Susan Merenstein, Pharmacist/Owner

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Top 10 Facts About Hashimoto’s

1. If you take Synthroid/levothyroxine or have hypothyroidism, low thyroid levels, or a sluggish thyroid, you likely have Hashimoto’s.

Hashimoto’s and hypothyroidism are NOT always the same. While Hashimoto’s is the leading cause of hypothyroidism, there is a difference between Hashimoto’s and hypothyroidism. A person can have one, and not the other.

Most cases of pure hypothyroidism can be remedied by taking thyroid hormones. However, as 97 percent of cases of hypothyroidism are due to advanced Hashimoto’s, Hashimoto’s (autoimmune thyroiditis) and the autoimmune attack will remain, even when proper levels of thyroid hormone are restored with medications (unless we find and treat the root cause).

The definition of hypothyroid is a thyroid that doesn’t produce enough thyroid hormone for the body, which is usually made evident by a high TSH and/or low Free T4 and Free T3. Some doctor’s refer to that as a “sluggish” thyroid.

Hypothyroidism is a clinical state that can occur as a result of different factors, such as deficiency, surgical removal of the thyroid, radioactive iodine treatment, not taking enough thyroid hormone, taking thyroid suppressing medications, or damage to the thyroid from an infection, an accident, or a condition like Hashimoto’s.

Hashimoto’s, on the other hand, is a progressive autoimmune condition that involves the body attacking its own thyroid gland, eventually leading to hypothyroidism. A person in the early stages of Hashimoto’s may not yet have hypothyroidism, just the attack on the thyroid gland. This autoimmune attack on the thyroid can cause symptoms, be triggered by various factors, and be responsive to lifestyle changes. I’ll discuss this further below.

The autoimmune attack on the thyroid develops decades before a person becomes hypothyroid, so catching the condition early allows us to prevent its progression. One may suffer from symptoms of Hashimoto’s for years before they are finally diagnosed with hypothyroidism and given thyroid medications.

Some common symptoms of Hashimoto’s include: anxiety, depression, weight gain, mood swings, fatigue, brain fog, cold hands and feet, and gastrointestinal issues.

Another common symptom is having multiple food sensitivities, especially to gluten, dairy and soy, which may not show up on a standard blood test, but can manifest as delayed symptoms after consuming these foods.

Hashimoto’s symptoms can be a spectrum: some people feel just fine, yet others may feel debilitated by their symptoms.

Some common symptoms of Hashimoto’s, based off of hypothyroidism, include:

  • Slower metabolism leading to weight gain
  • Forgetfulness
  • Feeling cold or cold intolerance
  • Depression
  • Fatigue
  • Dry skin
  • Constipation
  • Loss of ambition
  • Dry, coarse hair
  • Muscle cramps
  • Stiffness
  • Joint pain
  • A loss of the outer third eyebrow
  • Heavy menstrual periods
  • Infertility
  • Muscle aches
  • Puffy face
  • Slow heartbeat
  • Brittle nails
  • Arthritis

At the other end of the spectrum, when our body is in a hyperthyroid state, symptoms include:

  • Weight loss
  • Palpitations
  • Anxiety
  • Eye bulging
  • Tremors
  • Irritability
  • Infrequent menstrual periods
  • Fatigue
  • Heat intolerance
  • Increased appetite
  • Hair loss
  • Enlarged thyroid gland
  • Sweating
  • Frequent bowel movements
  • Infertility
  • Soft nails
  • Warm, moist palms
  • Finger tremors
  • Insomnia
  • Muscle weakness
  • Nervousness

I personally experienced irritable bowel syndrome, anxiety, and advanced carpal tunnel in both hands, which required me to wear wrist braces. Despite my symptoms, however, I looked fine (except for some bloating). I had hair on my head (despite losing much of it) and I didn’t need crutches (although I experienced leg and muscle pain). When I came home from work, all I could do was eat, watch TV, and fall asleep on the couch. I was living proof that thyroid symptoms may affect someone, even though they may look fine on the outside!

2. Hashimoto’s can affect fertility and libido.

Women with Hashimoto’s may experience fertility struggles, such as having trouble conceiving and having miscarriages. Their children may also have birth defects.

Female hormones, such as estrogen are thought to play a role in the development of autoimmune thyroid conditions. There are also three common periods of major hormonal changes in a woman’s life, where the onset of the disease can occur – puberty, pregnancy, and perimenopause.

Estrogen and prolactin have an important role in modulating the immune system, and may impact autoimmune disease. Estrogen can also change the requirements for thyroid hormone, and this may result in an autoimmune condition, especially in the presence of nutrient deficiencies. Prolactin, released by breastfeeding women to promote milk production, may also become elevated in women with Hashimoto’s (even when they’re not breastfeeding), and has been tied to both increased thyroid antibodies and infertility.

Research has also shown that both women and men with thyroid disease, experience a higher prevalence of low libido at some point in their lives – with some 64 percent of hypothyroid men suffering from diminished libido, along with other sexual function issues (such as erectile dysfunction, delayed ejaculation, and sperm abnormalities).

A low sex drive can also be caused by a number of co-occurring chronic health conditions, including other autoimmune diseases. For example, many women who have Polycystic Ovarian Syndrome (PCOS) have shared with me their own challenges with having a low sex drive.

3. Misdiagnosing Hashimoto’s is more common than you think.

Many doctors don’t test for Hashimoto’s, despite having their patients present with symptoms of thyroid disease.

Many conventional doctors simply test one’s TSH (thyroid stimulating hormone) and T4 levels (the amount of thyroid hormone circulating in your blood), because these values are tested for a general diagnosis of “thyroid disease.” However, these tests don’t decipher between hypothyroidism and Hashimoto’s, and often don’t flag Hashimoto’s or hypothyroidism until a later stage.

For this reason, it’s important to have a full thyroid paneldone, which includes not only TSH and T4, but also T3, TPO, and TG antibodies (whose presence can show how strong the autoimmune attack on the thyroid is).

Additionally, an ultrasound test can help to diagnose Hashimoto’s, as well as reveal what’s happening with your thyroid and see if there are any nodules present.

I’ll discuss more on how to get a proper diagnosis, further on in this article.

4. Getting on the right thyroid medications can be a game changer.

The conventional medical model treats autoimmune thyroid disorders in the same way as it would treat someone with a nutrient-deficiency-induced thyroid disorder, someone with a congenital defect of the thyroid gland, someone born without a thyroid, or someone who had their thyroid removed and treated with radioactive iodine. To treat these symptoms, synthetic thyroid hormones are often used.

The standard of care is to prescribe levothyroxine (known as T4), which can work wonders for some people’s symptoms. However, this same medication may be completely worthless for other people’s thyroid symptoms.

One reason could be due to poor absorption. Fortunately, Tirosint® (a gluten and dairy-free synthetic T4 hormone medication, free from harmful fillers), has recently become available. In my survey of over 2000 people with Hashimoto’s, those that switched to Tirosint® experienced a 68 percent improvement in labs. Fifty percent saw an improvement in mood, 62 percent saw an improvement in their energy levels, and 32 percent, an improvement in hair loss.

Additionally, T4 is a pro-drug, and needs to be turned into the more active T3 in the body, to exert most of its benefits. This conversion happens perfectly on paper and in a petri-dish, but as a pharmacist, I can tell you that it doesn’t always happen that way in every person’s body. Some people may not convert T4 to T3 properly. This could be due to various reasons — including genetics, nutrients, co-occurring conditions, and sometimes even stress. (41 conditions to be exact)

Of the readers I’ve surveyed, up to 59 percent have felt better taking a combination T4/T3 medication, while up to 43 percent have felt better on a synthetic T4 medication. While 69 percent saw an improvement in their thyroid lab results with the T4-only medication Synthroid® (69 percent), improvements to mood and overall energy were reported in 63 percent of people, after switching to a T3/T4 combination medication like Nature-Throid®.

Natural Desiccated Thyroid (NDT) is another T4/T3 medication option. This is also sometimes called Desiccated Thyroid Extract (DTE). These medications are derived from the thyroid gland of pigs and are considered to be bioidentical hormones.

NDT medications also contain the thyroid hormones T1 and T2, which may have some physiological activity as well. Many patients who did not feel well on conventional treatments have reported feeling much better after switching to an NDT medication like Armour®, Nature-Throid® or WP Thyroid®. (Note: While Armour does not have any gluten-containing ingredients, it is not tested for gluten content, and as such, is not “certified gluten-free.”)

When surveying my readers, I discovered that 59 percent did feel better after switching to Armour®, 57 percent felt better on Nature-Throid®, and 32 percent reported improvement with WP Thyroid®.

Unfortunately, there have been many shortages for NDT medications over the past year, due to recalls. For those who don’t have access to T3-containing medications, I recommend looking into a better absorbed form of T4, such as Tirosint.

5. Your doctor’s lab reference ranges may be outdated.

The TSH level considered to be “normal”, has been skewed for years. Researchers have shown that, when scientists first determined the reference range for thyroid hormones, they looked at people within the “normal” reference range who were actually hypothyroid, or had naturally higher TSH levels due to being elderly. This caused the normal reference range to be inflated, where a TSH of up to 10 μIU/mL was considered normal. (As a side note, when my TSH was at 4.5 μIU/mL, I felt like a sloth.)

Functional medicine practitioners have further defined that normal reference ranges should be between 1 to 2 μIU/mL, for a healthy person not taking thyroid medications. Anecdotally, I’ve found that most patients feel best with a TSH between 0.5-2 μIU/mL.

Thus, the goal is to have your thyroid medications help your labs fall into the optimal reference ranges (as noted in the graphic below).

(Although there is an updated range, many conventional doctors have been slow to join in. This is why I encourage you to work with a functional medicine practitioner who will treat you, and not just your labs.)

When your thyroid labs are optimal, you may see a reduction in your symptoms.

However, everyone is unique, so the most important thing is that you feel well. If your TSH range is slightly out of the optimal range, but you are feeling better than ever, then I wouldn’t focus so much on the number on your labs. What matters is the absence of symptoms.

6. Hashimoto’s can be reversed!

Once diagnosed with Hashimoto’s, most people are told that they will be fine as long as they take their synthetic thyroid hormone medication. However, patients don’t get an explanation as to why they have Hashimoto’s, what the autoimmune disease means for their future, and what actions they can do to support their thyroid and autoimmune disease… other than taking medication.

Most doctors dismiss autoimmune conditions as the result of certain genes and believe that once present, they cannot be reversed. However, leading researcher, Dr. Fasano, has proven otherwise. He has uncovered the three-legged stool of autoimmunity.

According to his research, there are three factors that need to be present for an autoimmune condition to develop:

  • A genetic predisposition
  • An external trigger
  • Intestinal permeability, also known as LEAKY GUT (a condition that involves “holes” in the intestinal lining, which allows toxins and food particles to pass through and further damage our gut)

Dr. Fasano found that, upon removing the intestinal permeability and/or trigger, an autoimmune condition will go into remission. For this reason, I believe in addressing the root causes of Hashimoto’s symptoms to reverse the condition. (And yes, remission is possible with Hashimoto’s!)

7. Many people share common underlying root causes of thyroid disease.

Beyond optimizing thyroid hormones, those who have Hashimoto’s often share these similar root causes:

  • Food Sensitivities – The most common food sensitivities found in people with Hashimoto’s are gluten, dairy, soy, grains (corn, in particular), nightshades (potatoes, tomatoes, and peppers), nuts, and seeds. When someone is first setting out to change their diet, I always recommend completely removing gluten, dairy and soy.
    • In surveying my readers and clients, I’ve found that about 93 percent have felt better on a gluten-free diet.
    • Another 75 percent reported feeling better on a dairy-free diet, 73 percent felt better grain-free, and another 60 percent said they felt better soy-free.
    • Egg and nightshade-free diets were helpful 40 percent and 35 percent of the time, respectively.
  • Nutrient Deficiencies– Micronutrient deficiencies are common in people with Hashimoto’s. This could be due to lack of sufficient thyroid hormones, as it makes nutrient extraction from food more difficult and less efficient. Nutrient deficiencies can also occur as a result of eating nutrient-poor foods, following a calorie-restricted diet, having inflammation from infections or food sensitivities, taking certain medications or having an imbalance of gut bacteria. These nutrient deficiencies contribute to the development of Hashimoto’s, as well as many of its symptoms. Restoring one’s nutrient levels through nutrient-dense foods, supplementation, and optimizing digestion, are some of the fastest ways to feel better with Hashimoto’s and begin to restore the body!
  • Impaired Stress Response– Stress affects so many different bodily functions, including metabolism, hormone production, immune system regulation, and emotional response. Thyroid function is also decreased when in a stressful situation. The body wants to preserve energy to deal with whatever issue is at hand — whether you are being chased by a bear or stuck in traffic — the adrenal glands cannot decipher what is happening when in a “fight or flight” response, so it reacts the same way. “Fight or flight” mode can save us from danger and help us tackle the challenging situations in life. However, problems arise when this type of stress is ongoing and the body is constantly suppressing thyroid function to preserve its resources. Additionally, high or low cortisol levels, caused by chronic stress to the adrenal glands, can cause hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). If left unmanaged, these blood sugar imbalances can lead to hypothyroid symptoms. An increase in cortisol will also disrupt the balance of the HPT (hypothalamic-pituitary-thyroid) axis, which the body relies on to keep thyroid levels steady.
  • Toxins – It is challenging to escape toxins from our environment because they are everywhere — cosmetics, skin products, pesticides, exhaust fumes — the list goes on! Whatever we inhale, ingest, and absorb into our skin, eventually ends up circulating in our body. In fact, in 2006, the Centers for Disease Control reported that the average American has 116 out of 148 commonly used synthetic compounds in their body! We are frequently exposed to xenoestrogens (found in BPA, soy, phthalates, parabens, etc.), which may increase TSH and perpetuate the autoimmune attack on the thyroid. Some other forms of toxins are halogens (bromide, chloride, and fluoride), which can compete with receptor sites in the thyroid gland and build up in our thyroid tissue, leading to inflammation and thyroid cell death, as they are structurally similar to iodine. Fluoride, in particular, can wreak havoc on the thyroid and is included in an array of products — bottled beverages, toothpaste, black and red tea, canned foods, certain medications, and even our drinking (tap) water! Fluoride was actually used to treat hyperthyroidism up until the 1950s, as it is an effective thyroid suppressor at daily doses of 0.9 to 4.2 mg. However, studies confirm that most adults in fluoridated communities ingest between 1.6 and 6.6 mg of fluoride a day, effectively suppressing their thyroid function.
  • Bacterial, Fungal, and Parasitic Infections – Chronic infections (such as small intestinal bacterial overgrowth or SIBO, Blastocystis Hominis, Candida overgrowth and H. Pylori) are the triggers of Hashimoto’s that get the least amount of attention, yet identifying and treating them can result in complete remission. There are protocols designed to eradicate them. In 2015, 80 percent of my clients who hit a plateau with nutrition and took the gut tests I recommended, tested positive for at least one gut infection.
  • Leaky Gut – Intestinal permeability (leaky gut) is one of the factors that must be present for autoimmunity to occur. A leaky gut has gaps in the gut lining that allow irritating molecules and substances to escape from the digestive system, and enter into the bloodstream. In a leaky gut, infections, viruses, and food particles that are able to find their way into the body through the intestinal wall, can cause food sensitivities and a host of other symptoms. This irritation can interrupt the immune system’s ability to regulate itself and put the body into a perpetual “attack mode” that is counterproductive to healing. Even those who have no apparent gastrointestinal symptoms may have a leaky gut, and addressing gut function might be the best place to start to bring healing to the body. If we can reverse leaky gut, we can prevent or reverse autoimmunity altogether.

8. Too much iodine can cause Hashimoto’s.

Iodine deficiency can cause hypothyroidism, as iodine is needed for the thyroid to function. In order to reduce the incidence of hypothyroidism, public health officials began adding iodine to the salt supplies in many industrialized companies.

For this reason, many people think that iodine is good for the thyroid. The truth is, having too little or too much iodine can be harmful!

Today, iodine deficiency is rare, and iodine excess is now recognized as a risk factor for developing autoimmune thyroid disease. Most cases of hypothyroidism in the United States, and other countries that add iodine to their salt supply, are caused by Hashimoto’s.

9. Diet can be a game changer for Hashimoto’s.

Using food as medicine (food pharmacology) is one of the most powerful tools you can use to bring your autoimmune condition into remission. I experienced the most healing when I removed the foods I was reacting to from my diet, and addressed my nutrient deficiencies.

Many of my readers and clients have experienced noticeable benefits from removing the following foods:

  • 88 percent reported feeling better gluten free
  • 87 percent reported feeling better on a sugar-free diet
  • 81 percent reported feeling better on a grain-free or Paleo diet
  • 79 percent reported feeling better on a dairy-free diet
  • 63 percent said they felt better soy free
  • 48 percent felt better egg free
  • 47 percent felt better on nightshade-free diets (tomato, potato, pepper, eggplant restriction)
  • 15 percent of people saw improvement with a nut-free diet
  • 7 percent reported feeling better off seeds
  • 63 to 79 percent of people feel better overall on the Autoimmune Paleo diet, which excludes all of the above-listed foods

Nutrient deficiencies are another common root cause of Hashimoto’s, and can be caused by infections, low stomach acid, fat malabsorption, a deficiency in digestive enzymes, eating nutrient-poor foods, following a calorie-restricted diet, food sensitivities, taking certain medications, or having an imbalance of gut bacteria.

The most common nutrient deficiencies in Hashimoto’s are selenium, vitamin D, B12, ferritin (the iron storage protein), thiamine, zinc and magnesium.

10. Low-dose naltrexone can be helpful for Hashimoto’s.

Naltrexone is an FDA-approved medication used for opioid withdrawal at a dose of 50 mg per day. However, low doses of 1.5 – 4.5 mg per day of this medication, have been found to tweak the immune system. They have also shown promise in improving cases of autoimmune disease, including Crohn’s, MS, and Hashimoto’s, as well as other immune system-related conditions such as cancer and HIV/AIDS. Naltrexone has also been reported to enhance immune function through increasing our endogenous endorphin production, reducing inflammation, promoting DNA synthesis, and slowing down motility in the GI tract to facilitate healing.

Low dose naltrexone (LDN) balances the immune system by increasing the number of T-regulatory cytokines and modulating TGF-B, leading to a reduction of Th-17 — the promoter of autoimmunity. This means that it turns off the cells that cause autoimmunity!

This medication is available only as a prescription and can be compounded into lower doses by special professional compounding pharmacies.

Do You Think (or Know) You Have Hashimoto’s? Here Are Your Next Steps

We offer hormone testing via blood spot

  • TSH – This stands for “Thyroid Stimulating Hormone.” This test is used to screen for thyroid disease. It is a pituitary gland hormone and responds to high and low amounts of circulating thyroid hormone in the body. In advanced cases of thyroid disease, the test will reveal high or low readings. The optimal reference range is 0.5-2 μIU/mL, and I find that most people feel best around 1 μIU/mL.

  • Free T4 – This test measures the amount of inactive thyroid hormone circulating in the body. T4 converts into T3, the active version of thyroid hormone. The optimal reference range is 15-23 pmol/L.

  • Free T3 – This test measures the active thyroid hormone circulating in the body. The optimal reference range is 5-7 pmol/L.

  • TPO & TG Antibodies – Most people with Hashimoto’s will have at least one of these antibodies elevated, and if test results show elevated numbers, this is an indication that the thyroid is essentially attacking itself. The optimal reference range for both TPO and TG antibodies is under 2 IU/mL.

  • Thyroid Ultrasound – Some people who have symptoms of thyroid disease or Hashimoto’s, may not have abnormal results on the lab tests mentioned above, which can lead to a misdiagnosis of Hashimoto’s or hypothyroidism. This is where I recommend a thyroid ultrasound to check for any abnormalities of the thyroid. Ideally, I recommend at least one ultrasound, especially for women of childbearing age. Some indications that can be found on an ultrasound include a rubbery thyroid, shrunken thyroid, enlarged thyroid, or abnormal growths in the thyroid.

The Takeaway

I hope that this article shed some light on how Hashimoto’s and thyroid disease can affect a person, aside from lab results being abnormal. There are so many factors that are involved when one is diagnosed with thyroid disease, and conventional Western medicine, unfortunately, does not provide the necessary information for proper healing.

By spreading this good news, my hope is that all doctors, pharmacists, and other practitioners will understand that the goal of Hashimoto’s and hypothyroidism treatment is not to simply feed the thyroid with synthetic hormone, but to treat each patient as the unique individual they are — as we all are! — and to dig deep to discover and address each root cause of their symptoms.

Those of us who have been through misdiagnoses, and have been told by doctors that we are “fine” when we did not feel that way, understand how thyroid disease can seem overwhelming. I want you to know that, although you may have Hashimoto’s, hypothyroidism, or another thyroid disease, you can put your condition into remission and still live life to your fullest potential! I — along with hundreds of my patients — are living proof that it can happen.

While this info may seem daunting, there are people and resources to support you.

For example, you can find a support group for people with Hashimoto’s, like Living with Hashimoto’s Disease. The comfort I received from knowing that there were others going through the same challenges as I, was enormous… and I highly recommend that you join such a group.

I also recommend finding practitioners who are knowledgeable in treating Hashimoto’s from a Root Cause approach. To help get you started, here’s a directory of recommended doctors.

As a final note, I want you to know that support is all around if you or a loved one is diagnosed with Hashimoto’s — you don’t have to battle this on your own. You’ve come to the right place. Here are some resources that I hope will help you or a loved one on your healing journey:


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  2. Vojdani A, Tarash I. Cross-Reaction between Gliadin and Different Food and Tissue Antigens. Food and Nutrition Sciences. 2013;4(1):20-32. doi:10.4236/fns.2013.41005.