Additional reporting done by Angela Myers.
Hashimoto’s usually causes a low-functioning thyroid, creating a cascade of symptoms that can be triggered at any time. Sometimes, it can cause a high functioning thyroid. Adding to the fire: It’s an autoimmune condition, meaning each flare damages the ever-important gland. But what does a Hashimoto's attack feel like, and what should you do if you experience one?
Hashimoto’s disease is an autoimmune condition that causes your immune system to make antibodies that attack and damage your thyroid (the butterfly-shaped gland at the base of your neck). About 5% of people have Hashimoto’s disease, and it affects eight times more women than men, most often those between ages 40 and 60, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto's disease symptoms vary from person to person, though there are some common signs.
What is a Hashimoto’s flare-up?
Before we dive into Hashimoto's attack, let's take a step back: What are autoimmune flare-ups in general? A flare-up occurs when symptoms suddenly and swiftly return, and while they can look like the symptoms you normally experience, flare-ups tend to be more severe.
Just as you’ve been coasting along and feeling pretty great, you’re hit again with familiar symptoms. Maybe you haven’t pooped in days. You’re suddenly cold and wearing your “summer sweaters.” You’re mopey as heck, and no number of naps can relieve the unrelenting fatigue.
Flares happen because of additional stress on your body, which taxes an immune system that is already hyper-vigilant, sending it into a tailspin. “When flares happen, there is a greater antibody response going on at that time, which leads to more destruction of the thyroid gland,” says Neeti Sharma, MD, a board-certified internal medicine physician at Parsley Health.
So, what does a Hashimoto's attack feel like? To start, these flare-ups lead to low levels of thyroid hormones. These hormones are essential for regulating your metabolism, body temp, heart rate, energy, menstrual cycle, mood, and hair and nail growth. When these hormones are out of whack, your body is, too.
That means during a Hashimoto's flare-up you may feel fatigue, gain weight, be perpetually cold, experience constipation, have fertility issues, brain fog, or have aching joints and muscles. However, not all symptoms are present for everyone or in all flare-ups.
What are the symptoms of Hashimoto’s disease?
Hashimoto's symptoms can be vague. It’s easy to chalk them up to stressful weeks or lack of sleep, so you may not even notice there’s a problem at first. “Many people don’t know they have Hashimoto’s,” says Dr. Sharma. “They may know they have hypothyroidism, but doctor’s offices don’t frequently check for antibodies that signal an autoimmune condition,” she explains.
Fatigue
Cold intolerance
Constipation
Dry skin
Puffy face
Muscle aches
Brain fog
Insomnia
Low mood or depression
Irregular or heavy periods
Enlarged thyroid gland (this is called a goiter)
Also be aware that it’s possible that a Hashimoto’s flare-up could cause your body to go into a hyperthyroid state, which means your thyroid is overactive. “With the destruction of thyroid cells, the gland releases thyroid hormones quickly into the bloodstream,” says Dr. Sharma. In that case, you can experience symptoms of hyperthyroidism, like:
Fatigue
Heat intolerance
Irritability
Rapid heartbeat
Sleep problems
Anxiety
Risk Factors for Hashimoto's Disease
While it’s not entirely clear why people develop autoimmune conditions, Dr. Sharma says that it’s likely that you have a genetic predisposition to autoimmunity that’s activated by something in the environment. “Your immune system goes into dysfunction when the body is not in a healthy environment, and your thyroid tends to be the system that’s most responsive when things are off.”
But genetics don't act alone. For a Hashimoto's flare-up to occur, a trigger has to be present. “Each individual will have a unique immune system that responds differently to the environment. There is no one-size-fits-all when it comes to triggers,” explains Dr. Sharma.
However, there are some common lifestyle factors that may precede a flare and they fit in several larger buckets: diet, lifestyle, environmental, and medical. Knowing what they are can help you pinpoint the ones that are true to you:
Your diet: According to Dr. Sharma, many people find that grains (specifically gluten -containing grains, like wheat, barley, or rye), high sodium intake, as well as high iodine intake are common triggers for a Hashimoto’s flare-up. Table salt is traditionally iodized, so if you’re eating a lot of high-salt foods you’re also likely consuming too much iodine.
Your lifestyle: Lack of sleep or insomnia, high levels of stress, as well as being too sedentary—or conversely—overtraining with high-intensity exercise are triggers for flare-ups.
The environment: Studies show that chemicals in plastics like bisphenol A (BPA), pesticide exposure, and air pollution, can disrupt thyroid function.
Medical: There are pathogens like H pylori that can cause stomach ulcers are now known to be an easily overlooked trigger for Hashimoto's. An illness can also trigger the disease, as can hormonal fluctuations, which is one reason why the disease may disproportionately affect women.
Hashimoto's Diagnosis and Testing
Hashimoto's disease is diagnosed by a doctor who will examine your medical history and order a blood test. A simple blood test is essential because Hashimoto’s thyroiditis is a progressive disease. These antibodies will eventually damage and destroy your thyroid gland, even if symptoms of Hashimoto’s disease are not present now, says Dr. Sharma. “It helps to know if you have it so that you can do something about it early on and avoid the specific triggers that cause a flare,” she says.
If Hashimoto's is present, you don't have to figure out what to do alone. After a diagnosis, a doctor will work with you to create a treatment plan and should continue to monitor symptoms and triggers.
Hashimoto’s Disease Treatment
You’ll want to work with a doctor who can spend time with you to find what sets off your Hashimoto’s disease. “We have to figure out each individual’s reason for why they have these autoimmune antibodies in the first place,” says Dr. Sharma. Identify what might have happened in your life to lead to the flare, and then hone in on those factors to better manage symptoms throughout a flare—and help you feel your best. These are some ways Parsley Health’s doctors work with members to help them manage increased antibody formation and inflammation that leads to flares.
Address your stress.
We all have stress, but when you have Hashimoto’s, it’s important to guard your time, give yourself some grace on your to-dos, and relax when you need it. It’s also important to realize that an overload of mental stress isn’t just a trigger for a flare itself, but can also impact your ability to care for yourself as you otherwise would, says Dr. Sharma. For instance, if you’re under stress, you might reach for less healthy foods or might be going to bed later or staying up late with worry and anxiety. Now is the time to go full-stop with self-care: unplugging when you need to/temporarily deleting social media apps, going to bed early, calling a friend to vent, and taking walks outside if you have the energy.
Check your supplements.
Is your body getting what it needs to fully support thyroid function? “We want to make sure that you’re supplemented enough with selenium and vitamin D in particular. You need all of the building blocks it takes to make thyroid hormone so that you’re not going into a hypothyroid state because of nutritional deficiencies,” says Dr. Sharma. We also want to make sure you are not getting excess iodine.
Eat fresh, whole foods.
Inflammation increases the autoimmune reaction, so focus on eating an anti-inflammatory diet, says Dr. Sharma. “Focus on non-processed foods, lots of vegetables and greens, organic meats, and reduce sugar intake,” she advises. Eat more dark leafy greens, which pack a powerful antioxidant called glutathione to help reduce inflammation, she says.
Ditch sugar and gluten.
Cookies and ice cream may be comforting in times of stress, but they’ll only exacerbate your symptoms now. Loading up your diet with sugar will lead to spikes and dips in blood sugar, something that activates your immune system, says Dr. Sharma. Since gluten is a trigger for many people, consider avoiding gluten-containing foods (many packaged snacks, wheat pasta, bread, cereal, and junk foods).
Watch your iodine.
Iodine is a mineral that your thyroid uses to make thyroid hormones. However, a high iodine intake, which can come from too much table salt (in the form of processed, packaged foods) will negatively affect thyroid functioning, says Dr. Sharma. She recommends sticking to a low-iodine diet during Hashimoto’s flare-ups.
When to See a Doctor
As soon as symptoms appear, see a doctor about Hashimoto's disease. While this condition often progresses slowly, early diagnosis and developing a robust treatment plan can prevent future flare-ups. Since the disease has a genetic component, it's also best to bring up Hashimoto's with a doctor if there's a family history of thyroid disease.
To make your time at the doctor's meaningful, consider asking:
What Hashimoto's triggers should I be looking for?
Are there any lifestyle adjustments I can make to avoid future flare-ups?
What symptoms might I experience, and what should I do if I experience them?
When should I schedule a follow-up appointment?
Frequently Asked Questions
What are the worst symptoms of Hashimoto's?
The worst symptoms of Hashimoto's can vary from person to person since "worst" is subjective. That being said, some of the symptoms that cause the most complications or disruption to daily life include fatigue, depression, muscle aches, brain fog, and rapid heartbeat.
What aggravates Hashimoto's?
Environmental triggers aggravate Hashimoto's and can cause a flare-up. Triggers differ from person to person, but some of the most common include processed foods, sugar, gluten, lack of sleep, and a sedentary lifestyle.
What are Hashimoto's inflammatory attacks?
Hashimoto's inflammatory attacks occur when symptoms intensify or are made worse, usually due to an environmental trigger like sugar or exposure to pesticides. Because attacks are marked by a sudden and swift return (or increased severity) of symptoms, they are also called flare-ups.
How does a person with Hashimoto's feel?
Hashimoto's disease looks different for everyone, but some common symptoms include fatigue, brain fog, muscle aches, and constipation. The disease can also impact how you feel mentally, and it has been linked to depression and anxiety. Additionally, many with Hashimoto's suffer from insomnia or trouble sleeping.
Final Thoughts
When a Hashimoto attack occurs, it can interrupt your day-to-day life and leave you feeling drained emotionally and physically. Fortunately, flare-up triggers and symptoms can be managed, often with the help of a trusted physician. Contact Parsley Health for more insight on how to control and prevent Hashimoto's flare-ups.
