Can hypothyroidism come and go?

Hypothyroidism, also known as underactive thyroid, is a condition where the thyroid gland does not produce enough thyroid hormone. Thyroid hormone is important for regulating metabolism and many other body functions. When levels of thyroid hormone are low, it can cause symptoms like fatigue, weight gain, feeling cold, and more.

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What causes hypothyroidism?

There are a few potential causes of hypothyroidism:

Hashimoto’s thyroiditis – This is an autoimmune disease where the immune system attacks and damages the thyroid. It is the most common cause of hypothyroidism in the United States.
Thyroid surgery – Removal of part or all of the thyroid gland can cause hypothyroidism.
Radiation therapy – Radiation treatment to the neck area for cancers like lymphoma can damage the thyroid.

Medications – Some medications like lithium and interferon alpha can prevent the thyroid from functioning normally.
Congenital hypothyroidism – Babies can sometimes be born with an underactive thyroid.
Iodine deficiency – Not getting enough iodine in your diet can lead to hypothyroidism.

Pituitary disorders – The pituitary gland produces TSH which signals the thyroid to make hormones. Problems with the pituitary gland can disrupt this signaling.

Does hypothyroidism fluctuate?

For many people, hypothyroidism is a chronic, lifelong condition. However, in some cases hypothyroidism can go through periods where symptoms improve or worsen. There are a few reasons why thyroid levels can fluctuate in certain individuals:

Hashimoto’s disease – With Hashimoto’s, the immune system attacks the thyroid in flares. During flare-ups, more thyroid tissue can be damaged which lowers hormone levels. In between flares, symptoms may improve.

Pregnancy – Hormone changes during pregnancy can impact thyroid function. Thyroid levels tend to decline during pregnancy and after giving birth.
Medication changes – If you are taking thyroid hormone replacement medication like levothyroxine, changes in your dose can affect your thyroid levels.
Dietary changes – Increased consumption of goitrogenic foods like soy, cruciferous vegetables, and certain nutrients like iodine and selenium impact thyroid function.

Other illnesses – Severe stress, infections, diabetes, and other conditions can temporarily increase or decrease thyroid levels.
Postpartum thyroiditis – After giving birth, some women experience inflammation of the thyroid gland which can first raise thyroid hormone levels and then lower them.

So in patients with certain underlying causes like Hashimoto’s or dietary triggers, hypothyroidism may come and go. However, for many patients hormone levels remain stable once on replacement medication.

Symptoms of fluctuating thyroid levels

If your thyroid levels are seesawing, you may notice your hypothyroidism symptoms worsening and then improving. Here are some signs that your thyroid hormone levels are fluctuating:

Fatigue – As levels drop, fatigue often increases. You may feel very tired even after ample rest.
Weight changes – Lower thyroid hormone can slow metabolism leading to weight gain. Weight loss may occur as levels rise.

Hair loss – More hair shedding and thinning hair is common with falling thyroid hormone levels.
Mood changes – Hypothyroidism can contribute to feelings of sadness or depression. Mood may lift when hormone levels improve.
Feeling cold – Body temperature regulation gets thrown off with inconsistent thyroid levels.

Constipation – Gastrointestinal motility slows during hypothyroid phases.
Brain fog – You may have trouble concentrating and remembering things clearly as thyroid levels decline.
Sleep disruptions – Fluctuating between hypo and hyper states can negatively impact sleep quality.

Pay attention to any hypothyroidism symptoms that seem to come and go. Track your symptoms and get your thyroid levels tested over time. This can help determine if you are dealing with shifting thyroid hormone levels.

Should I have my thyroid levels frequently tested?

If you suspect your hypothyroidism may be fluctuating or you have an underlying condition like Hashimoto’s, getting your thyroid hormone levels checked more regularly can be helpful. This allows you and your doctor to identify patterns and make medication adjustments as needed.

Here are some situations where more frequent thyroid testing is recommended:

Newly diagnosed hypothyroidism – Test every 4-6 weeks after starting treatment until levels stabilize.
Hashimoto’s thyroiditis – Test every 3-6 months to assess for changes.
Pregnancy – Test at the start of pregnancy and monitor as needed based on symptoms.

After giving birth – Test around 4-8 weeks postpartum.
Dose change – Recheck 4-6 weeks after any adjustment in thyroid medication dose.
Symptoms not improving – If hypothyroidism symptoms persist, recheck TSH and thyroid hormones.

For individuals whose hypothyroidism is well-controlled with medication and symptoms remain consistent, yearly testing is likely sufficient. But increase testing frequency if you notice your symptoms fluctuating.

Treatments for fluctuating hypothyroidism

If it appears your hypothyroidism is not consistent and your levels are rising and falling, there are a few treatment approaches your doctor may use:

Thyroid hormone replacement medication – Getting the right levothyroxine dose dialed in can help stabilize thyroid levels. Frequent testing guides dosage changes.

Immune modulating medications – For Hashimoto’s patients, medications like low dose naltrexone or plasmapheresis may help calm autoimmune flares.
Dietary modification – An elimination diet can identify trigger foods. Avoiding goitrogens may also help.
Stress reduction – Managing stress through yoga, meditation, psychotherapy etc. can help control flare-ups.

Treatment of underlying issues – Tackling other conditions like diabetes, nutrient deficiencies, or adrenal disorders may support thyroid stability.

While it can take some trial and error to find the right plan, getting to steady thyroid levels is possible. Work closely with your endocrinologist and let them know if you experience your hypothyroidism symptoms coming and going. Ongoing communication and testing allows you to stay on top of thyroid changes.

Can hypothyroidism resolve on its own?

In some scenarios, hypothyroidism may be temporary and thyroid function can recover down the line without treatment. Here are some cases where hypothyroidism resolves on its own:

Postpartum thyroiditis – Postpartum thyroiditis causes thyroid inflammation after pregnancy. For many women, hormone levels return to normal in 6-12 months.
Subacute thyroiditis – Caused by a virus, subacute thyroiditis involves painful thyroid inflammation but usually resolves as the infection clears.
Medication-induced hypothyroidism – Stopping medications like lithium or interferon alpha often restores normal thyroid function.

Dietary deficiency – An iodine or selenium deficiency can disrupt thyroid hormone production. Correcting the deficiency may resolve hypothyroidism.

However, for most patients with chronic autoimmune hypothyroidism or permanent thyroid damage, the condition is lifelong and requires thyroid hormone replacement medication indefinitely. Work with your doctor to determine what is causing your hypothyroidism to evaluate whether it may resolve on its own or not.

Takeaways

In some cases like Hashimoto’s disease, hypothyroidism can fluctuate between periods of worsening and improving symptoms.

Frequent thyroid lab testing helps detect changing levels so medication dosages can be adjusted accordingly.
Adjusting thyroid medication, managing triggers, and treating underlying issues can help stabilize thyroid function.
Certain short-term forms like postpartum thyroiditis may resolve on their own, but lifelong treatment is usually needed for chronic hypothyroidism.

Stay in close contact with your doctor if you suspect your hypothyroidism symptoms are coming and going so steps can be taken to regulate your thyroid hormone levels.