Hashimoto's: Understanding the Stages

Hashimoto's disease is a problem where your body attacks its own thyroid gland. This can cause your thyroid to work too slowly. Many people in the U.S. have Hashimoto's.

To help manage Hashimoto's, it's important to know what stage you're in. By noticing how your body feels and working with your doctor, you can take better care of yourself.

Let's learn about the different stages of Hashimoto's.

Stage 1: Genetics

In the first stage, you have a higher chance of getting Hashimoto's or another autoimmune disease because of your family's health history. But don't worry, your thyroid is still working fine right now. You probably won't feel any different, and your thyroid tests will look normal. Most people don’t know they have this genetic predisposition.

Stage 2: Trigger Stage

So, you're at risk for Hashimoto's because of your family. Now, something needs to happen to "turn on" the disease. This is called a trigger.

Women are more likely to get Hashimoto's than men. Things like pregnancy or menopause can start it. Even too much estrogen can be a problem.

Other things in your life can also be triggers. Stuff like pollution, germs, or even major stress can make your body attack itself. Eating lots of junk food and not getting enough good stuff like vitamins can also be a problem.

But remember, just because you have a chance to get Hashimoto's doesn't mean you will.

Once Hashimoto's starts, your body does something weird. Your immune system, which is supposed to fight germs, starts attacking your thyroid gland. It thinks the thyroid is an enemy! This causes inflammation.

At this point, your thyroid is still working pretty well, so you might not feel sick. But some people get tired, forgetful, moody, or gain weight.

Your doctor can check your blood for special antibodies that show if you have Hashimoto's. Even if you have these signs, you might not need medicine yet.

This stage can last for a long time. It's actually a good time to find out you have Hashimoto's because you can try to stop it from getting worse by changing what you eat and how you live.

Stage 3: Subclinical hypothyroidism

At this stage, the antibody attack on the thyroid gland becomes stronger and more efficient, working more quickly to attack your gland. It’s at this point that the gland’s ability to produce enough thyroid hormone starts to flag. Thyroid tests may show a slightly higher TSH level, usually still within the reference range or right on the border of the upper end of the range. Even with a normal range TSH level, you will typically have Free T4 levels that fall in the low end of the range or are below the cutoff.

With subclinical hypothyroidism, some people at this stage are still asymptomatic. Others begin to experience hypothyroidism symptoms, including fatigue, weight gain, hair loss, and cold sensitivity. You may also start to notice goiter (swelling of the thyroid gland.)

If your TSH level is still within the normal range, your doctor will likely recommend “expectant management.” This means you will be regularly monitored for any changes in thyroid hormone levels and be prescribed medication only when your thyroid blood values are clearly out of the “normal” range.

It’s also common during this stage for thyroid levels – and symptoms -- to fluctuate as increasing damage to the thyroid makes it more erratic in releasing thyroid hormone.

If you’re diagnosed at this stage, you still have an opportunity to keep your thyroid gland functional and avoid progressing to full, overt hypothyroidism by following a healthy lifestyle.

Stage 4: Clinical Hypothyroidism

This is when most people find out they have Hashimoto's. Your thyroid is really struggling now. It can't make enough of the stuff your body needs.

You'll probably feel really tired and other problems will get worse. Your body needs thyroid hormones to work right, so without enough, you'll feel the effects.

Stage 5: Thyroid Atrophy & Progression of other autoimmune disorders

In some cases, Hashimoto's can get really bad. Your thyroid can get so damaged that it can't work at all. It shrinks up and stops making the hormones your body needs.

If this happens, you'll need to take medicine for the rest of your life to replace the missing thyroid hormones.

If you have Hashimoto's, you're more likely to get other autoimmune diseases. These are diseases where your body attacks itself. Some examples are celiac disease (problems with your intestines), psoriasis (skin problems), and rheumatoid arthritis (painful joints).

It's like your body's army is confused and starts fighting its own people instead of germs. Once it starts attacking one part of your body, it can start attacking other parts too.

Catching Hashimoto's Early

The best way to fight Hashimoto's is to find it early. You should get a special blood test called a Functional Thyroid test starting around age 20. Then, get tested every 5 years after that. If you start feeling off, get tested right away.

If you catch Hashimoto's early, you might be able to stop it from getting worse by eating right, exercising, and taking certain supplements.

Want to learn more about this special blood test? Click here!