Healthy Hormones

The Hashimotos Symptoms Checklist

Hashimoto's thyroiditis is the most common autoimmune disorder.

If you have been diagnosed with hypothyroidism, there is a high likelihood that you have Hashimoto's and don't even know it.

It's important to be tested for Hashimoto's if you have symptoms of low or high thyroid or both!

If you have an autoimmune disorder, you should also be tested for Hashimotos.

In this article, I will discuss the common symptoms associated with Hashimoto's thyroiditis - in the early stages, middle stages and late stages - and how to make the diagnosis by showing you what tests you will need to request from your doctor.

I discuss the best natural treatments for Hashimotos in this article.

Here we go...


What is Hashimoto's Thyroiditis?

Hashimoto's Thyroiditis (from now on I will refer to it as Hashimoto's) is an autoimmune disorder. In other words, something causes your immune system to go rogue and start attacking your thyroid gland.

It was first described by a Japanese physician, Dr. Hakaru Hashimoto, in 1912.

It is common in Japan because of their heavy fish consumption. Fish contain a lot of iodine, which when found in high amounts is a common cause of autoimmune thyroid disease.

It is the most common autoimmune disorder in the US and its incidence is increasing rapidly.

In fact, in my office I typically diagnose one to three new patients every week with Hashimoto's!

The next obvious question is - why?

Most physicians think that it is almost purely due to our genes. However, that is only part of the story.

In a study of identical twins with an autoimmune disorder, only 50% of their twins also had an autoimmune disorder.

While that shows a strong link to genetics, there is obviously something else at play as well or that percentage would be higher.

There appear to be several factors that contribute to the development of Hashimotos:

    • Genetics - family history of thyroid disease, variations in cellular thyroid components
    • Toxins - Iodine, fluoride, perchlorate, mercury, cadmium, etc.
    • Nutrient Deficiencies - Vitamin D, B vitamins, zinc, selenium, iodine
    • Infections - EBV, coxsackie virus, human parvovirus B19, herpes virus, H. pylori

All of these factors may create a situation where the immune system attacks a part of your body (in this case, your thyroid) instead of just the foreign invaders that they are designed to attack.

How Common is Hashimotos?

Up to 10% of the US population has Hashimoto's, and it occurs more often the older we get.

It is much more common in women. In fact, 7 women are diagnosed for every 1 man that is diagnosed. Some experts estimate that it may be present in up to 20% of women!

It is more commonly seen around the times of puberty, pregnancy and menopause, which seems to show that hormone fluctuations may play a role in the development of Hashimotos.

If appears to be more common in Caucasians and Japanese individuals.

So what are the common symptoms of Hashimotos?

Hashimoto's Symptoms Checklist

Hashimoto's is by far the most common cause of hypothyroidism, or low thyroid. In fact, some researchers believe up to 90% of hypothyroidism is due to Hashimoto's!

Hashimoto's causes hypothyroidism because the antibodies produced by our confused immune system cause inflammation in the thyroid cells. That inflammation will damage the cells and eventually destroy them.

2 factors cause the variation in symptoms in Hashimoto's:

    • Fluctuations in thyroid hormone levels
    • The level of inflammation from the autoimmune condition

The level of inflammation can wax and wane, which can cause the severity of symptoms to vary as well.

Think of an arthritic knee.  At times the inflammation is not too bad so the symptoms are mild.  At other times, the inflammation is increased which also worsens the symptoms.

At times, the inflammation can cause an increased release of thyroid hormone which can result in symptoms of hyperthyroidism.

That is because as the thyroid cells are being destroyed, stored hormones can be released into the blood stream, causing a toxic load of thyroid hormone.

Enough thyroid cells will eventually be destroyed that the thyroid will no longer be able to produce adequate thyroid hormone to keep up with the demands of the body. Hypothyroidism then develops.

By the time that most Hashimoto's patients are diagnosed, they have probably had the condition for years.

However, the thyroid was not damaged early in the disease to the point of causing enough symptoms to make the patient seek medical help. Or they may have blamed the symptoms on something else.

Early Symptoms of Hashimoto's

Early symptoms of Hashimoto's are typically mild symptoms.  These include:

    • Mild fatigue
    • 5-10 pounds of weight gain
    • Depressed mood
    • Difficulty focusing
    • Dry skin, dry and brittle hair, nonspecific rashes
    • Mild constipation
    • Mild fluid retention (especially in the face and lower extremities)
    • Voice changes or the sensation of throat swelling
    • Reduced ability to sweat
    • Mild joint pain and muscle aches
    • Mild to moderate changes in the menstrual cycle

If you have any of these symptoms, it is important that you get your thyroid antibody levels checked.

At this point, if the inflammation is reversed, it is possible to avoid permanent damage to the thyroid gland.

Hyperthyroid Symptoms

Over the next several years, people with Hashimoto's can fluctuate between hyperthyroidism and hypothyroidism.

This is because the thyroid antibodies will attach to the thyroid gland and cause increased inflammation.

This inflammation may trigger the thyroid to release a surge of thyroid hormone which will cause symptoms of hyperthyroidism.  These symptoms can be even worse if the person is already on thyroid medication.

Symptoms that indicate an increased level of thyroid hormone include:

    • Hot flashes or episodes of heat intolerance
    • Jitteriness
    • Symptoms of anxiety
    • Fatigue or big swings in energy level
    • Insomnia
    • Facial flushing
    • Heart palpitations or racing pulse
    • Weight loss or weight gain

Not all Hashimoto's patients will have these episodes of hyperthyroidism.

Some folks just have a progressive decline in thyroid function and have classic symptoms of hypothyroidism.

Symptoms of Advanced Hashimoto's

Eventually, if the Hashimoto's isn't found and addressed, all thyroid stores will be depleted and hypothyroid symptoms will occur.

The typical symptoms of a patient with advanced Hashimoto's include:

    • Extreme fatigue/exhaustion
    • Moderate weight gain (usually 20-30 pounds)
    • Hair loss or hair thinning
    • Mood changes, typically depression
    • Menstrual irregularities
    • Chronic and debilitating muscle or joint pain
    • Chronic constipation, other GI issues such as gas/bloating, SIBO, acid reflux, low stomach acid

I discuss a more extensive list of symptoms of hypothyroidism in my article found here.

Even in the advanced stages, patients can still have "flares" during which their symptoms are much worse.

These symptoms can include worsening fatigue, jitteriness, sudden weight gain, brain fog, and GI symptoms.

If this happens, it is important to see your doctor for further evaluation and labwork.

Your healthcare provider may also notice an enlarged thyroid gland on exam (called a goiter). The majority of goiters are caused by Hashimoto's.

In fact, people with Hashimoto's are 3 times more likely to develop thyroid cancer than people without Hashimoto's.

If your thyroid is enlarged, you need to see a doctor to get a definitive diagnosis. Enlargement can also be caused by other conditions, including thyroid cancer.

How to Diagnose Hashimotos

Hashimotos can be diagnosed in 3 ways:

    • Positive thyroid antibodies
    • Positive thyroid ultrasound
    • Positive thyroid biopsy (fine needle aspiration)

The vast majority of patients are diagnosed with Hashimoto's by finding elevated levels of thyroid antibodies on blood testing.

I will occasionally discover an enlarged thyroid on physical exam, but that is usually only a handful of times per year.

Get a Complete Thyroid Panel

Hashimoto's will not be diagnosed without a complete thyroid panel.

A TSH, which is typically the only thyroid test ordered by most conventional doctors, will not diagnose autoimmune thyroid disease. The TSH typically will not become permanently elevated until the Hashimoto's has become advanced.

A Complete Thyroid Panel Includes:

  • TSH
  • free T4
  • free T3
  • reverse T3
  • TPO antibodies
  • Thyroglobulin antibodies

90% of Hashimoto's patients have elevated TPO antibodies. 80% have elevated thyroglobulin antibodies.

If either the TPO or thyroglobulin antibodies are >35 ng/ml, the diagnosis of Hashimoto's can be made.

A small percentage of Hashimoto's patients will have normal antibody levels, but their ultrasound will be abnormal or their thyroid biopsy will show evidence of the disease.

It is also recommended that all patients with elevated thyroid antibodies should have a thyroid ultrasound. If it is normal, the ultrasound should be checked every 2 years. If it shows evidence that the thyroid is growing, a repeat ultrasound should be performed every 6 months.

Evaluate Inflammation

It is also a good idea to monitor the level of inflammation in your body if you have Hashimoto's.

Inflammation itself can worsen thyroid function by reducing T4 to T3 conversion.

It can also worsen insulin resistance and adrenal dysfunction.

All of these issues can lead to worsening fatigue, weight gain, and other symptoms that can worsen the hypothyroid symptoms that are already present.

Inflammation can be evaluated by checking the following lab tests:

    • Erythrocyte Sedimentation Rate (ESR)
    • C-Reactive Protein (CRP)
    • Ferritin

If these levels are elevated, it is a sign that inflammation is increased in the body and your thyroid gland may be under assault and being damaged.

Look For Other Autoimmune Conditions

One study showed that up to 5% of patients with Hashimoto's have celiac disease. Another study showed up to 50% of celiac patients have Hashimoto's.

Therefore, it is recommended that all patients who are diagnosed with Hashimoto's should be tested for celiac disease.

Statistically, if a patient has an autoimmune disorder such as Hashimoto's, they have a higher risk of having a second autoimmune disorder. These include Type I diabetes, multiple sclerosis, rheumatoid arthritis, lupus, celiac disease, Addison's disease, and others.

Consider Hashimoto's If You Have a Mood Disorder

Many Hashimoto's patients may be misdiagnosed with mood conditions such as depression, anxiety, and bipolar disorder.

One study also showed that people with these conditions have a higher prevalence of anti-thyroid antibodies.

Because of this, any person with anxiety, depression, or other mood disorders should have a complete thyroid panel checked.

Instead of taking anti-depressants or anti-anxiety medications, they may need their thyroid issue treated!

So I Have Hashimotos.  What is My Prognosis?

Most conventional doctors are taught that Hashimoto's is an irreversible, inevitable disease that will eventually kill the thyroid.

They are taught that patients should just have periodic thyroid levels checked and thyroid medication should be prescribed once the levels are abnormal and the patient becomes hypothyroid.

They don't believe anything else can be done.

Of note, one study showed that up to 20% of patients with Hashimoto's can have spontaneous recovery of their thyroid function.

Just like in other autoimmune diseases, I believe (and the literature supports this belief), that the course of Hashimoto's can be slowed or even reversed with proper lifestyle interventions.

I will discuss many of those interventions in my treatment article found here.

Hypothyroidism does not have to be inevitable in Hashimoto's!


Hashimoto's thyroiditis is the most common autoimmune disorder.

90% of all hypothyroidism may be due to Hashimotos.

Early in Hashimoto's, the symptoms may be mild and not recodgnized as being due to a thyroid issue.

In some patients, their symptoms may vacillate between hypothyroid and hyperthyroid because of fluctuations in inflammation levels.

If Hashmoto's has been present for years, it will eventually destroy the thyroid gland which will cause typical symptoms of hypothyroidism.  Thyroid medication will be required.

Hashimotos is typically diagnosed by having a TPO antibody and/or thyroglobulin antibody level >35, or with a positive thyroid ultrasound or biopsy.

Inflammatory markers should also be tested.

All patients that are diagnosed with Hashimotos should have a thyroid ultrasound and be tested for celiac disease.

With appropriate lifestyle interventions, the progression of Hashimoto's can be slowed or even reversed.

Now it's your turn...

Have you been diagnosed with Hashimotos?

What symptoms did it cause in you?

Leave your comments below.

About the Author Dr. Jeff Whelchel

Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.

Leave a Comment:

Carol Reyes says January 17, 2018

Dr. Whelchel,
I understand that you are not taking new patients. Is there a physician that you recommend in Amarillo or surrounding area that is knowledgeable in the area of Hashimotos? I was diagnosed with fibromyalgia in 1995. Recently, I have been experiencing some thyroid issues. I would really like to go to someone who is practicing aggressive thyroid treatment. My primary physician and don’t exactly agree on how much thyroid I need. I was taking 90 mg of Armour and he didn’t like my test results so he changed it to 60 mg. I don’t believe he is doing a complete thyroid panel. He is a good doctor but I do know some doctors don’t agree on this. Thank you.

    Dr. Jeff Whelchel says January 18, 2018

    Hi Carol. I’m sorry you are having a hard time finding a doctor that will listen to you. Most doctors are not taught how to aggressively treat Hashimoto’s. I would suggest you consider joining my online membership program. Go here to learn more:

Kristie says February 15, 2020

Hi Dr. Jeff:

I feel so blessed to have found your site. I so appreciate your incredible knowledge, dedication and the way that you care enough to kindly answer every persons posts.
I am a 64 year old woman who has been seriously struggling with undertreated Hashimoto’s for the last three years. When my primary physician wasn’t addressing my tanking levels and symptoms, I switched to a FM doctor who I have been seeing for the last 10 months. Despite medications changes just about every month, we have not been able to get my thyroid optimal. The symptoms started three years ago, when, out of nowhere and for no apparent reason, I gained 35 pounds. I developed severe swelling all over my body that has been so debilitating that it is extremely painful and difficult to be on my feet. I have spinal stenosis and DDD, so, the extra fluid and weight significantly aggravate those conditions. I also have severe abdominal bloating and distention and every other symptom of Hashimoto’s and hormonal imbalances. I was wondering if you could answer a question that I have, since I have researched extensively and have come up with no answers and I’m quite sure that you have come across this problem in your practice. Will the extensive systemic mucin accumulation go away once my thyroid and other hormone levels are optimal? Also, do you know of any way to reduce the mucin in the meantime? I have tried NAC and Bromelain, without success. I am currently taking Synthroid 88 mcg and Cytomel 15 mcg. as well as Estradiol 1mg. and Progesterone 200mg daily. I follow a clean, whole foods, and intermittent fasting diet. I feel as if I am on no thyroid meds, as they seem not to make any difference. Is there some explanation for why I could be having such a persistent problem responding to thyroid meds?
Current Labs: TSH: 0.16 (0.450-4.500), Free T4: 0.94 (0.82-1.77), Free T3: 2.5 (2.0-4.4), SHBG: 127.5 (17.3-125.0), Free Estradiol: 0.32 (0.6-7.1), Progesterone: 2.3 (0.0-0.1), Free Testosterone: 1.0 (0.0-4.2), Cortisol (Saliva) 8:00 a.m.: 0.257 (0.025-0.600), Noon: 0.054 (<0.010-0.330), 4:00 p.m.: 0.073 (0.010-0.200), Midnight: 0.059 (<0.010-0.090). Any insight or help you could offer would be so appreciated. I am trying very hard to regain my health and am feeling pretty hopeless, at this point. Living like this is not a life worth living and I am trying to make the rest of my life, the very best of my life. Thank you, so much and God bless you for all you do to help so many people. 🙂

    Dr. Jeff Whelchel says February 24, 2020

    Hi Kristie. I’m sorry you have been having problems.

    Mucin is not something that I typically pay attention to. It sounds to me like you have some intestinal dysbiosis (leaky gut) issues in addition to your Hashimoto’s.

    I would suggest taking some adrenal adaptogens to help with your adrenal function, a good spore-based probiotic for your gut, fermented foods to help with your gut bacteria. I also like to have the free T3 level >3.2, so your thyroid meds need adjusting. You also did not list your TPO antibody level or thyroglobulin antibody level. Make sure those are monitored as well.

    Remember, autoimmune conditions have 3 components – genetics, gut issues, and some sort of physical and/or emotional stress. When in doubt, focus on your gut health.

    There are some people that also have a thyroid receptor resistance issue. Lots of things to consider with you.

    You are welcome to come see me in Amarillo, TX, if all else fails. Go to or call 806-350-7807.

    Good luck.

      Kristie says February 25, 2020

      Hi Dr. Jeff:
      Thank you so very much for your response.
      I am taking Ashwagandha as well as Adrenal Glandular to support my adrenals. If there is something else you would recommend in addition, I would appreciate the recommendation. I eat fermented foods for my gut (just call me the Kimchi Queen)! Lol! I was taking probiotics and perhaps should go back to using them, as well.
      I agree with you about raising my T3. I have been leaning on my FM doc to increase my Cytomel, but, he is very cautious and is raising is VERY slowly, because I have a long standing history of a cardiac arrhythmia. I’m hoping that we will be able to increase it at my next appointment in 2 weeks. Even with the increases in dosage, it doesn’t seem to be coming up as much as it should, so perhaps that may be due to thyroid receptor resistance? Last TPO Ab was 14 (0-34) and Thyroglobulin Ab was <1.0 (0.0-0.9) back in March of last year.
      I have been also struggling with awful insomnia and night sweats every night. I was wondering if this is connected to low thyroid levels or imbalance of estrogen and progesterone? Would so appreciate your input on that, as I am a bit confused as to what my optimal Estradiol (free) and Progesterone should be on BHRT. My FM is not well versed in BHRT and he admittedly is using me as a guinea pig to learn from.
      I SO very much appreciate your invaluable insight and recommendations. I know that I have all three components of the autoimmune conditions in play, which is probably why I am having such challenges restoring my health. If I were able, I would come to Amarillo on the next plane! I wish I could, but, I am on disability and finances prevent me from being able to. You are the most knowledgeable doctor on these issues. Thank you, again for all your help. It gives me hope that things may get better. I SO appreciate your caring dedication and your responding to my questions. Thank you, thank you, thank you from the bottom of my grateful heart. 🙂

Mekarri says March 24, 2021

I’ve been diagnosed with depression, essential tremors, neuropathy, hypereflexia, hypothyroidism, fibromyalgia. I have unexplained hot flashes, burning like sensations on my skin. My doctor sent me for an mri to look for MS. It came back normal. I suggested she test for Hashimoto’s and she said I don’t match the criteria. However, she agreed to test me. I’ve been seen by multiple doctors over a decade. They are all stumped. I’m on a waiting list for a nerve conduction study, because my doctor is convinced it’s neurological. I’m not understanding how I don’t match the criteria for this.

    Dr. Jeff Whelchel says April 11, 2021

    Ask you doctor to check a TPO antibody and thyroglobulin antibody level. You could also request a thyroid u/s. I hope you feel better soon.

Add Your Reply