, ask if there's anything you need to do to prepare for common diagnostic tests.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. For example, if you've been feeling more forgetful than usual, this is important information to share with your doctor. Also tell your doctor about changes you've noticed in your physical appearance, such as unexplained weight gain or a difference in your skin.
- Write down key personal information, including any changes in your menstrual cycle and in your sex life. Let your doctor know if your libido has changed.
- Make a list of all medications, vitamins or supplements you're taking or have used in the past. Include the specific name and dose of these medications and how long you've been taking them.
- Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Create a list of questions so that you can make the most of your time with your doctor. For Hashimoto's disease, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- What tests do I need?
- Is this condition likely temporary or long lasting?
- What treatment do you recommend?
- How long will I need to take medications?
- What side effects could I experience from the medications you're recommending?
- How will you monitor whether my treatment is working?
- Will I experience long-term complications from this condition?
- Do I need to change my diet?
- Will exercise help?
- I have other health conditions. How can I best manage these conditions together?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don't hesitate to ask other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- What are your symptoms, and when did you first notice them?
- How have your symptoms changed over time?
- Have you noticed changes in your energy level or your mood?
- Has your appearance changed, including weight gain or skin dryness?
- Has your voice changed?
- Have your bowel habits changed? How?
- Do you have muscle or joint pain? Where?
- Have you noticed a change in your sensitivity to cold?
- Have you felt more forgetful than usual?
- Has your interest in sex decreased? If you're a woman, has your menstrual cycle changed?
- Are you being treated or have you recently been treated for other medical conditions?
- Do any of your family members have thyroid disease?