Diagnosed with Hashimoto's or an underactive thyroid?

Have you been recently diagnosed with Hashimoto’s or an underactive thyroid? Welcome to the club. You are not alone; there are millions of us living with this condition worldwide. Here are some information that will help you understand Hashimoto’s.


What is Hashimoto's?

Hashimoto’s is known under several names: Hashimoto’s disease, Hashimoto’s thyroiditis, autoimmune thyroiditis or chronic lymphocytic thyroiditis.

Hashimoto’s is a chronic autoimmune condition causing the thyroid gland to become underactive.
The thyroid is a small, butterfly shaped organ in the front part of your neck, producing hormones thyroxine (T4) and triiodothyronine (T3)controlling your metabolism and making it possible for every cell in your body to have enough energy to function.

In autoimmune condition your own immune cells by mistake attack and destroy your thyroid gland. This makes thyroid unable to produce enough, or in some cases any, hormones to ensure proper functioning of the body, and many of your body’s functions will slow down.

What are the symptoms of Hashimoto's?

Hashimoto’s is usually a slowly progressing condition, with no symptoms at first, and can go unnoticed for years. As the condition progresses, there are more symptoms showing:
Swelling of the neck, coming from enlargement of thyroid gland. This is called goiter. Swelling may come and go away, it is usually not painful, but may cause some discomfort when swallowing food or liquids.
Fatigue – feeling out of ordinary tired for no apparent reason and for a longer periods of time
Weight Gain
Sensitivity to cold – inability to tolerate cold, most often having cold hands or feet
Muscle and joint pain – pain coming from no apparent reason, not from a sports or other type of injury.
Digestive problems – ranging and often switching from constipation to diarrhea
Dry, itching skin and flaking nails
Losing hair
Problems with focus and/or memory
Irregular menstrual cycles and fertility problems

Why did you get Hashimoto's?

Hashimoto’s is caused by a combination of genes you inherited from your biological ancestors and the environment you live in, such as sun exposure, pollutants in the air, food you eat and your lifestyle.

How is Hashimoto's diagnosed?

Your doctor will ask you questions to assess your medical history and you will do a thyroid functional test, which is a simple blood tests.
By testing for the thyroid stimulating hormone (TSH), levels of free thyroxine (fT4) and free triiodothyronine (fT3) your doctor will determine if your thyroid is underactive. Your doctor will determine if you have Hashimoto’s by checking the levels of one or two antibodies for thyroperoxidase (TPO) and thyroglobulin (Tg).

In some cases, especially if you feel your neck is swollen, your doctor might check your thyroid gland by ultrasound.

How is Hashimoto's treated?

If your doctor determines your thyroid is not producing enough hormones necessary for your day-to-day functioning, you will be prescribed a medication to compensate for the lack of thyroid hormones.

The most common medication to prescribe is called Levothyroxine, and it exists under many brand names, most commonly Synthroid. It is a synthetically produced medication, and it substitutes for low T4 levels.

Initially, your doctor will closely monitor your thyroid hormone blood levels and changes in your symptoms every 6 to 8 weeks, and adjust your medication dose if necessary. Once your dose is established and your symptoms improved, your doctor will check you up every 6 months.

In case synthetic T4 therapy does not work for you, your doctor might prescribe you an alternative therapy, a combination of T4 and T3, which can be produced in the lab (synthetic) or is prepared from the animal thyroid gland (natural thyroid).

How to take medication

You might be recommended to take the medication in the morning, before you have eaten. The reason for this recommendation is because foods and certain other medications might interfere with the efficacy of Levothyroxine, if taken together.
In general, it is recommended to wait at least 30 minutes after taking the pill to eat, and to avoid taking supplements for about 4 hours.
You can opt in to take medication at some other time during the day, in that case it is good to make sure you take medication at least two hours after your last meal.

Health complications caused by Hashimoto's

The most common health complication of having Hashimoto’s is developing an underactive thyroid (hypothyroidism).
Other complications include high blood cholesterol levelsheart problems and developing other autoimmune diseases (such as Rheumatoid Arthritis, Crohn’s, Diabetes Type II etc).
Hypothyroidism can cause problems during pregnancy for both the mother and the baby. During the course of pregnancy your body will need more thyroid hormones to support growing baby, this is why it is important to tell your doctor you are pregnant as early as you can. In general, synthetic levothyroxine is marked safe to take during the pregnancy. To make sure your specific brand or your specific medication is safe, talk to your healthcare practitioner.


Understanding your condition & staying healthy

Soon, you’ll start noticing your symptoms can have different intensities and durations. Don’t panic! Read below for 11 actions you can immediately take to understand and manage your thyroid condition.


1. Log your symptoms and tests

As you start to understand your Hashimoto’s or underactive thyroid, it can be handy to use BOOST THYROID app to log your symptoms and your lab tests. This will give you a good and quantifiable overview of your health over time, and make it easier to talk to your healthcare provider about how your symptoms are changing, improving or worsening and how to further improve your health. For example, the symptoms you feel today might change or fully disappear, while you might start feeling a new symptom(s). Recording your lifestyle and uncovering health patterns can help you pinpoint potential origins of new symptoms, which is the key to keeping you healthy.

2. Take your medications on time

When you were diagnosed, it’s likely you were put on hormone replacement therapy. There are three types: Levothyroxine is a synthetic hormone thyroxine (T4) replacement, most commonly used as a first line therapy and effective for about 8 in 10 patients. Combined synthetic Levothyroxine and Liothyronine, thyroxine (T4) and triiodothyronine (T3), work well for people unable to produce the active hormone T3 out of T4. Lastly, natural thyroid preparations are obtained from pigs or cattle and contain a mixture of natural T3 and T4 (14–23).
While people can occasionally miss Levothyroxine without feeling a major impact, the effect of Liothyronine is similar to a caffeine shot, and you are likely to notice each missed pill.
When taking your medication you should follow a couple of simple rules maximize its effectiveness,
Take your medication on an empty stomach
Do not eat for 30–60 minutes after taking the pill
Do not take supplements within 4 hours of taking your medication

If you are taking additional medication, talk to your healthcare provider to find out if it is safe to take them together.

You can set reminders in BOOST THYROID so you never miss taking your medication.

3. Adjust your exercise routine

Being physically active is necessary to maintain both a healthy body and high spirits. If you have an underactive thyroid, over-exercising might lead to a drop in thyroid hormone levels. If you do high intensity or long duration strenuous exercise, either allow yourself a couple days break in between your sessions or reduce the intensity.

4. Find a balanced diet that works for you

Eating healthy is especially important if you have Hashimoto’s. Certain foods in particular may trigger your flare-ups. The trick is to know which foods and in which amounts are triggering digestive and other issues. Fortunately, you don’t need to make up a diet on your own — many eating regimens have been shown to help Hashimoto’s symptoms. How do you know which one to try? Pick one diet and measure the impact to seIf if your symptoms decline. It’s your choice from the bunch: autoimmune protocol, specific food group exclusion diet, the whole30, dairy free and many more.

5. Know if you should take supplements & which to take 

When searching online, you’ll inevitably run across ads for different supplements. It’s true that the thyroid needs certain vitamins and minerals in order to maintain its function, and at times our bodies may lack some necessary vitamins and minerals because of diet, lifestyle or our geography.
Some of the better known and researched supplements are iodine, selenium, vitamin D, vitamin B complex, omega 3 and zinc. A good balance of each mineral will ensure the thyroid not only produces enough hormone T4, but that both T4 and T3 can help each cell of the body to use the energy needed for its basic biologic processes.
It’s good to talk to your doctor before taking any supplement. If necessary, your doctor can do a simple blood test to check the levels of each vitamin and mineral in your body.

6. Connect with support groups

There are many of us around the globe living with an underactive thyroid who are happy to share our knowledge and experiences. Many online groups provide excellent support — and some of them have a good dose of humor about what we experience. You can ask your healthcare provider about patient support groups in your vicinity, or go online and check for non-profit organizations or patient groups.

7. Learn about thyroid biology

The more knowledge you have about your thyroid, the more power you will have over your condition. Aim for scientifically backed, trusted information, like on, WebMD, the American Thyroid Association’s and our website.
When surfing the vast amount of information online, try to be critical and check for scientific references in any written piece you read. If you find some advice radically different than on the mainstream pages and believe it can help you, it’s important to talk to your doctor before following any of the recommended routines.

8. Build a trusting and respectful relationship with your doctor


You and your doctor are in for a long ride together, so it’s important to have an honest and respectful relationship where you feel heard and taken care of. Try to help your doctor by providing systematic descriptions of your symptoms and your lifestyle. This will reduce the time your doctor will need to figure out what is really going on.

9. Reduce stress and increase your happiness

Stress is one of the environmental triggers of autoimmune diseases. During high stress periods, both hormone balance and the immune system will change — and not for the better. Avoid stress, and work on feeling positive and happy about yourself. Start with tackling smaller grievances, and work towards the bigger issues. Remember to laugh, hug people and take it easy. Your body will say thank you by feeling better.

10. Listen to your body

We are all unique; perhaps symptoms you are experiencing have not been well researched or documented so far. That does not mean they are not real. They are, but you will need a bit more time and energy to get to the bottom of them with the help of your doctor. Also, if some things that worked for the others do not work for you, it’s also fine; we are all different. You will find your balance and your best zone by listening to your body and being in sync with it.

11. Set goals to improve your health, measure & visualise your progress

Changing habits and old ways takes time, but it is worth if it will result in you feeling better, healthier and happier. Set reasonable goals, perhaps not too ambitious, to avoid stressing yourself if you can’t follow through. Small steps and small improvements might be just enough to start this path.


Do you have any questions?
Ask us.


1. Warburton DE, et al. Health benefits of physical activity, 2006
2. Lankhaar JA, et al. Impact of overt and subclinical hypothyroidism on exercise tolerance, 2014
3. Ciloglu F, et al. Exercise intensity and its effects on thyroid hormones, 2005
4. Al-Hashem F, et al. Exhaustive exercise and vitamins C and E modulate thyroid hormone levels at low and high altitudes, 2012
5. Vojdani A. A Potential Link between Environmental Triggers and Autoimmunity, 2014
6. Pabst O, et al. Oral tolerance to food protein, 2012
7. Ch’ng CL, et al. Celiac disease and autoimmune thyroid disease, 2007
8. Jenkins DJ, et al. Effects of high- and low-isoflavone (phytoestrogen) soy foods on inflammatory biomarkers and proinflammatory cytokines in middle-aged men and women, 2002
9. Doerge DR, et al. Goitrogenic and estrogenic activity of soy isoflavones, 2002
10. Santin AP, et al. Role of estrogen in thyroid function and growth regulation, 2011
11. Manzel A, et al. Role of “Western diet” in inflammatory autoimmune diseases, 2014
12. Effraimidis G, et al. Alcohol consumption as a risk factor for autoimmune thyroid disease: a prospective study, 2012
13. Grosso G, et al. Nut consumption and age-related disease, 2016
14. Chalmers JR, et al. The synthesis of thyroxine and related substances. Part V. A synthesis of L-thyroxine from L-tyrosine, 1949
15. Hoffenberg R. Primary hypothyroidism, 1978
16. Cotton GE, et al. Suppression of thyrotropin (h-TSH) in serums of patients with myxedema of varying etiology treated with thyroid hormones, 1971
17. Gorman CA, et al. Comparative effectiveness of dextrothyroxine and levothyroxine in correcting hypothyroidism and lowering blood lipid levels in hypothyroid patients, 1979
18. Jonklaas J, et al. American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement, 2014
19. Wieringa WM, et al. 2012 ETA guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism, 2012
20. Kaufman SC, et al. Thyroid hormone use: trends in the United States from 1960 through 1988, 1991
21. Williams RH. The thyroid, 1955
22. Frawley TF, et al. Metabolic and therapeutic effects of triiodothyronine, 1956
23. Smith RN, et al. Controlled clinical trial of combined triiodothyronine and thyroxine in the treatment of hypothyroidism, 1970
24. Chung HR. Iodine and thyroid function, 2014
25. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc, 2001
26. International Council for the Control of Iodine Deficiency Disorders
27. Zimmermann MB. Iodine deficiency, 2009

28. Hess SY. The impact of common micronutrient deficiencies on iodine and thyroid metabolism: the evidence from human studies, 2010
29. Jameson JL, et al. Endocrinology adult and pediatric: the thyroid gland, 2013
30. Ventura M, et al. Selenium and Thyroid Disease: From Pathophysiology to Treatment, 2017

31. Sunde RA. Selenium, 2012
32. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids, 2000
33. Arthur JR. The role of selenium in thyroid hormone metabolism and effects of selenium deficiency on thyroid hormone and iodine metabolism, 1992
34. Rayman MP. Selenium and human health, 2012
35. World Health Organization, Food and Agriculture Organization of the United Nations. Vitamin and Mineral Requirements in Human Nutrition, 2004
36. Turker O, et al. Selenium treatment in autoimmune thyroiditis: 9-month follow-up with variable doses, 2006
37. Gartner R, et al. Selenium in the treatment of autoimmune thyroiditis, 2003
38. Nacamulli D, et al. Influence of physiological dietary selenium supplementation on the natural course of autoimmune thyroiditis, 2010
39. Mao J, et al. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency, 2016
40. Negro R, et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies, 2007
41. Rasmussen L. B., et al. Selenium status, thyroid volume, and multiple nodule formation in an area with mild iodine deficiency, 2011
42. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D, 2010
43. Muscogiuri, G. et al. Vitamin D and thyroid disease: to D or not to D? 2015
44. Howick MF, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline, 2011
45. Cranney C, et al. Effectiveness and safety of vitamin D, 2007
46. Adoring L, Intervention in autoimmunity: the potential of vitamin D receptor agonists, 2005
47. D’Aurizio F, et al. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases? 2015
48. Tamer G, et al. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid 21, 891–896, 2011
49. Kriegel MA, et al. Does vitamin D affect risk of developing autoimmune disease?: a systematic review, 2011
50. Schwalfenberg GK, Solar radiation and vitamin D: mitigating environmental factors in autoimmune disease, 2012
51. Niche Y, et al. Zinc metabolism in thyroid disease, 1980
52. Prasad AS. Clinical, endocrinologic, and biochemical effects of zinc deficiency, 1985
53. Prasad AS. Impact of the discovery of human zinc deficiency on health, 2009
54. Baltaci AK, et al. Opposite effects of zinc and melatonin on thyroid hormones in rats, 2004
55. Ertek S, et al. Relationship between serum zinc levels, thyroid hormones and thyroid volume following successful iodine supplementation, 2010
56. Garber JR, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association, 2012
57. Caturegli P, et al. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity Reviews, 2014