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Have you been recently diagnosed with Hashimoto’s disease or an underactive thyroid? Welcome to the club!  

Hashimoto’s is a common autoimmune condition that is the primary cause of hypothyroidism – an underactive thyroid – in the United States, and millions of people are living with these conditions across the globe.

Being diagnosed with a thyroid condition like Hashimoto’s or hypothyroidism can be overwhelming, so if you’ve just joined the club, it’s essential to know what to expect and how to manage these conditions. This article shares 13 crucial things you should know about Hashimoto’s or hypothyroidism to help you better understand and manage your thyroid condition for optimal wellness. 

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1. Understand the basics of hypothyroidism and Hashimoto’s

It’s important to have at least a basic understanding of hypothyroidism and Hashimoto’s disease as a foundation.

Hypothyroidism is a condition in which the thyroid gland does not produce enough hormones, leading to various symptoms. Hypothyroidism is more common in older adults, especially women over age 60. In adults, hypothyroidism can develop due to autoimmune disease, iodine deficiencies, certain medications, and surgical or radioactive iodine treatments – for an overactive thyroid (hyperthyroidism), thyroid cancer, goiter, or nodules – among other causes.

Some common symptoms of hypothyroidism include tiredness, sensitivity to cold, weight gain, constipation, depression, brain fog, muscle aches and weakness, dry and scaly skin, brittle hair and nails, hair loss, loss of libido, pain, numbness, and tingling sensations in the hand and fingers, and irregular periods or heavy periods.  

The diagnosis of hypothyroidism is based on clinical symptoms and laboratory tests.

The Thyroid Stimulating Hormone (TSH) test measures a pituitary hormone that regulates thyroid hormone production. A TSH level above the reference range indicates hypothyroidism. Circulating levels of thyroid hormones thyroxine (T4) and triiodothyronine (T3) that are low or low-normal can also indicate hypothyroidism.

Treating hypothyroidism involves restoring thyroid levels to normal and relieving symptoms with thyroid hormone replacement medication.

Hashimoto’s thyroiditis is an autoimmune disease that affects the thyroid gland. When you have Hashimoto’s disease, your immune system produces antibodies that mistakenly attack and destroy thyroid cells. Over time, the destruction of thyroid cells results in an underactive thyroid. Hashimoto’s is the most common cause of hypothyroidism in the United States.

Because of the resulting hypothyroidism, Hashimoto’s symptoms mirror those of an underactive thyroid. Because Hashimoto’s involves inflammation of the thyroid gland, patients can also have goiter (enlargement of the thyroid gland), discomfort in the neck or throat, and lumps or nodules in the thyroid.

Hashimoto’s is typically diagnosed by a complete thyroid panel that includes TSH, Free T4, Free T3, and the most critical test – thyroid peroxidase (TPO) antibodies. Elevated TPO antibodies are typically evidence of Hashimoto’s disease.

Hashimoto’s thyroiditis with hypothyroidism is treated with thyroid hormone replacement medication.

Hashimoto’s thyroiditis without evidence of hypothyroidism is often just monitored without treatment. Monitoring is essential, however, because having Hashimoto’s puts you at an increased risk of developing hypothyroidism over time.

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2. Be patient – getting it right can take time

Once diagnosed with hypothyroidism, you’ll most likely be prescribed thyroid hormone replacement medication to compensate for your lack of sufficient thyroid hormones.

The choice of thyroid hormone replacement medication is ideally a decision between you and your health care provider. Levothyroxine (synthetic thyroxine/T4) tablets are typically the first line of treatment and work well for many thyroid patients.

Patients who have allergies to fillers and other inactive ingredients or gastrointestinal conditions that affect absorption may be prescribed a liquid form of levothyroxine for better response.

Sometimes, liothyronine (synthetic triiodothyronine/T3) is prescribed as an addition to the T4 treatment.

Another option is porcine natural desiccated thyroid (NDT) drugs, a natural thyroid medication that includes both T4 and T3 hormones from pigs.

Whichever thyroid hormone replacement drug is prescribed, your healthcare provider will decide on an initial dose based on the following: 

• Your body weight 
• Your TSH levels
• Your Free T3 levels
• Additional health conditions you might have
• Your age
• Whether you’re pregnant

Your provider typically starts with a low dose and increases by increments every 6 to 8 weeks, depending on your bloodwork and symptoms.

On average, it takes three rounds of dose adjustments to reach the optimal dose (6, 7). In the best-case scenario, it typically takes around four months after starting treatment for thyroid levels to normalize.

3. You may need medication adjustments

If you continue to experience symptoms even after your bloodwork shows thyroid levels in the normal range, you should talk to your healthcare provider about your treatment options.

For example, if you have allergies or sensitivities to one brand or generic levothyroxine, you may do better switching to another brand that doesn’t include the problem fillers, dyes, and inactive ingredients.

You can also ask to have your free triiodothyronine (Free T3) tested. This test may reveal low or low-normal levels of the active thyroid hormone. In this situation, you may benefit from the addition – or an increased dosage – of liothyronine to help normalize T3 levels.

Some patients also report better symptom relief when taking NDT drugs versus synthetic thyroid medication.

You may also need a dosage adjustment if:

• you experience a significant change in body weight (e.g., weight gain or loss of more than 10 pounds)
• you start or stop a high-fiber diet
• you start experiencing signs of thyroid hormone overtreatment, such as excessive sweating, heart palpitations, hand tremors, anxiety, or weight loss

Also, keep in mind that if you’re taking generic levothyroxine, you may have fluctuations in thyroid levels and symptoms. Different generic levothyroxine tablets have different potencies, ranging from 95 to 105% of the stated potency of the tablet. When you get refills of generic levothyroxine, your pharmacy is free to switch from one manufacturer to another. The potency differences between the generics can lead to fluctuating thyroid levels and changes in your symptoms. The solution is staying on brand-name levothyroxine – or ensuring you always get the same generic from your pharmacy.

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Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.

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4. Take your medications the right way, regularly

It’s essential to take your medication consistently and at the same time of day. Typically, your health care provider will recommend taking your thyroid medication in the morning, on an empty stomach, an hour before eating or drinking anything besides water. (This includes regular and decaf coffee!) You should also wait an hour before taking any supplements or medications. 

For supplements and foods that contain iron or calcium, you should wait at least three to four hours after taking your thyroid medication.

You also can discuss with your provider whether to take thyroid medication at bedtime. Taking your thyroid drugs at night can enhance absorption and give you the freedom to eat, drink, and take medications and supplements first thing in the morning.

If you’re taking a T3 drug like liothyronine (Cytomel) or natural desiccated thyroid, talk to your healthcare provider about whether you should take a divided dose. Because T3 is fast-acting, dividing your dose can help smooth out peaks and valleys in your T3 levels and prevent overstimulation from the T3.

For more information, read How And When To Take Your Thyroid Medication.

5. Test regularly and know your numbers

After you start your thyroid condition, it’s crucial to test your thyroid regularly.

While you’re still adjusting and optimizing your thyroid levels, some experts recommend testing at least every three months. Once you reach optimal thyroid levels, you should have a complete thyroid panel every six months.

(Note: The Paloma Complete Thyroid Test kit is an easy, affordable, and convenient way to test your thyroid – TSH, Free T4, Free T3, and TPO antibodies – from home. You can also add testing for Reverse T3 and Vitamin D levels.)

6. Keep track of your symptoms and test results

It’s important to keep track of your hypothyroidism symptoms and any changes you experience over time. Keeping track of symptoms can help you and your healthcare providers identify patterns and determine if the symptoms are sufficiently treated, so you can adjust as needed. In addition, symptom tracking can empower you and give you greater control over your chronic health condition.

In addition to regular testing, it’s also important to track your test results. This gives you an overview of your condition over time and can help you identify your optimal thyroid levels based on symptoms.

Whether you track paper copies of your test results, keep a spreadsheet or electronic copies, or use a tracking app like Paloma’s thyroid symptom tracker, having a birds-eye view of your thyroid test results is powerful information that can play a key role in your thyroid wellness.

7. Stay physically active

Being physically active can help individuals with hypothyroidism manage fatigue, weight gain, and joint pain. However, it’s best to engage in low-impact activities that minimize stress on joints such as the knee, hip, or back and not over-exercise, which can worsen fatigue.

Some healthy options include yoga, Pilates, walking, swimming, and biking. Strength training can also be beneficial for building muscle and counteracting the effects of hypothyroidism on weight gain.

For more information, read Exercise Fundamentals For Thyroid Patients.

8. Pay attention to nutrition and diet

There is no single “best diet” for hypothyroidism and Hashimoto’s. Determining the best way to eat for your thyroid condition depends on several factors, including:

• Your food allergies and sensitivities
• Whether you need to lose weight
• Other conditions, such as diabetes 

Here are a few things to keep in mind:

• There’s evidence that gluten can aggravate autoimmune diseases like Hashimoto’s, and a gluten-free diet may help reduce antibodies and hypothyroidism symptoms in some patients.
• Hashimoto’s patients report improvements in antibodies, inflammation, and thyroid symptoms when following a specific Autoimmune Protocol (AIP) diet. (Note: Paloma’s free thyroid app includes a multi-week AIP program for thyroid patients.)
• Generally, a healthy diet for hypothyroidism should focus on anti-inflammatory foods, lean proteins, minimal intake of processed foods and sugar, and, whenever possible, incorporate organic foods free of hormones, pesticides, and genetic modifications.

9. Take needed supplements

Some better-known and well-researched supplements for thyroid health are iodine, selenium, vitamin D, vitamin B complex, and zinc. A good balance of each of these supplements can help ensure that the thyroid not only produces enough T4 but converts it to T3 and that the thyroid hormone can reach the body's cells. 

Note: Paloma’s Daily Thyroid Care supplement is an easy way to get the critical nutrients needed for optimal hypothyroidism and Hashimoto’s care.

10. Build a partnership with your doctor

Thyroid patients often need to work closely with their doctors to manage their condition effectively. Whether you have hypothyroidism or Hashimoto’s, building a productive partnership with your doctor is essential.

Here are some tips on how to build a productive partnership with your doctor as a thyroid patient:

Do Your Research: Before your appointment, do some research – from reliable sources – so that you can better understand what questions to ask your doctor.

Make a List of Questions and Concerns: Prepare a list of questions and concerns to discuss with your doctor during your scheduled appointment. Prioritizing your list of questions is particularly important, as, like many thyroid patients, you likely have many concerns about medication management, side effects, diet and exercise guidelines, and long-term health implications. Write down your questions and have them available during your appointment. Pro tip: Discuss the most critical issues first, so you have enough time to address them.

Communicate Openly and Honestly: Be open and honest with your doctor about your symptoms, medication regimen, and any personal or family health history that may affect your thyroid condition. This will help your doctor to make more informed decisions regarding your treatment plan. Don’t be afraid to ask your doctor to explain any medical terms or instructions you do not understand, and take notes to help you remember important details after your appointment.

Create a Treatment Plan Together: Your doctor will likely recommend a treatment plan based on your individual needs and medical history. However, it is vital to work together to develop a realistic and manageable plan for you. Discuss your concerns or challenges with your doctor and work together to adjust your plan as necessary.

Follow Up and Stay Informed: After your appointment, follow up on any recommendations made by your doctor and keep track of any changes in your symptoms or side effects. Stay informed on the latest developments in thyroid care and treatment options, and keep an open line of communication with your doctor regarding any concerns or questions you may have.

11. Manage your stress

Stress is one of the environmental triggers of autoimmune diseases, and chronic, unrelieved stress can worsen the symptoms of hypothyroidism and Hashimoto’s. It’s essential to find a physiological stress-reducing activity and practice it daily. Effective stress management can:

• Reduce depression and anxiety
• Reduce food cravings
• Improve your immune health
• Reduce blood pressure
• Improve sleep
• Improve hormonal balance
• Reduce mental and physical fatigue

Effective stress management practices can include meditation, breathwork, gentle yoga, Tai Chi, Qi Gong, playing a musical instrument, or needlework and crafting, among other activities.

For more information, read What’s Stress Got to Do With It?

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12. Get enough sleep

Ensuring you’re getting enough quality sleep – ideally, from 7 to 9 hours per night – is crucial to help support your health.

Insufficient sleep can have a range of adverse health effects, including:

• Lack of alertness and focus
• Excessive daytime sleepiness
• Impaired memory and cognitive function
• Impaired insulin sensitivity
• Increased cravings for sugar and carbohydrates
• Increased appetite
• Reduced immunity

Chronic sleep deprivation can also increase the likelihood of chronic health problems such as heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, depression, anxiety, and dementia.

For more information, read Sleep And Hypothyroidism.

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13. Get support and share the journey!

Many people living with an underactive thyroid and Hashimoto’s are willing to share their knowledge, experiences, and advice. Connecting with them in a support community can be critical to your wellness journey.

Paloma’s free thyroid community is an empowering space where you can ask questions, interact with other thyroid patients, and learn about your condition.

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Thyroid testing is an ever-present part of a new thyroid patient’s journey to wellness. One way to make that easier is with the convenient Paloma Complete thyroid test kit, which makes it easy to monitor your progress with regular blood tests from home. While many labs only look at Thyroid Stimulating Hormone (TSH) to assess thyroid function, Paloma Health’s test kit also measures Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). You can also add on Reverse T3 and Vitamin D testing.

A diagnosis of hypothyroidism or Hashimoto’s becomes less daunting when you get your thyroid care from Paloma Health. Paloma specializes in comprehensive diagnosis and treatment of Hashimoto’s and hypothyroidism. Virtual visits with our team of trusted thyroid care providers will ensure you get expert care for every aspect of your thyroid health.

With Paloma Health, you can get your blood tests, virtual visits, medical guidance, thyroid hormone prescriptions, and personalized care – all from your home!

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Vedrana Högqvist Tabor, Ph.D., contributed to this article.