iThei mdcdaelcinfd o c elllllrlllll tThe hlcinfd olsbdkpvouvCo-Occurring Conditions
Hashimoto’s may be associated with other autoimmune diseases such
as type 1 diabetes mellitus, multiple sclerosis, rheumatoid arthritis,
celiac disease, lupus, Addison’s disease, pernicious anemia, and hy-
poparathyroidism. Polyglandular autoimmunity is a medical term
used to describe when one person has two or more autoimmune
conditions.^1
DIAGNOSIS
Tests for Hashimoto’s
Thyroid ultrasounds and blood tests are used to diagnose Hashimoto’s.
Laboratory tests are available to check thyroid function and autoim-
mune thyroid markers. If we were to perform blood tests in advanced
untreated Hashimoto’s, we would find an elevated TSH and low lev-
els of T3 and T4. Thyroid antibodies are also found in most cases
of Hashimoto’s.
Screening Test
TSH is used as a screening test for thyroid function, but this test does not
always catch thyroid abnormalities. TSH does not become permanently
elevated until the Hashimoto’s is advanced. Thus, people may have a
normal TSH for years while experiencing unpleasant thyroid symptoms.
They will present to their physicians with complaints of weight gain,
fatigue, and other symptoms and will be told their thyroid tests are nor-
mal. TSH levels can fluctuate throughout the day, however, and the body
often compensates by shifting energy away from metabolism and other
body functions.
Untreated hypothyroidism eventually results in an abnormally elevated
TSH. In contrast, untreated hyperthyroidism results in an abnormally
low TSH. A person with Hashimoto’s may fluctuate between the two
extremes and at time have “normal” readings.
This is because when the level of thyroid hormones is low, TSH is re-
leased to order the body to compensate and make more hormone.
When TSH is released, it signals the body to produce more hydrogen per-
oxide. Thyroid hormone production requires iodide from food to be oxi-
dized into iodine, a molecule that can attach to tyrosine and make thyroid
hormone. Hydrogen peroxide is required for this conversion. A reactive