Hashimoto's Treatment | Doctors & Treatment Information

Hashimoto’s disease is a chronic disorder of the thyroid gland. Experts also refer to it as thyroiditis, autoimmune thyroiditis, or Hashimoto’s thyroiditis, terms that describe the disease’s autoimmune-mediated, inflammatory nature.

An immune system disorder in which autoantibodies target thyroid tissue leads to inflammation.

Those affected hardly notice Hashimoto’s thyroiditis in its early stages. Over time, the progressive, subclinical inflammation leads to the destruction of thyroid tissue.

The thyroid no longer produces sufficient amounts of thyroid hormones, resulting in symptoms of an underactive thyroid (hypothyroidism). A severe flare-up of inflammation can lead to a short-term overproduction of hormones and hyperthyroidism.

If the thyroid gland atrophies due to chronic inflammation, the body lacks important hormones @ Dr_Microbe /AdobeStock

Since the exact cause of Hashimoto’s disease is unknown, there is no curative treatment.

The goals of Hashimoto’s treatment are:

• reducing inflammation to slow down organ damage, as well as
• replacing thyroid hormones (hormone therapy) in cases of reduced hormone production and symptoms of hypothyroidism.

For both, the doctor prescribes medication.

When functioning normally, the thyroid gland produces the hormone thyroxine (T4), which the body converts to triiodothyronine (T3). Patients take synthetic levothyroxine (L-thyroxine) in tablet form. The synthetic form is very similar to the T4 produced by the thyroid gland.

To regulate the endocrine system long-term, daily intake of the tablets is often necessary for life. Proper dosage adjustment is important, so the doctor must monitor the levels regularly.

Typically, the doctor will adjust the TSH (thyroid-stimulating hormone) level. In cases of hypothyroidism, T4 is usually too low and the TSH level is too high. During treatment, this ratio should reverse so that the T4 level rises into the reference range and the TSH level decreases. Avoid taking too high a dose of levothyroxine, as this can lead to bone loss and heart rhythm disturbances.

Thyroid diagnostics are used to classify symptoms and assess thyroid function.

These include:

• Ultrasound examinations
• Blood tests and
• Scintigraphy

Ultrasound examination of the thyroid @ Kalim /AdobeStock

In most cases, levothyroxine therapy can control symptoms and regulate hormone levels and metabolism. If there is no improvement, the doctor may consider combination therapy with levothyroxine and triiodothyronine (T4 and T3).

Although it is possible to reduce inflammation and regulate hormone levels, it is difficult to halt Hashimoto’s disease. Alternative medical approaches involve additional selenium supplementation to regulate immune processes.

The first follow-up visit usually takes place two to six weeks after the start of therapy. Depending on blood test results (TSH, free T4, free T3), the doctor may adjust the dosage. Once the condition is successfully stabilized, follow-up visits for Hashimoto’s treatment consist of blood tests and ultrasound examinations. These are performed at intervals of six or twelve months. When reviewing blood test results, the doctor checks hormone levels and thyroid antibodies (TPO-AK, Tg-AK). 

An increase in autoantibodies may indicate a flare-up of inflammation. With a thyroid ultrasound, the doctor examines the thyroid’s structure and size. Changes in echogenicity can also indicate inflammation. 

Enlargement may occur in cases of hyperthyroidism. As the disease progresses, or in cases of tissue destruction or hypothyroidism, the thyroid gland may shrink.

When treating Hashimoto’s disease with L-thyroxine, care must be taken to avoid interactions with other medications, dietary supplements, or foods.

Certain medications and some foods inhibit the absorption of the hormone. Therefore, patients must take it every four hours. Typically, the doctor recommends taking levothyroxine on an empty stomach after waking up, about half an hour before breakfast.

Medications and foods that interfere with absorption:

• Soy products and high-fiber diets
• Iron, calcium, or multivitamin supplements
• Antacids and Sucrabest
• Cholesterol-lowering medications

Also, avoid excessive iodine intake so as not to exacerbate the inflammatory response. The iodine that

people consume through food has virtually no effect. Supplementation in the form of tablets, on the other hand, is harmful.

During Hashimoto’s treatment, also watch for symptoms of hypothyroidism or hyperthyroidism. These are signs that your doctor needs to readjust your L-thyroxine dose. Since this is an immune system disorder, it is possible that other organs may also be affected. If you experience any relevant symptoms, be sure to get tested for other autoimmune diseases so that treatment can be started early.

Levothyroxine therapy has very few side effects. Hypersensitivity reactions to the excipients in the medications sometimes occur. In such cases, the doctor will prescribe L-thyroxine from a different manufacturer. Symptoms of hyperthyroidism may occur as a complication of treatment if the dose is too high.

Hormone supplementation, combined with a balanced diet that has a positive effect on inflammatory processes, slows the progression of the disease. Even in cases of complete thyroid dysfunction, hormone replacement therapy allows for a normal quality of life.

The goal of Hashimoto’s treatment is to reduce inflammation in the thyroid gland and to replace thyroid hormones in cases of hypothyroidism. Selenium supplementation also alleviates the autoimmune process that causes tissue destruction.

An endocrinologist or internist typically prescribes levothyroxine as a hormone replacement therapy, which allows for effective control of hormone levels. Anti-inflammatory medications are used in cases of severe inflammatory reactions. A healthy diet helps regulate inflammatory processes.