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Written by
Fiona Lim
Medically Reviewed by
Dr. Anshul Gupta

What Is Hashimoto’s?

Hashimoto’s disease, otherwise known as Hashimoto’s thyroiditis, is an autoimmune disease in which the immune system attacks healthy cells in the thyroid gland. The thyroid is an essential part of the endocrine system, which produces hormones that control growth, metabolism, and many other bodily functions. The cause of Hashimoto’s is poorly understood but there are factors that increase your risk of developing the disorder, such as genetics, lifestyle, and underlying infections or diseases. (Source)

How Is Hashimoto’s Diagnosed?

Symptoms of Hashimoto’s disease such as fatigue and weight gain may suggest hypothyroidism, but they are too nonspecific to be helpful in diagnosing the condition. It is also possible to go years without any noticeable symptoms while the disease slowly progresses. Thyroid hormone and antibody tests usually are needed to confirm a Hashimoto’s diagnosis. 

Thyroid hormones tested include:

  • thyroid-stimulating hormone (TSH)
  • TSH is released by the pituitary gland to stimulate the thyroid to produce its hormones. An abnormal TSH suggests the thyroid is not functioning properly.
  • thyroxine (T4)
  • The main thyroid hormone, T4 is usually evaluated in tandem with TSH — a high TSH and low T4 indicates hypothyroidism, and a low TSH and high T4 indicates hyperthyroidism. 
  • triiodothyronine (T3)
  • Produced by the thyroid in smaller amounts than T4, T3 is more often used to help diagnose hyperthyroidism than hypothyroidism. Integrative and functional health practitioners put a greater emphasis on T3 testing.

Thyroid antibodies tested include:

  • thyroid peroxidase antibodies (TPOAb)
  • Thyroid peroxidase (TPO) is a thyroid enzyme that is critical to the production of thyroid hormones. Positive TPO antibody levels suggest the presence of autoimmune thyroid disease, either Hashimoto’s (hypothyroidism) or Graves’ (hyperthyroidism).
  • thyroglobulin antibodies (TgAb)
  • Thyroglobulin is a thyroid protein involved in production of thyroid hormones. Thyroglobulin antibody tests are generally done if TPOAb levels are negative but autoimmune thyroid disease is still suspected.

(Source, Source, Source)

What Does Being in Remission Mean?

Being in remission means that signs and symptoms of a disease have decreased or disappeared. For Hashimoto’s, remission includes relief from symptoms as well as achievement of normal thyroid antibody and hormone levels.

The range for what is considered “normal” and the units of measurement can vary from lab to lab, so it’s best to have repeat tests run at the same facility.

Typical values include:

  • normal TSH level: 0.35–4.5 mIU/L (milli-international units per liter)
  • TSH above this range indicates hypothyroidism. 
  • TSH below this range indicates hyperthyroidism. (Source)
  • normal free T4 level: 0.9–2.3 ng/dL (nanograms per deciliter)
  • Free T4 below this range with high TSH indicates hypothyroidism caused by autoimmunity (primary hypothyroidism).
  • Free T4 above this range with low TSH suggests primary hyperthyroidism, most commonly Graves’ disease. (Source)
  • normal free T3 level: 130–450 pg/dL (picograms per deciliter)
  • Free T3 above this range indicates hyperthyroidism, or other conditions where the thyroid is overactive.
  • Free T3 below this range indicates thyroiditis, with Hashimoto’s disease being the most common cause. (Source)
  • normal TPOAb level: below 9.0 IU/mL 
  • Having a positive TPOAb test means your TPOAb level is above 9.0 IU/mL and is generally associated with Hashimoto’s. 
  • Having a negative TPOAb test means that your TPOAb level is below 9.0 IU/mL. (Source)
  • normal TgAb level: below 4.0 IU/mL (international units per milliliter) 
  • Having a positive TgAb test means your TgAb level is above 4.0 IU/mL, which supports the diagnosis of Hashimoto’s.
  • Having a negative TgAb test means that your TgAb level is below 4.0 IU/mL. (Source)

What Can I Do to Manage Hashimoto’s?

Although Hashimoto’s is irreversible and cannot be cured, understanding the root causes that trigger symptoms and managing those triggers through dietary and lifestyle interventions may help you prevent onset of Hashimoto’s or achieve Hashimoto’s remission. 

  • Adopting a gluten-free, paleo, or autoimmune protocol (AIP) diet can help reduce inflammation and identify foods that trigger the immune system. (Source)
  • Supplementation with vitamin D may help slow down the progression of Hashimoto’s. Vitamin D deficiency, which is often found in people diagnosed with Hashimoto’s, is associated with greater severity of hypothyroidism. (Source, Source)
  • Minimizing stress, which affects the immune system both directly and indirectly, may help reduce susceptibility to thyroid autoimmune diseases. (Source)
  • Poor sleep quality has been found to be associated with hypothyroidism and increasing TSH levels. Getting enough quality sleep at night can help support your immune system and reduce your risk of developing Hashimoto’s. (Source)

Further testing with your health care provider should be considered if you have already made all of these changes and don’t see any improvements.

The Bottom Line on Putting Hashimoto’s Into Remission

Putting Hashimoto’s into remission may be achieved by targeting the root cause that triggers your symptoms. By managing those triggers, you may be able to achieve normal levels of thyroid antibodies and hormones, along with a decrease in Hashimoto’s symptoms.

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