Hashimoto’s thyroiditis is a common autoimmune condition, but that doesn’t mean every patient experiences it in the same way. At Texas Diabetes & Endocrinology, our endocrinologists look beyond the diagnosis to understand how your thyroid is functioning, what may be contributing to your symptoms, and how your thyroid health fits into your overall health.
Here are seven things we wish more patients understood about Hashimoto’s.
What Is Hashimoto’s, and How Is It Different From Hypothyroidism?
Hashimoto’s thyroiditis is an autoimmune condition in which the immune system mistakenly targets the thyroid gland. Over time, this can damage the thyroid and affect its ability to produce enough thyroid hormone, leading to hypothyroidism. Hashimoto’s is the most common cause of hypothyroidism in the United States.
You can have Hashimoto’s without having hypothyroidism. Some people have evidence of the autoimmune condition while their thyroid continues to produce enough hormone to function normally. Others develop hypothyroidism as the condition affects the thyroid over time.
What Does a Positive Thyroid Antibody Test Mean?
Thyroid antibodies are proteins produced by the immune system that mistakenly target proteins in the thyroid. In Hashimoto’s, the most common are thyroid peroxidase (TPO) antibodies and thyroglobulin (Tg) antibodies. Their presence can indicate that the immune system is reacting against the thyroid.
A positive TPO antibody blood test result can support a diagnosis of Hashimoto’s, but the antibody test does not tell us how well your thyroid is functioning by itself.
Your endocrinologist may consider your:
- TSH: A hormone produced by the pituitary gland that signals the thyroid to make thyroid hormone.
- Free T4: The main circulating thyroid hormone available to your body.
- Symptoms and medical history: Important context for interpreting your test results.
Think of it this way:
The antibody test tells us about the autoimmune process. TSH and Free T4 tell us how well the thyroid is functioning.
Can You Have Hashimoto’s With Normal Thyroid Levels?
Yes. You can have thyroid antibodies associated with Hashimoto’s while your thyroid is still functioning normally.
In this situation, the immune system shows evidence of an autoimmune response, but the thyroid is still producing enough hormone to meet the body’s needs.
If your TSH and Free T4 are normal, thyroid hormone medication generally isn’t needed simply because your thyroid antibodies are elevated. Instead, your endocrinologist may recommend monitoring your thyroid function over time.
This is why a positive antibody test shouldn’t be viewed in isolation. The goal is to understand whether Hashimoto’s is currently affecting your thyroid function and what, if anything, needs to be done.
Does Hashimoto’s Cause Weight Gain or Make It Harder to Lose Weight?
Hashimoto’s can contribute to weight gain when it causes hypothyroidism, but thyroid function is only one factor that influences weight.
Thyroid hormones play an important role in metabolism. When thyroid hormone levels are too low, your body may use energy more slowly, which can contribute to weight gain and difficulty losing weight.
If your thyroid hormone levels are appropriately treated and you’re still struggling with your weight, your thyroid may not be the whole explanation.
Weight and metabolic health can be influenced by many factors, including:
- Insulin sensitivity
- Sleep
- Nutrition
- Physical activity
- Medications
- Age
- Genetics
- Other hormonal or medical conditions
This is where looking at the bigger picture matters.
Do I Need Thyroid Medication If I Have Hashimoto’s?
Not necessarily.
If you have positive thyroid antibodies but your thyroid function tests are normal, you generally do not need thyroid hormone medication solely because you have Hashimoto’s.
If Hashimoto’s causes hypothyroidism, thyroid hormone replacement with levothyroxine is the standard treatment. The appropriate dose depends on your individual thyroid function, medical history, age, weight, and other factors.
Your treatment may also need to be adjusted over time as your thyroid function changes.
Do I Need to Change My Diet or Take Supplements for Hashimoto’s?
There is no specific diet that has been proven to cure Hashimoto’s.
You may see recommendations online to eliminate gluten, dairy, sugar, or other foods, or to take supplements marketed specifically for thyroid health. But having Hashimoto’s does not automatically mean you need a restrictive diet or a collection of thyroid supplements.
Some supplements can also interfere with thyroid medication or affect thyroid function. That’s why it’s important to discuss supplements and major dietary changes with your healthcare provider before starting them.
Why See an Endocrinologist for Hashimoto’s?
Hashimoto’s affects the thyroid, but your thyroid doesn’t operate in isolation.
Thyroid hormones play an important role in metabolism and can influence energy use, weight, cholesterol, and other processes throughout the body. An endocrinologist can help determine whether your thyroid is contributing to your symptoms and whether other hormonal or metabolic factors may also be involved.
Our endocrinologists look at your thyroid function in the context of your overall health—not simply one abnormal lab result.
Our goal is to help you understand what’s happening, determine whether treatment is needed, and develop a plan that fits your individual health needs.
To schedule an appointment at our Central Austin, South Austin or Round Rock office, request an appointment online or call (512) 458-8400.
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