Hashimoto's disease: signs, symptoms, and complications


When talking about the symptoms of Hashimoto's disease (Hashimoto's thyroiditis), most of the time they refer to the clinical symptoms of low thyroid function: fatigue, sensitivity to cold, hair loss, constipation and others. Although Hashimoto's disease reduces the thyroid gland 's ability to produce hormones the body needs to maintain normal metabolism (converting oxygen and calories into energy), it only occurs after the associated inflammation of the thyroid gland, known as Chronic lymphocytic thyroiditis, causes hypothyroidism . whose symptoms are commonly found.

Illustration by Emily Roberts, Get Drug Information

Frequent symptoms

Although most people with Hashimoto's have no obvious symptoms in the early stages of the disease, some may experience mild swelling in the front of the throat ( goiter ) caused by direct inflammation of the gland.

Hashimoto's disease generally progresses slowly over many years and causes progressive damage to the thyroid gland, leading to an associative decrease in the production of thyroid hormones.

While some people use the terms Hashimoto's disease and hypothyroidism interchangeably, Hashimoto's disease is more precisely described as the most common condition that can cause hypothyroidism.

The symptoms of hypothyroidism and Hashimoto's are the same.

The most common are:

  • Fatigue
  • Hypersensitivity to cold
  • Constipation
  • Pale and dry skin
  • Swelling in the face
  • Brittle nails
  • Hair loss (alopecia)
  • Augmented tongue
  • Unexplained weight gain despite no dietary changes
  • Muscle pain (myalgia)
  • Joint pain (arthralgia)
  • Muscular weakness
  • Heavy menstrual bleeding (menorrhagia)
  • Irregular menstruation (oligomenorrhea)
  • Depression
  • Memory blackouts (brain fog)
  • Low sex drive
  • Growth retardation in children


As Hashimoto's disease progresses, it can cause irreparable damage to the thyroid gland. In an effort to produce more thyroid hormone, the gland itself begins to enlarge, leading to the development of goiter .

There are different types of goiter:

  • Diffuse, characterized by mild and generalized edema.
  • Gnarled, characterized by a lump
  • Multi-node (multiple bundles)
  • Retrosternal (extending to the windpipe)

While a smaller goiter may not need treatment, radioactive iodine (RAI) may be required to reduce the size of a larger goiter . A retrosternal goiter sometimes requires surgical removal if it interferes with breathing or swallowing.

Progressive metabolic dysregulation and increasing hormonal imbalances can begin to affect many organ systems, leading to a cascade of complications that extend well beyond the thyroid itself.


If thyroid hormone levels are too low, they can interfere with the hormonal mechanisms that regulate the menstrual cycle and cause ovulation. This can lead to infertility, which affects up to 50% of women with Hashimoto's, according to a study published in the International Journal of Endocrinology.

Even with proper treatment for hypothyroidism , there is no guarantee that fertility can be fully restored in severely Hashimoto-affected women.

Heart disease

Even mild hypothyroidism can have a profound effect on heart health. Dysregulation of thyroid hormones can cause high levels of "bad" LDL (low-density lipoprotein) cholesterol, leading to hardening of the arteries (atherosclerosis) and an increased risk of heart contractions. seizures and strokes.

Pericardial effusion, a collection of fluid around the heart, can affect up to 30% of people with hypothyroidism.

Although it is a mild form in most cases, severe hypothyroidism can lead to pericardial tamponade , a condition in which the heart is less able to pump blood. In some cases, this can lead to a potentially fatal drop in blood pressure.

Complications of pregnancy

Since maternal thyroid hormone is vital for the development of the fetus, untreated hypothyroidism during pregnancy can lead to potentially serious complications for both mother and baby.

Studies have shown that untreated hypothyroidism nearly doubles the risk of preterm birth and significantly increases the risk of low birth weight, premature rupture of membranes, fetal heart rhythm disturbances, and fetal respiratory distress .

Even with subclinical hypothyroidism (in which there are no observable symptoms), pregnant women have a higher risk of preeclampsia, gestational diabetes, postpartum hemorrhage, and postpartum depression than women without thyroid disease.

Hashimoto's encephalopathy

Hashimoto's encephalopathy is a rare complication in which cerebral edema can cause severe and debilitating neurological symptoms. The disease affects about two in 100,000 people each year and is typically between the ages of 41 and 44. Women are affected four times more often than men.

Hashimoto's encephalopathy generally manifests itself in two ways:

  • Persistent impairment of cognitive function leading to tremors, drowsiness, confusion, hallucinations, dementia, and, rarely, coma.
  • Seizures or sudden attacks similar to a stroke.

Hashimoto's encephalopathy is usually treated with intravenous corticosteroids, such as prednisone , to quickly relieve inflammation and swelling in the brain.


Myxedema is a severe form of hypothyroidism in which your metabolism slows to the point where you can slip into a coma and potentially die. It is associated with an untreated disease and can be recognized by characteristic changes in the skin and other organs, including :

  • Swollen and puffy skin
  • Droopy eyelids
  • Severe cold intolerance
  • Decrease in body temperature leading to hypothermia .
  • Slow breathing
  • Extreme exhaustion
  • Slow motion
  • Confusion
  • Psychosis
  • Shock

Myxedema is considered a medical emergency that requires immediate medical attention.

When to see a doctor

As a largely "invisible" disease in its early stages, Hashimoto's disease is often first detected during routine screening when thyroid hormone levels are abnormally low.

Since Hashimoto's disease is usually inherited, it is recommended that you get tested if someone in your family has the disease.

Talk to your doctor if you begin to experience the classic signs of hypothyroidism, including persistent fatigue, facial swelling, dry skin, hair loss, abnormal menstruation, and unexplained weight gain. Early diagnosis and treatment will improve your outcome.

Frequently asked questions

  • The symptoms of hypothyroidism get worse , so you may feel tired and gain weight, or you may develop other general symptoms of an underactive thyroid gland, such as cognitive problems, sensitivity to cold, dry skin, constipation, and hair loss.

  • The most common signs include goiter, heart disease, depression, peripheral nerve disease, and infertility. In rare cases, mental confusion, increased drowsiness, or sudden seizures can be a sign of Hashimoto's encephalopathy, in which the brain swells and causes neurological problems. Meanwhile, chest pain and shortness of breath can be a sign of cardiac tamponade, a rare and life-threatening heart condition caused by hypothyroidism.

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