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If you have symptoms of hypothyroidism, how do you know if it’s caused by Hashimoto’s, an autoimmune thyroid disease? Although about 90 percent of hypothyroidism cases in the United States are caused by Hashimoto’s, most doctors do not test for it. Why? Because it does not change their treatment. However, it’s vitally important for you to know whether you have Hashimoto’s to stop the damage to your thyroid and prevent other autoimmune diseases.

Hashimoto’s is an autoimmune condition in which the immune system attacks and destroys the thyroid gland over time. Even if medications normalize TSH (thyroid stimulating hormone) on a blood test, an unmanaged autoimmune Hashimoto’s condition continues to damage and destroy the thyroid gland and cause symptoms.

One of the most common scenarios with undiagnosed Hashimoto’s is that your hypothyroidism and symptoms continue to worsen even through you take your thyroid hormone medications. Your doctor may also continually increase your dosage.

Another common scenario is when symptoms and TSH levels fluctuate between being under active and over active. The person can feel like they are hypothyroid one week and hyperthyroid the next. In fact, some doctors may even mistakenly diagnose them with hyperthyroidism when in fact it’s the result of autoimmune Hashimoto’s waxing and waning attacks on the thyroid gland.

This means the patient could suffer from fatigue, headaches, constipation, and depression one week and then when the thyroid becomes over active they suffer from heart palpitations, anxiety, tremors, and insomnia. Blood tests will also show the TSH level going up and down during these swings, which may result in an inaccurate diagnosis.

Sometimes TSH can even be normal as it’s going through a swing resulting in a misdiagnosis all together. Instead, the patient is diagnosed with an anxiety disorder or even bipolar disorder.

What causes these swings with Hashimoto’s hypothyroidism? Autoimmune diseases are not steady. Instead they flare up or go into remission depending on triggers, which can be dietary, chemical, stress related, hormonal, and so on.

When an autoimmune flare damages the thyroid, it releases hormones that are stored in the gland. These thyroid hormones flood the bloodstream in excess causing symptoms that look like hyperthyroidism.

To confirm whether you have Hashimoto’s, you need to run thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TGB Ab) test. It’s also helpful to rule out hyperthyroidism, or Graves’ disease.

But keep in mind that because the immune system fluctuates with autoimmune disease, it’s possible to produce a negative antibodies test result. If symptoms strongly suggest Hashimoto’s it’s important to test again.

Ask my office for more advice on identifying Hashimoto’s hypothyroidism.