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What does a Hashimoto flare up feel like?

Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that causes the immune system to attack the thyroid gland. This leads to inflammation and damage to the thyroid tissue, resulting in hypothyroidism or underactive thyroid. People with Hashimoto’s experience periods of flare ups where symptoms suddenly worsen. But what exactly does a Hashimoto’s flare up feel like?

Common Symptoms of a Hashimoto’s Flare Up

Some of the most common symptoms experienced during a Hashimoto’s flare up include:

  • Fatigue – Feeling extremely tired and sluggish no matter how much rest you get.
  • Brain fog – Having difficulty concentrating, remembering things, and making decisions.
  • Muscle aches and joint pain – Experiencing pain, stiffness, and swelling in the muscles and joints.
  • Hair loss – Losing more hair than usual, sometimes in clumps.
  • Weight changes – Gaining or losing a significant amount of weight unexpectedly.
  • Irregular periods – Having very heavy, light, or missed periods if you menstruate.
  • Depression and mood changes – Feeling more irritable, anxious, sad, or depressed.
  • Constipation – Having infrequent, hard, and dry stools.
  • Dry skin and hair – Skin and hair becoming coarse, dry, scaly, and brittle.

However, the severity of symptoms can vary significantly from person to person. Not everyone with Hashimoto’s will experience all of these symptoms during a flare up.

Less Common Symptoms

Some less common symptoms that may occur during a flare up include:

  • Heart palpitations
  • Breathlessness
  • Dizziness
  • Tremors or shakiness
  • Swollen gland in the neck
  • Hoarse voice
  • Carpal tunnel syndrome
  • Tingling or numbness in hands and feet
  • Elevated blood pressure
  • Elevated cholesterol levels
  • Vitamin and nutrient deficiencies

What Triggers a Hashimoto’s Flare?

There are several potential triggers that can cause a Hashimoto’s flare up:

  • Hormonal changes – Fluctuations in estrogen, progesterone, and cortisol levels during puberty, menstruation, pregnancy, and menopause can trigger flares.
  • Stress – Physical or emotional stress causes cortisol levels to rise, triggering inflammation and flares.
  • Medications – Some medications like lithium, interferon alpha, and interleukin-2 can trigger autoimmunity and flares.
  • Infections – Viral infections, sinus infections, yeast infections, etc. can activate the immune system and trigger flares.
  • Diet – Food sensitivities like gluten, dairy, soy, eggs, and nightshades are common flare triggers.
  • Iodine – High iodine intake through supplements and medications can exacerbate Hashimoto’s.
  • Radioactive contrast agents – Exposure to X-ray dyes and imaging agents may increase flares.
  • Pregnancy – The drastic hormonal changes of pregnancy often lead to more severe flares.
  • Thyroid hormone changes – Altering thyroid medication dose can sometimes disrupt hormone balance and trigger flares.

Flare Up vs Hyperthyroidism

It’s important to note that a Hashimoto’s flare up is different from hyperthyroidism or overactive thyroid. Though flares may cause temporary hyper-like symptoms, the underlying cause is a worsening of the autoimmune attack on the thyroid rather than actual overproduction of thyroid hormones.

Common symptoms that may resemble hyperthyroidism during a flare include:

  • Racing heart or palpitations
  • Feeling wired or jittery
  • Heat intolerance
  • Trouble sleeping
  • Irritability or nervousness
  • Muscle weakness
  • Weight loss

However, these hyperthyroid-like symptoms are usually transient and alternate with the fatigue, brain fog, and other hypothyroid symptoms more commonly seen in Hashimoto’s. Testing thyroid hormone levels can help reveal whether a flare or true hyperthyroidism is occurring.

How Long do Hashimoto’s Flares Last?

The duration of a Hashimoto’s flare can vary greatly. Some flares may last only a few days or weeks. Others can persist for many months at a time. According to studies, the average flare lasts around 3 months but can range from a few weeks to over 6 months.

Flare length depends on the trigger, how quickly it is identified, and how well it is addressed. Eliminating triggers like food sensitivities and lowering stress levels can help shorten flares. Other flares induced by things like pregnancy may simply run their course.

Tests to Evaluate a Flare

If you suspect you are having a Hashimoto’s flare, certain lab tests and exams may help confirm it:

  • Thyroid function tests – Check TSH, Free T4, Free T3 to assess thyroid status.
  • Thyroid antibodies test – High antibodies indicates worsening autoimmunity.
  • Complete blood count – Checks for anemia and nutritional deficiencies.
  • C-reactive protein – Elevated levels may indicate inflammation.
  • Vitamin D, iron, B12 – Deficiencies are common with Hashimoto’s.
  • Neck ultrasound – Can reveal thyroid inflammation and enlargement.

Tracking symptoms in a flare journal and sharing it with your doctor can also help identify flare triggers and determine appropriate treatment.

Treatments to Manage Flares

Though difficult to completely prevent, there are several ways to try and shorten the duration of a Hashimoto’s flare:

  • Adjust thyroid medication – Your dose may need temporary increase if TSH rises.
  • Limit flare triggers – Avoid infections, added stress, dietary triggers, etc.
  • Anti-inflammatory diet – Follow a gluten-free, dairy-free, unprocessed diet.
  • Stress reduction – Try yoga, meditation, massage to lower cortisol.
  • Supplements – Selenomethionine, vitamin D3, omega-3s, etc. may help.
  • Low-intensity exercise – Gentle workouts improve stamina without added strain.
  • Alternative therapies – Acupuncture, infrared sauna, CBD oil, etc. may provide relief.

Seeing an endocrinologist who specializes in thyroid disorders can ensure proper treatment to manage flares when they occur. But staying in tune with your body and being observant of symptoms is key to detecting a flare up early.

Tips for Coping with a Hashimoto’s Flare

Here are some tips to help you cope when a Hashimoto’s flare strikes:

  • Listen to your body and rest as needed. Don’t push yourself to overexert.
  • Ask for help with household tasks and delegate duties if possible.
  • Reduce activities and commitments until your symptoms improve.
  • Make relaxation and stress management a priority.
  • Eat a simple, nourishing diet focused on whole foods.
  • Take medications, supplements, and vitamins as recommended.
  • Drink plenty of water and stay hydrated.
  • Be patient with yourself and lower expectations for what you can do.
  • Spend time doing enjoyable hobbies and activities you have energy for.
  • Connect with your healthcare team regularly for guidance and support.

When to Seek Emergency Care

Most Hashimoto’s flares can be managed at home with rest, medication adjustments, and lifestyle changes. However, in rare cases, an acute flare can become life-threatening and require emergency medical care.

Seek immediate medical attention if you experience:

  • Rapid, pounding heart rate or heart palpitations
  • Fever over 101 F (38.3 C)
  • Difficulty breathing or shortness of breath
  • Fainting or suddenly collapsing
  • New vision problems, double vision, or eye pain
  • Severe swelling in neck or difficulty swallowing
  • Chest pain
  • Uncontrolled shaking or tremors
  • Severe unexplained abdominal pain

Though unlikely, a thyroid storm or crisis from untreated hyperthyroidism can arise from a severe Hashimoto’s flare. Immediate medical treatment is needed to avoid serious complications from thyroid storm like shock, heart failure, and even death in extreme cases.

Living with Hashimoto’s Flares

Learning to manage the ebb and flow of Hashimoto’s flare ups can feel daunting at first. But being vigilant about tracking your symptoms, identifying triggers, and communicating with your healthcare providers can help you better weather the flare storms.

Having patience, lowering expectations, and reaching out for support during flares is wise. With time, the right treatment plan can help reduce the frequency and intensity of flares and provide you with an improved quality of life.

The Takeaway

Hashimoto’s flare ups can be frustrating and disruptive when they strike. Typical symptoms include fatigue, brain fog, muscle aches, hair loss, digestive issues, and depression. Triggers like hormone changes, stress, infections, medications, and diet can provoke flares. While flares may resemble hyperthyroidism at times, they represent a worsening of the underlying autoimmune attack on the thyroid.

Managing flares involves adequate rest, anti-inflammatory diet, stress reduction, thyroid medication adjustments, and supplements. Seeing an endocrinologist knowledgeable about Hashimoto’s can ensure proper treatment. Staying tuned in to your body and being patient with yourself helps cope with flares. Over time, flares often become less frequent and intense with proper thyroid management.