Smitha Nair M.D.

The Five Stages of Hashimoto’s

Hashimoto’s is characterized by inflammation of the thyroid gland and high levels of antibodies against thyroid enzymes.

Once diagnosed with Hashimoto’s, you are at a greater risk for other autoimmune diseases such as type 1 diabetes, celiac disease, multiple sclerosis, rheumatoid arthritis, Crohn’s disease, lupus, Addison’s disease, vitiligo, pernicious anemia and many others.

Keep in mind that you may start off with a different autoimmune condition, such as celiac disease, and then it can progress to Hashimoto’s.

If you are diagnosed with Hashimoto’s before you are diagnosed with hypothyroidism, this gives you the chance to identify the underlying reason for the immune system’s attack on the thyroid. That’s why early diagnosis is so important.

Below are the five stages of Hashimoto’s. If you aren’t feeling well and identify with any of the stages, it is advised that you get yourself tested.

  • Stage 1 – At this stage, people only have the genetic predisposition to develop Hashimoto’s and don’t have any manifestations of the condition. The thyroid function is still optimal with no evidence of an immune attack on the gland.
  • Stage 2 – It’s this stage that is the beginning of the autoimmune attack on the thyroid. A patient can be highly symptomatic at this point with anxiety, fatigue, miscarriage/infertility, mood swings, excess weight or weight loss symptoms.

    And even at this early stage, it’s been found that there is always impaired gut wall function.

    But, if advanced testing is not done, people may be diagnosed with anxiety or depression. You may need to ask your doctor to order the advanced testing.

    In this early stage of Hashimoto’s, a person will usually have elevated thyroid antibodies. Up to 80-90% may show an elevation of thyroid antibodies when tested in blood, thyroglobulin antibodies, and thyroid peroxidase antibodies, respectively.
  • Stage 3 – At this stage tests may show an elevated TSH but the conventional approach may be a watch and wait approach. This stage is also known as subclinical hypothyroidism.

    Studies have shown that adding a small dose of thyroid medication at this stage to lower the TSH results in a reduction of thyroid antibodies and can also make a big difference in your symptoms.

    Most progressive, integrative, and functional medicine physicians will often recommend thyroid hormone treatment at this stage. At this stage, it may be possible to balance the autoimmune attack response and wean yourself off thyroid medication under a doctor’s supervision.

    Preventing further damage is possible at this stage by making lifestyle changes and looking at the root cause of this autoimmune condition. It is still possible to reverse the condition!
  • Stage 4 – Overt thyroid gland failure is involved. At stage 4 the thyroid cannot make enough hormone and is not able to compensate due to advanced thyroid damage. Elevated TSH and low levels of T3 and T4 will be seen on thyroid tests. This is the stage that many people will be given a prescription for synthetic thyroxine such as levothyroxine (Synthroid, Levoxyl, and others).

    Medication is required at this stage to prevent serious health consequences.

    Lifestyle changes and getting to the root cause are critical at this stage. By Stage 4, it’s likely that you’ve had an inflammatory process in your body for almost a decade so you will need to take on the most aggressive treatment.
  • Stage 5 – This is the last stage of Hashimoto’s which causes the progression to additional autoimmune diseases such as lupus, rheumatoid arthritis, Sjorgren’s, psoriasis, and others.

    A recommendation at this stage may be to remove your thyroid gland. However, removing the thyroid gland will eliminate thyroid antibodies, but unfortunately, will not stop the autoimmune progression.

If you have one autoimmune disease, it will put you at risk for others. This is why addressing the root cause is so important. Taking synthetic thyroxine, alone, may not get you back to feeling your best. Your goal is to slow down, reduce and even eliminate the autoimmune attack on your thyroid.

If you are taking synthetic thyroxine and still not feeling your best, you might benefit from also adding a complementary approach along with your medication. A functional medicine practitioner can help you understand how a complementary approach can benefit you and guide you through it. This would include some lifestyle changes as well as changes to your diet.

For all of you who are struggling with feeling their best, there is help and there is hope.

To schedule your appointment with functional medicine practitioner Dr. Nair, MD, click here.