Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that causes the immune system to attack and destroy the thyroid gland. This often leads to hypothyroidism, or underactive thyroid. Hashimoto’s is a progressive disease, meaning it tends to get worse over time. However, the rate and severity of worsening can vary quite a bit from person to person.
Gradual Progression
In most cases, Hashimoto’s disease progresses gradually over many years. The immune system slowly damages more and more of the thyroid tissue, leading to worsening hypothyroidism. This means thyroid hormone levels continue to decline, causing symptoms to become more noticeable. However, it may take months or even years for symptoms to worsen. It is not uncommon for someone with Hashimoto’s to have stable thyroid levels and symptoms for a while before seeing declines. The gradual progression of Hashimoto’s means routine monitoring of thyroid levels is important to detect worsening hypothyroidism.
Factors That Can Accelerate Progression
While Hashimoto’s tends to slowly get worse over decades, there are some factors that can accelerate its progression and lead to more rapid worsening of hypothyroidism:
- Pregnancy – The hormonal changes of pregnancy often cause Hashimoto’s to flare up and progress more quickly.
- Childbirth – The postpartum period after giving birth is another time Hashimoto’s often accelerates.
- Iodine excess – Consuming high amounts of iodine can exacerbate Hashimoto’s and speed its progression.
- Medications – Certain medications like interferon alpha, lithium, interleukin-2 can trigger Hashimoto’s flares.
- Infections – Bacterial and viral infections are associated with Hashimoto’s flares and worsening.
- Stress – Physical or emotional stress can accelerate Hashimoto’s progression.
- Smoking – Cigarette smoking is linked to faster progression of Hashimoto’s disease.
The triggers above do not always cause acceleration in Hashimoto’s disease, but in some people they are associated with periods of quicker progression and worsening of hypothyroid symptoms compared to baseline status.
Variation in Progression
It is important to understand that Hashimoto’s affects people differently. Some may have very slow and gradual worsening of their condition over 20+ years. They are able to mostly keep their symptoms in check with thyroid medication adjustments. Others seem to have a more volatile and unpredictable disease course, with flares causing significant changes in thyroid levels and symptoms from one year to the next. The reasons for these differences are not entirely clear but seem to involve individual genetics and environmental factors. So progression can vary greatly from one Hashimoto’s patient to another.
Periodic Flares
Many people with Hashimoto’s go through periodic flares, during which symptoms suddenly get worse for a period of time before improving again. Flares may occur in cycles of several weeks or months. Triggers often include infections, hormone changes, stress, and dietary indiscretions. Flares indicate the immune system has ramped up its attack on thyroid tissue, causing a temporary worsening of hypothyroidism. So while in the long run Hashimoto’s progresses gradually, people do experience periodic dips related to flares along the way.
Symptoms Tend to Compound
As Hashimoto’s progresses over years, the symptoms caused by hypothyroidism often compound and new ones can emerge. The mild symptoms in the early stages tend to gradually get more severe. For example, fatigue may go from mild tiredness to debilitating exhaustion. Joint aches might turn into pain that impairs mobility and quality of life. Weight gain accelerates. Constipation and stomach issues get worse. In addition, new symptoms like hair loss, dry skin, brain fog, depression, and infertility may show up after several years.
Impact on Thyroid Hormones
The gradual destruction of thyroid tissue by the immune system causes declining levels of thyroid hormones T4 and T3 over time. The following generally occurs with disease progression:
- T4 (thyroxine) decreases slowly over many years.
- T3 (triiodothyronine) levels remain normal at first as the body compensates but eventually decline.
- Thyroid stimulating hormone (TSH) steadily rises, indicating more stimulation is needed for the thyroid.
- Thyroid antibodies like TPOAb and TgAb rise significantly over time.
Falling T4 and T3 coupled with rising TSH signals worsening hypothyroidism. The higher thyroid antibodies confirm the immune attack on the thyroid is progressively destroying it.
Need for Medication Adjustments
As Hashimoto’s gets worse, the dose of thyroid medication often needs to be increased to keep up with the declining hormone output from the thyroid gland. The synthetic thyroid hormone levothyroxine is the typical medication used. Most patients start at a low dose like 25 or 50 mcg. Over the years as their thyroid function decreases, the dosage might need to be incrementally increased to 75, 100, 125 mcg or higher to properly replace the lost thyroid production. Close monitoring of TSH and symptom changes helps determine when dosage increases are needed to counteract the progression of Hashimoto’s.
Eventual Thyroid Gland Destruction
Many patients wonder if the immune system will eventually destroy their thyroid completely. The answer is it can, but not everyone progresses to total thyroid failure. Studies looking at the long-term outlook of Hashimoto’s disease have found:
- 10% developed severe primary hypothyroidism within 5 years of diagnosis.
- 33% had severe primary hypothyroidism after 10 years.
- 70% had it after 25 years.
This data indicates most people have at least some functioning thyroid tissue even decades after being diagnosed with Hashimoto’s. But a subset will see total thyroid destruction within 10 years, while it may take other patients upward of 25 years to reach that point.
Monitoring Progression
To keep tabs on the progression of Hashimoto’s over time, there are certain key parameters doctors monitor at annual checkups or more frequently if symptoms are changing:
- TSH level – Rising TSH indicates worsening hypothyroidism.
- Free T4 – Falling free T4 signals declining thyroid function.
- Thyroid antibodies – Rising antibodies confirms more immune attack on the thyroid.
- Symptoms – Worsening of hypothyroid symptoms suggests progression.
- Goiter size – Thyroid ultrasounds to track increase in gland enlargement.
This data is used to determine if and when medication dosages need to be adjusted or other treatment changes made in response to Hashimoto’s worsening over time.
Lifestyle Changes to Slow Progression
While there is no cure for Hashimoto’s, certain lifestyle modifications may help slow progression of the disease for some people. These include:
- Thyroid-friendly diet – Follow an anti-inflammatory diet, avoid gluten and soy, limit dairy and sugar intake.
- Stress reduction – Engage in relaxing activities, get good sleep, practice mind-body therapies like meditation.
- Supplements – Selenium, vitamin D, omega-3 fish oils, and probiotics may lessen immune attacks on the thyroid.
- Moderate exercise – Regular light to moderate intensity workouts can help improve thyroid function.
- Thyroid hormone therapy – Taking levothyroxine consistently can prevent worsening of hypothyroidism.
While these strategies may help slow its development in some patients, Hashimoto’s disease does still tend to gradually worsen over time. Ongoing monitoring and treatment adjustments are key to managing its slow progression.
The Outlook
The majority of people with Hashimoto’s thyroiditis will see a slow but steady worsening of their condition over years or decades. This results in declining thyroid function and more overt hypothyroid symptoms. However, the rate of progression varies widely between individuals due to genetic and lifestyle factors. Periodic flare-ups can also accelerate the downwards trajectory. While Hashimoto’s tends to get worse over time, proper treatment can help keep symptoms managed as the condition runs its course.
Key Points
- Hashimoto’s disease causes gradual destruction of the thyroid gland over months and years.
- Progression leads to worsening hypothyroidism as thyroid hormone levels fall.
- Symptoms usually get more severe and additional ones may emerge.
- Worsening is gradual in most cases but may speed up during flare-ups or after giving birth.
- Thyroid medication dosages often need to be increased over time to compensate for declining thyroid function.
- Lifestyle changes like diet, stress reduction, and supplements may help slow (but not stop) disease progression.
- Regular monitoring and treatment adjustments are key to managing symptoms as Hashimoto’s runs its course.
The Bottom Line
Yes, Hashimoto’s is a progressive disease that tends to gradually worsen over years or decades. The immune system attack causes increasing destruction of the thyroid gland, leading to declined thyroid function and more overt hypothyroid symptoms over time. Treatment is aimed at managing symptoms and slowing the progression rate through lifestyle modifications and medication adjustments when necessary. While Hashimoto’s itself is not curable, patients can live well with the condition by working closely with their healthcare team to stay on top of disease changes as they happen.