**What are the stages of Hashimoto's thyroiditis?** Hashimoto's thyroiditis is an immune disorder that affects the thyroid. In this disease, the body's immune system mistakenly attacks the thyroid tissue and causes inflammation and gradual destruction of the thyroid tissue. More precisely, antithyroid antibodies attack the thyroid. Due to this immune attack, the thyroid is not able to produce enough thyroid hormones and this causes hypothyroidism. This lack of thyroid hormones can cause symptoms such as fatigue, weight loss, reduced ability to tolerate cold, problems with weight control, depression, constipation, and changes in skin and hair. There are 5 stages of Hashimoto's thyroiditis, we will introduce each one below. The most important thing about Hashimoto's disease is that it often starts in a semi-hidden form (subclinical) and its symptoms are not revealed until the thyroid is severely destroyed. In other words, many people may have Hashimoto's disease for years but have no specific symptoms for a long time. Hashimoto's disease is usually controlled with thyroid medication to compensate for the lack of thyroid hormones. In rare cases, if the thyroid is severely damaged and serious complications occur, alternative treatment such as thyroid surgery (thyroidectomy) may be needed. It should be noted that Hashimoto's disease requires constant care and medical supervision. To know when **Hashimoto's thyroid surgery** is recommended, click on the link. To know the symptoms of Hashimoto's disease, how to diagnose and treat it, click on the link. ### **5 stages of Hashimoto + how to diagnose and treat the disease** Hashimoto's disease develops gradually and can be diagnosed in 5 different stages. The stages of Hashimoto's thyroiditis are: #### **Step 1: Family history and genetic predisposition** In the early stage, a person is genetically predisposed to Hashimoto's, but is not exposed to the necessary stimuli. Therefore, TSH and T4/T3 hormones have normal levels in the body. In this case, these people do not have any thyroid antibodies in their body and do not feel any changes in their thyroid gland. This can be called stage zero, because at this stage there are no signs of the disease. If you have a history of thyroid disease in your family, your relatives and children may already be at this stage. This stage is the best time for prevention. #### **Step 2: Immune cell penetration into the thyroid gland** Hashimoto's is characterized by an overabundance of lymphocytes (white blood cells) in the thyroid gland. A high number of white blood cells in an organ means there is a problem. It's thought that immune cells may be there with good intentions at first — to clean up dead and diseased thyroid cells — but in some cases, they start attacking healthy thyroid tissue. In the early stage of Hashimoto's, a person will usually have high thyroid antibodies. Tests up to 80-90% may show an increase in thyroid antibodies in the blood. At this time, thyroglobulin and thyroid peroxidase antibodies are tested respectively. However, some people may never have thyroid antibodies in their blood, but certainly, after a thyroid ultrasound or biopsy, changes in the thyroid gland consistent with Hashimoto's will be revealed. At this stage, TSH, Free T3 and Free T4 levels will still be normal. Usually at this stage, people may experience symptoms such as anxiety, fatigue, miscarriage/infertility, mood swings, weight gain or weight loss. Because their bodies are fighting hard to maintain their thyroid levels, this can be tiring and depleting of normal body functions and nutrients. In addition, at this stage, the function of the intestinal wall is almost completely disrupted. Unfortunately, Hashimoto's is not diagnosed by mainstream medicine at this stage and antidepressants may even be prescribed for "mood symptoms". In the second stage, it is the best time to prevent the progression of the disease and damage to the thyroid gland, because the inflammation in the body has started at this stage. In an overview, you need to identify your triggers and strengthen your body: - Food sensitivities - Reduction of nutrients - Intestinal permeability - Poisons Adrenal dysfunction - Chronic infections #### **Stage 3: Subclinical hypothyroidism** The third stage of Hashimoto's is known as subclinical hypothyroidism. At this stage, the TSH level may be slightly increased in the blood test (3-10 mU/L), and the free T3 and free T4 levels are normal. A person's thyroid antibodies may be even higher than in stage 2. Because the increase of TSH can increase the inflammation of the thyroid gland. However, some people will still be antibody negative in the tests. At this stage, the person begins to experience more symptoms, which eventually leads to overt hypothyroidism. #### **Stage 4: Overt hypothyroidism** At this stage, thyroid gland failure has started. The thyroid gland will be destroyed to the point where it will no longer be able to produce its own thyroid hormone. A person will have high TSH, with low levels of T3 and T4. Thyroid antibodies may be even higher than before. This stage is the most common time for a person to be diagnosed with Hashimoto's because this is when a person usually experiences a significant amount of thyroid symptoms. In this condition, a person needs thyroid medication to prevent serious health consequences. Lifestyle changes are critical at this stage. In stage 4, regeneration of normal tissue will be very challenging, but fortunately, there are new options that can speed up the recovery of thyroid tissue. #### **Stage 5: Progression to other autoimmune disorders** Having Hashimoto's puts a person at higher risk for developing other autoimmune diseases such as celiac disease, psoriasis, Sjogren's, rheumatoid arthritis, lupus, multiple sclerosis, and many others. At this stage, the person is likely to be treated with thyroid medication, but unfortunately, thyroid medication and removal of the thyroid gland are ineffective in stopping the progression of the disease. In the following situations, removal of the thyroid gland or thyroid surgery may be recommended: - Hashimoto's is not well controlled with drugs. - The thyroid gland is enlarged. - Antibodies are out of control. - Graves' disease - Thyroid nodules or thyroid cancer occur. ### **What are the symptoms of Hashimoto's disease?** The symptoms of Hashimoto's thyroiditis may vary according to the stage and severity of the disease. In the early stages, people may have no symptoms or experience mild symptoms. But as the disease progresses, the symptoms become more obvious. It is better to act faster for Hashimoto's treatment. Some common symptoms of Hashimoto's thyroid disease include: #### **Thyroid deficiency (hypothyroid)** - Constant feeling of tiredness and low energy - Weight gain or difficulty in weight control - Colds and cold intolerance - Problems with concentration and memory - Dry and brittle hair - Dry and itchy skin - Changes in periods and infertility in women #### Read more: **11 ways to control fatigue caused by Hashimoto's!** #### **increasing thyroid volume** In the early stages of the disease, the increase in thyroid volume may not be felt by the person. In more advanced stages, an enlarged thyroid can cause swelling and pressure in the neck area, which may cause breathing or swallowing problems. There are other symptoms that include: - Depression and anxiety - Digestive problems such as constipation - Change in heart rate In this article, you learned about the stages of Hashimoto's thyroiditis. Note that the symptoms of Hashimoto's thyroid may overlap with the symptoms of many other thyroid and non-thyroid diseases. For accurate diagnosis and proper treatment, consultation with a thyroid specialist is essential. **Read more:** **Why is blood sugar control vital in Hashimoto's?** Dr. Seyed Ahmad Fanai is a thyroid and parathyroid surgeon and an active member of the American Association of Thyroid Surgeons (ATA). You can contact us for appointment and consultation.