Stages in Hashimoto’s
Stages in Hashimoto’s
Navigating Hashimoto's: Understanding and Embracing Every Stage
Living with Hashimoto's thyroiditis can feel overwhelming, especially when the path to diagnosis isn’t straightforward. My journey started similarly to many others – I was well on my way to Stage 4 when I was finally diagnosed with hypothyroidism. It took almost a year and multiple doctor visits to get a Hashimoto's diagnosis. Many doctors dismissed my concerns, saying, “We already know you have hypothyroidism, so it doesn’t matter if it’s Hashimoto’s.” One even added, “I’ll test the numbers, but I won’t diagnose or treat based on them; I treat based on TSH and T4.”
After finally receiving my Hashimoto's diagnosis, it took another year to find someone who would treat it as an autoimmune response attacking my thyroid – not just a thyroid disease. Through persistence, I found support and treatment that acknowledged the autoimmune nature of Hashimoto’s, allowing me to better manage my health.
For anyone navigating this journey, here’s an overview of Hashimoto’s stages to help you feel more empowered at each step.
Stage 0: Genetic Predisposition
The journey often begins quietly, sometimes years before symptoms appear. Knowing your family history and focusing on overall wellness can set a strong foundation.
It’s not until you combine your family history with other triggers such as EBV infection, other viral infections, major stressors in your life, exposure to chemicals or heavy metals, eating an unhealthy diet, not exercising enough, and so on, that you will then develop Hashimoto’s.
Stage 1: Immune Cell Infiltration
Stage 1 is immune cell infiltration of the thyroid gland. Despite the fact that antibodies are present in this stage, most people are NOT diagnosed in this stage.
Why?
Even though you have positive antibodies, the symptoms associated with this stage tend to be VERY mild and they are often not related to your thyroid. Such as low energy and feeling run down. Antibodies may develop long before symptoms arise. If you notice subtle changes or have a family history of thyroid issues, advocate for yourself and seek testing early.
Stage 2: Subclinical Hypothyroidism
This stage brings more noticeable symptoms like fatigue and brain fog, but diagnosis can still be tricky. Lifestyle adjustments can help at this stage – and remember, your body is worth listening to.
Here we see 2 very important markers on your thyroid lab tests. First is a RISE in TSH (this is never normal and means that something is wrong with the thyroid gland).
Second, a RISE in your thyroid antibodies
These two markers will also now be associated with the start of low-grade thyroid symptoms such as weight gain, fatigue, constipation, and mild hair loss.
Stage 2.5: Thyroid Hormone Fluctuation
In this stage, your thyroid may switch from hypo to hyper which can make diagnosis difficult.
One month you may experience weight gain and constipation and the other you may experience hot flashes, weight loss, and diarrhea.
Getting a diagnosis during this time can be confusing.
Stage 3: Overt Hypothyroidism
(+ Antibodies, Increased TSH, Decreased Free T3/Free T4)
As thyroid function begins to slow, symptoms like fatigue, brain fog, and weight changes become noticeable. While frustrating, this stage can be an opportunity to adjust lifestyle factors that may influence thyroid health. Nutrient-dense foods, mindfulness, and staying active are powerful allies.
The good news is that most people are finally diagnosed here, the bad news is that it’s very late in the disease. Around 10+ years or so have passed from stage 1 to stage 3 and getting a diagnosis has been hard.
If you remain untreated, you will experience significant weight gain, significant fatigue, significant hair loss, significant constipation, and so on.
Natural therapies can still effective in stage 3, you will need to be aggressive with them and they will sometimes require the help of medication.
If you catch Hashimoto’s in stage 1, you may be able to get by just going gluten or dairy-free.
By the time you get to stage 3, those lifestyle changes likely won’t cut it.
At this point you will need to make lifestyle changes such as the elimination diet, going gluten, dairy, and soy-free, or even low FODMAP or AIP.
Stage 4: Hypothyroidism
When thyroid hormone levels drop, daily symptoms may increase, from sluggishness to cold sensitivity. Many find relief through medications that help balance hormone levels. Consider exploring dietary and holistic practices that support your journey toward balance.
Hashimoto’s is an autoimmune Response. When you have one, you are more likely to develop another. If you fail to fix whatever was causing the immune dysfunction that started your Hashimoto’s in the beginning, your body may eventually start to develop antibodies to OTHER tissues.
If your body creates antibodies to gluten it’s Celiac disease.
If your body creates antibodies to destroy your joints it’s rheumatoid arthritis.
If your body creates antibodies to destroy your salivary glands its Sjogren’s.
If your body creates antibodies to destroy melanin in your skin its Vitiligo
and so on…
Treating your thyroid with medication alone at this point will NOT stop the progression of your autoimmune disease.
Stage 5: Myxedema (Severe Hypothyroidism)
While rare, being aware of this stage highlights the importance of treating Hashimoto's as an autoimmune condition. Stay proactive and prioritize self-care to keep your health in balance.
Once you are in this stage, your thyroid gland has atrophied and shrunk from the damage.
Sadly, once in this stage, the damage is irreversible and you have likely had Hashimoto’s for 20-30+ years.
It’s much harder to optimize thyroid hormone at this stage but it’s definitely still possible.
Embracing Your Hashimoto’s Journey
Hashimoto's can be challenging, but each stage offers an opportunity for greater self-awareness and healing. If you're advocating for your health or searching for the right support, know that you’re not alone. By sharing our stories, we can foster understanding and compassion on this journey.
What should you know?
Know your family history
Advocate for testing beyond TSH if you start to experience mild symptoms.
In range labs are NOT optimal labs and should not be treated as such.
Making lifestyle changes can stop and even prevent an autoimmune response from happening.
Medication does not have to be a life sentence if caught early enough and paired with the appropriate lifestyle changes.
If you develop additional autoimmune responses your Hashimoto’s is not being treated, it’s being medicated.
Lifestyle changes should expand beyond just food
If you are already in stage 5 lifestyle changes can still make a lasting impact.
