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The Link Between Hashimoto’s and Thyroid Dysfunction (Part 2)

Dr. Numan Niaz

2 min read

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Hashimoto’s disease, an autoimmune condition that gradually reduces thyroid hormone production via antibody attacks on the thyroid gland, is a lifelong condition, but can be successfully managed. Hashimoto’s and thyroid dysfunction are linked and can be treated using the following treatment options:

Hormone Replacement Therapy

Since thyroid hormone deficiency is the most likely outcome of Hashimoto’s, artificial hormones that are identical to the naturally produced Thyroxine (T4) hormone, i.e. Levothyroxine, is commonly prescribed in order to retain normal body functioning, specifically metabolism and cardiac function. Levothyroxine is usually taken in pill form and is a permanent treatment.

However, since levels of the Thyroid Stimulating Hormone (TSH), the most favorable determinant of thyroid dysfunction, are usually within the normal range in a thyroid function blood test during the initial stages of Hashimoto’s Disease, most doctors employ the ‘wait-and-see’ approach to observe whether hormone levels will rise or fall before beginning treatment. Yet numerous studies show that preventative low-dose Levothyroxine treatment in such cases slows, or even halts, the disease’s progression altogether.

Combination Therapy

While Levothyroxine treatment yields successful results in most patients, thyroid hormone balance and metabolic functioning may not be completely restored in certain individuals, particularly those who have undergone a thyroidectomy (surgical thyroid gland removal). For this purpose, some doctors may combine reduced doses of T4 (Levothyroxine) with small amounts of T3 (the converted form of T4 used by the body) medication. However, this combined-treatment is usually prescribed at an initial 3-6 month trial period, as it may result in excess T3 accumulation, causing sleep issues and heart rate acceleration.

Selenium Supplements

In addition to preventative Levothyroxine therapy, regular selenium supplements of 200 mcg per day may be able to decelerate the autoimmune attacks and prevent complete thyroid gland destruction by significantly reducing Thyroid Peroxidase Enzyme (the thyroid attacking antibodies) levels.

Dosage Monitoring

Since excess amounts of Levothyroxine can worsen or increase the risk of developing osteoporosis by accelerating bone loss, cause arrhythmias (abnormal heart rhythm disorders), or hyperthyroidism, patients are usually given a TSH-level blood test 6-8 weeks after first beginning treatment for determining adequate Levothyroxine dosage; which is then adjusted accordingly. New blood tests are required after every dose adjustment, which are then reduced to 6-monthly and yearly tests once the optimum dosage is determined.

Also, in order to allow the heart to adjust to the increased metabolism in patients with severe hypothyroidism or coronary artery disease, treatment is usually started and gradually increased from a lower to higher dosage.

Alternative medicine

The usual treatment for Hashimoto’s disease is levothyroxine, the synthetic form of thyroxine (T-4). However, extracts are available that contain thyroid hormone derived from the thyroid glands of pigs. These products — Armour Thyroid, for example — contain both levothyroxine and triiodothyronine (T-3).


  • Since different brands have different potencies, consult with your doctor before changing your hormone therapy brand to ensure that you’re still receiving the right dosage.
  • Do not skip doses or discontinue your medication in order to avoid a severe recurrence of symptoms.
  • Do not skip follow-up appointments as optimum medication doses may change over time.
  • While taking Levothyroxine before or after other medications and meals may help ensure the medication’s effective absorption, consult with your doctor if you take iron or calcium supplements or iron-containing multivitamins, Aluminum Hydroxide (an antacid), Sucralfate (ulcer medication), or Cholestyramine (a cholesterol-lowering medication), as they may interfere with Levothyroxine absorption.
  • While goiters usually require a few months to shrink with medication in those with swollen thyroid glands, the gland may have to be surgically removed if the goiter is very large or unresponsive to medication.
Preparing for the doctor’s appointment

The first step towards treatment will involve visiting your general physician. Upon checking the symptoms, he may refer your to an endocrinologist who specializes in treating thyroidal issues. 

The following section will discuss what you can expect during your appointment and how you can prepare for it to go well. 

What you can do
  • Make a list of the tell-tale symptoms you have observed; this means you should also include any problems you are facing that are unrelated to Hashimoto’s. Try and explain as many details as you possibly can including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make sure you remember your medications; make a list of any medications you are taking or have taken in the past. It will help if you can mention the specific dosage and the timeline of consumption. 
  • Take someone with you; this can help you calm any nerves. You can take a friend or family member who can also help you remember any detail you might forget. 

If you observe any unusual changes in your condition, or the condition fails to improve after a certain time, despite proper treatment, see with your Endocrinologist immediately. You can also book an appointment with a top Endocrinologist in Lahore, Karachi and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your thyroid concerns.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Numan Niaz
Dr. Numan Niaz - Author Dr. Nauman Niaz is a Internal Medicine Specialist practicing in Islamabad. Dr. Nauman Niaz has the following degrees: MBBS (Pb), MRCP (UK), FRCP (Glasgow), FRCP (Ireland), FRCP (London), FRCP (Edin), Ph.D (WA), Post Doc (Oxford) and has 24 years of experience.

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