How to tell if you have Hashimotos | Integrative functional medicine blog

How to tell if you have Hashimotos

If your doctor says you have hypothyroidism, this can explain why you might be feeling like crap, experiencing crazy weight gain, and your hair might be falling out in clumps, or your scared to brush your hair for fear of pulling more out.

But how do you know if Hashimoto’s (the auto immune form of hypothyroid) is causing your hypothyroidism?
So glad you asked!

Hashimoto’s is an autoimmune disease, meaning the immune system is attacking and destroying the thyroid gland.

Hashimoto’s is responsible for more than 90 percent of hypothyroid cases. Chances are strong it’s the cause of your low thyroid function too.

Stay tuned to find out if your low thyroid is due to Hashimoto's or some other reason, such as toxins, adrenal fatigue, or possibly some other unlucky reason. Unfortunately, sometimes it does just happen. You know the saying, $#iT happens!

But if your doctor does not want to screen for Hashimoto’s or if you would like to be sure, here are some tips to help you figure out if you have Hashimoto’s hypothyroidism.

You may ask, "why doesn't my doctor want to know if I have hashimotos?"

The answer is simple my friend. Because they don't care!

No really, they dont. And it's not necessarily that they don't really care or care about you. It's that from a treatment point of view they don't care because it is not going to change the treatment that they give you. It won't change how they dose your medications if you get any. Nor will it change (most likely) what medication they give you. So from that perspective, it makes sense.

I sometimes tell my own patients the same thing, but in a much nicer way. They may ask about a certain test and I tell them that for right now, I don't care about that test because it wont change treatment at this point.


From a Hashimoto's perspective you should absolutely care because there are a ton of things you can do to help. But thats another topic. Well, maybe not another topic but a different subject of this topic. Back on track!

You feel worse despite taking your thyroid medication
One of the most common signs of Hashimoto’s is you still have symptoms despite taking your thyroid meds. Or maybe your meds dont make any difference at all in how you feel.

In fact, your doctor prescribes ever increasing doses as your thyroid function deteriorates. You may even notice no difference if you forget to take your meds. Why don’t thyroid meds help in many cases of Hashimoto’s? Because the immune system continues to attack and destroy the thyroid gland even though the meds may make your TSH levels look normal.

You swing back and forth between low thyroid and high thyroid symptoms
Swinging back and forth between under active and over active thyroid function is another common sign of Hashimoto’s.

One week you suffer from fatigue, headaches, constipation, depression, and low libido. The next week you have insomnia, a racing heart, anxiety, and tremors. This is because a flare up that damages thyroid tissue causes excess thyroid hormone to spill into the bloodstream. You may be misdiagnosed with anxiety or even bipolar disorder. Or God knows what other condition. Or even worse, maybe they tell you it's all in your head.

If you run blood tests during these surges and crashes you will see TSH also peaks and drops. TSH may even test as normal for short periods as its moves between these swings. This can lead to a misdiagnosis if you drew your blood during that time.

You have pernicious anemia, celiac disease, or other autoimmune diseases

Autoimmune diseases such as Hashimoto’s are the result of an imbalanced immune system. It’s very common for people with one autoimmune disease to develop more. This is because the imbalanced system becomes overly sensitive and loses tolerance to new tissues in the body. I tell this to all my patients, an autoimmune disease is not a disease of that system or organ (ie - thyroid, skin, nerves, etc.) it is a disease of the immune system that happens to attack that organ or tissues. And it can and most likely will spread!

If you have hypothyroidism and other autoimmune diseases, chances are you also have Hashimoto’s. Pernicious anemia (an autoimmune disease that causes B12 deficiency), celiac disease, or a gluten intolerance are all commonly linked to Hashimoto’s.

If you think you might have Hashimoto’s, see if any of these symptoms apply to you.

Under active thyroid symptoms
  • Feeling tired or sluggish
  • Feeling cold — hands, feet, all over
  • Require excessive amounts of sleep to function well
  • Weight gain despite adhering to a low-calorie diet
  • Gaining weight easily
  • Difficult, infrequent bowel movements
  • Depression and lack of motivation
  • Morning headaches that wear off as the day progresses
  • Outer third of eyebrow thins
  • Thinning of hair on scalp, face, or genitals, or excessive hair loss
  • Dryness of skin and/or scalp
  • Mental sluggishness
Over active thyroid symptoms
  • Heart palpitations
  • Inward trembling
  • Increased pulse rate, even at rest
  • Feeling nervous and emotional
  • Insomnia
  • Night sweats
  • Difficulty gaining weight
Confirming Hashimoto’s
Symptoms are important but a blood test provides the proof you may need to convince doctors or family members. Look for these markers: These are the tell-tale blood markers for Thyroid autoimmunity.

Thyroid peroxidase antibodies (TPO Ab). In most cases of Hashimoto’s the immune system attacks TPO, an enzyme that triggers thyroid hormone production.

Thyroglobulin antibodies (TGB Ab). You should also test for antibodies to TGB, which the thyroid uses to produce thyroid hormones.

Thyroid stimulating hormone antibodies (TSH Ab). This test can identify Graves’ disease (hyperthyroidism), although sometimes TSH antibodies can be elevated in Hashimoto’s. On lab tests, this marker is often labeled thyroid stimulating immunoglobulin (TSI). If your autoimmune thyroid condition is advanced, you have multiple autoimmune diseases, and/or you react to bioidentical thyroid meds but not synthetic, you may also have antibodies to T4 and T3.

When your test comes back negative despite massive symptoms
Don’t despair if your test comes back negative even though you have all the classic symptoms. Because the immune system and inflammation wax and wane, you may have had your blood draw during a time the immune system is not attacking the thyroid gland. However, if your test is positive this confirms Hashimoto’s hypothyroidism and that the immune system should be a target for therapy.

Knowledge is power, and you're just a little more powerful now. Dont forget that a thyroid test is not just TSH, there are generally 10 thyroid number I run and sometimes 11.

Managing Hashimoto's is about managing an autoimmune disease. A properly trained and certified Functional Medicine practitioner should be able to help. Psst ! FYI - we also do online consultations.

I'm Dr. Craig Mortensen
Be healthy, be happy!

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