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How is Hashimoto's thyroiditis diagnosed?

TTo diagnose Hashimoto's thyroiditis, a physician should assess symptoms and complaints commonly seen in hypothyroidism, carefully examine the neck to look for enlargement of the thyroid gland, and take a detailed history of family members. Blood tests are essential to diagnose Hashimoto's thyroiditis. Specific blood tests determine the level of thyroid function.

During the early stage of thyroiditis, the levels of thyroid hormones (T3 and T4) may be normal. With chronic hypothyroidism, the thyroid hormone levels fall, and the level of thyroid stimulating hormone (TSH) becomes high. The most useful assay for determining thyroid status is measurement of TSH in the blood. As mentioned earlier, TSH is secreted by the pituitary gland. As the level of thyroid hormone falls, the pituitary gland responds by releasing more thyroid stimulating hormone (TSH). The increase in TSH can actually precede the fall of thyroid hormone to low levels by months or years, so the first sign of hypothyroidism may be an elevated TSH level even when levels of thyroid hormones are normal.

The blood work mentioned above confirms the diagnosis of hypothyroidism, but does not point to an underlying cause. The combination of the patient's clinical history, antibody screening (as mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem. If a pituitary or hypothalamic cause is suspected, MRI of the brain and other studies may be warranted. These investigations should be made on a case-by-case basis.

Illustration of the Pituitary Gland
Illustration of the Pituitary Gland

The blood tests also usually include an analysis of antibodies (anti-thyroperoxidase antibodies) to aid diagnosis. If the anti-TPO antibodies are elevated at all, the diagnosis is made. Early on in the course of the disease, however, the patient may have negative antibodies.

If the gland is large, or there are symptoms of esophageal compression, an ultrasound may be performed to see if the gland is compressing either the esophagus (the food tube) or the trachea (the airway).

Return to Hashimoto's Thyroiditis

See what others are saying

Comment from: Mei., 35-44 Female (Patient) Published: June 23

I was diagnosed with Epstein-Barr virus infection 30 years ago. I had five months of constant headache, alternating fever and chills, brain fog and total fatigue. I went to bed tired and woke up tired. There were days I couldn't sleep at all and days I slept 20 hours and still woke up fatigued and with barely energy to get dressed. I felt lazy, slothful and stupid because I couldn't hold an intelligent thought. I felt like nobody believed it was real. I've been okay until April. It started with the fatigue all over again.

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Comment from: LydiaW, 35-44 Female (Patient) Published: January 07

I was diagnosed with Hashimoto's thyroiditis at the age of 26. I am 43 now. When I was 21, I had pneumonia and then bronchitis shortly after, and started showing symptoms. It wasn't until I was 26 that I was properly diagnosed. My TSH levels had stabilized with Synthroid and I had no symptoms, until the birth of my daughter six years ago when I was 37. Since then, I've gained 50 pounds despite exercise and eating healthy, am extremely tired, and have very dry skin and some hair loss. Imagine being an elite runner and gaining 50 pounds and four dress sizes, while in training for a 10K. I had gone to the same endocrinology practice for almost 15 years, and have switched recently after being told that I was the one at fault for the weight gain and fatigue, because my TSH was in the normal range. The new endocrinologist told me that, although my TSH levels are in the normal range, they are not my normal, as everyone is different, and said he would steadily increase my dosage every few months until I feel better. He said, after reviewing my TSH tests from the past 10 years that my TSH level had spiked after the birth of my daughter. All I can say is, if you still feel lousy and your endocrinologist/doctor refuses to do anything different, fire them and find someone else. I should have done it much sooner. I now feel like I have a chance to run a 10K this year. I don't expect to lose the 50 pounds quickly, but I believe that I now will be able to at least lose enough of the weight to run a 10K again and see the other symptoms diminish.

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Comment from: MN Girl, 55-64 Female (Patient) Published: April 16

I had been on thyroid medicine for years. My TSH jumped. MY gynecologist is the one who caught it. I told her about the deep chills I had been having and the terrible muscle cramps I had been getting in my thighs. She did blood work and diagnosed Hashimoto's thyroiditis.

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