Which stage of Hashimoto’s are you in?

Seven stages of an underactive thyroid condition

by Dr. Vedrana Högqvist Tabor

Hashimoto’s is a lifelong and progressive autoimmune disease. It starts quietly, usually long before you were or will be diagnosed, and develops slowly. There are several stages of Hashimoto’s.

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1. Initiation

This is the very first stage, the start of Hashimoto’s. At this stage, on a molecular level, your immune system starts making molecules that will mistakenly recognize part of the thyroid gland as a foreign body and start destroying it.

This is happening on a small scale, and you mostly won’t feel any symptoms related to an underactive thyroid. You might experience problems with digestion because your gut is where most of the immune cells are made. Leaky gut is described in depth in this other post.

At this stage, your thyroid is still close to fully functional. That means TSH blood tests will not be sensitive enough to reveal Hashimoto’s. If you are tested for thyroid antibodies (TPO or TG), get a thyroid ultrasound or have a biopsy, your doctor might diagnose you with Hashimoto’s.

This stage can take several years, and it is the best stage for diagnosis, because you can follow a healthy lifestyle and prevent Hashimoto’s from reaching stage 2.

2. Expansion

At this stage, immune cells start increasing in number and efficiency, working faster to destroy bigger portions of your thyroid gland.

You might start feeling a few early symptoms, such as fatigue, hair loss, or sensitivity to cold.

You might get a swollen neck during flare ups and you might feel more symptoms or higher intensity of symptoms after certain foods, stress, or colds.

Your TSH will most likely still be in the normal range, while your fT4 level may be slightly lower than it was before.
This stage might take a few months or years, but in certain cases it might take only a few weeks.

If diagnosed at this stage, you have a great chance to keep your thyroid gland sufficiently functional and altogether avoid taking medications by following a healthy lifestyle.

3. Full blown disease

This stage is usually the tipping point for your thyroid health. You will likely start feeling increasingly tired, and you might start experiencing many other symptoms with an increasing frequency and intensity.

A blood test of thyroid hormones will show that your TSH is elevated. Depending on the country or lab where it was done, your doctor might prescribe therapy with thyroid hormone replacement, the most common one being T4 (levothyroxine). If your values are only slightly shifted, your doctor might prescribe expectant management, meaning you will be regularly monitored for any changes in thyroid hormone levels, and be prescribed medication once your thyroid blood values are clearly out of the “normal” zone.

If diagnosed at this stage, you still have a very good chance to keep your thyroid gland highly functional with minimal medication, or altogether avoid taking medication by implementing and following a healthy lifestyle. Certain symptoms might stay, and you might need to work harder to get back to your balance. If you want to know more, here are some tips on what to do.

4. Medicated Hashimoto’s

This is the stage when the majority of people are diagnosed with Hashimoto’s. At this stage, thyroid function is not sufficient to produce enough T4 and T3 for daily body function.

To compensate for the loss of thyroid function, your doctor will increase the dose of synthetic thyroid hormones. Most people usually start with the lowest dose of T4 and as they age, this dose ramps up.

It is crucial to have enough thyroid hormones in the body to complete some of the basic body functions, such as metabolism, brain function, and body temperature regulation. This is why it is important to take thyroid medication if your own thyroid cannot produce enough. At the same time, balancing thyroid hormones will not do much to prevent the immune system from further destroying the thyroid gland. This can be managed by living a healthy lifestyle.

5. Medicated and lifestyle-managed Hashimoto’s

At this stage, you will need to adjust your lifestyle in order to manage your weight and your flare ups, as well as to keep Hashimoto’s at bay.

Maintaining a healthy weight will help prevent heart and bone problems, as well as some other health issues.

6. Putting the brakes on the disease

At this stage, by following a healthy diet and exercise routine, one can halt further disease progression. This is what many people refer to as “reversion”. It is important to know that the autoimmune condition can indeed be blocked, but it will not be reversed. This means the moment you stop following the healthy lifestyle, the condition will be triggered again.

An underactive thyroid can be fixed to a certain extent. The thyroid as a gland has some regenerative potential, but it is notoriously slow at regenerating (1,2). It might take months and years, especially if large portions of the thyroid are already destroyed.

7. Preventively managing Hashimoto’s

This stage is for life.

You need to avoid all of the triggers you have discovered that work against your thyroid. The immune system is a bit tricky, and it might happen that after some time other foods start causing flare ups. The good news is at that stage, you will know your body so well that you will be able to recognize the signs early on.

Good to know

We are all different, and many of the triggers of flare ups that you experience, the majority of others might not. Luckily, there are some common triggers that might help you on your path to health. According to our research:

  • Wheat (including gluten) causes problems to 7 in 10 people
  • Dairy (milk, yogurt) causes problems to 5 in 10 people
  • Soy causes problems to 3 in 10 people
  • Alcohol causes problems to 3 in 10 people
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If you have any of the following, you are at a higher risk of developing Hashimoto’s

  • 5 in 10 people had low vitamin D levels before diagnosis
  • 5 in 10 people had at least one family member diagnosed with Hashimoto’s
  • 6 in 10 people had at least one family member diagnosed with any other autoimmune disease
  • 6 in 10 people diagnosed with Hashimoto’s were born in spring months.
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You can track your symptoms with the Boost Thyroid app and learn more about your body and thyroid.