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Hashimoto's is an autoimmune thyroid disease and one of the most common autoimmune conditions overall. A large meta-analysis estimates that about 7.5% of adults worldwide have it, with estimates for women reaching as high as 17.5%. (Source: Hu et al., Frontiers in Public Health). If you have just received test results showing elevated antibodies, you are not an exception.
It’s just that no one told you. In a ten-minute doctor's appointment, there is no time for that.
I found out about my Hashimoto's quite by accident when I went in for breast surgery. My TSH was 9 and anti-TPO was 100. Until then, despite my symptoms and check-ups, no one had ever ordered thyroid hormone tests for me. That is why I wrote this text the way I wish someone had explained it to me at the beginning.
Did you just get a diagnosis? The first three weeks are the most confusing. I’ve summarized them in a free guide for the first 3 weeks: what questions to ask your endocrinologist, how to track your results, and where to start with your diet.
Hashimoto's (Hashimoto's thyroiditis, chronic autoimmune thyroiditis) is a condition in which the immune system mistakenly attacks its own thyroid gland. It is named after the Japanese physician Hakaru Hashimoto, who described it in 1912. "Hashimoto's syndrome," "Hashimoto's disease," "Hashimoto's thyroiditis" - it’s all the same diagnosis, just phrased differently.
What happens in the body? Lymphocytes, a type of white blood cell, enter the thyroid tissue. The body creates antibodies against two of its proteins: thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg). The inflammation lasts for years, silently, and gradually damages the cells that produce T4 and T3 hormones.
This is probably the most important part of the entire text, so I will break it down:
You can have Hashimoto's for years with perfectly normal TSH levels. In some women, hormone levels remain within range for their entire lives, while in others, the thyroid eventually slows down. In our region, Hashimoto's is also the most common cause of hypothyroidism. Read more about the slowed function of the gland in our article on hypothyroidism.
Women. And not just slightly more often, but four to ten times more often than men, depending on the study. It is most often discovered between the ages of 30 and 50, but it also occurs in teenagers, during pregnancy, postpartum, and during menopause.
There is no reliable registry for Serbia. If you apply global estimates to our adult population, we are talking about hundreds of thousands of people. Many of them do not know they have positive antibodies.
That is why you are not alone in the endocrinologist's waiting room. You are likely not the only one holding the same test results.
In the beginning, there are often no symptoms at all. The disease is discovered by chance during a routine check-up, at a gynecologist's office while planning a pregnancy, or, as in my case, before surgery. When symptoms do appear, they are usually the result of a drop in hormones, so they resemble the symptoms of hypothyroidism.
My list looked like this: fatigue, hair loss, feeling cold, anxiety, depression, brain fog, and stubborn weight that wouldn't budge. And my biggest problem, which once landed me in the emergency room, was constipation.
For most women, the list comes down to some of these:
None of these symptoms on their own mean you have Hashimoto's. Fatigue has a hundred causes. The problem is that symptoms accumulate slowly over months, making it easy to blame them on work, children, age, or stress. Many women spend years being told "it's just nerves" before anyone checks their TSH.
I was one of them.
For some women, the disease begins with the opposite symptoms. As inflammation destroys cells, stored hormones are released into the bloodstream. For a short time, you may experience heart palpitations, nervousness, insomnia, and weight loss. This phase is called hashitoxicosis; it lasts from a few weeks to a few months and is easily mistaken for Graves' disease. After that, hormone levels usually drop.
The thyroid gland can be enlarged (goiter), normal in size, or, later on, shrunken. An enlarged gland is sometimes visible as swelling on the front of the neck and causes a feeling of tightness when swallowing or wearing turtlenecks.
Hashimoto's is usually painless. If you have severe neck pain, see a doctor sooner, as that more often indicates a different type of thyroiditis.
Symptoms specific to women, from cycles to menopause, are covered in this article: thyroid symptoms in women.
There is no single cause. Anyone who tells you otherwise is probably trying to sell you something.
Hashimoto's occurs when a genetic predisposition meets an environmental trigger. Here is what we know:
Stress and viral infections are often mentioned as triggers. Many women link the onset of the disease to a difficult period in their lives, and I understand that. I will be honest here as well: evidence for this exists, but it is weaker than the evidence for the factors in the table. I write in more detail about each trigger in the article cause of Hashimoto's.
A diagnosis is not based on how you feel. It is based on test results. An endocrinologist typically looks at four things:
Anti-Tg antibodies are performed as a supplement, especially when anti-TPO results are negative.
Your status depends on the combination of these results. Hashimoto's with normal hormone levels. Hashimoto's with subclinical hypothyroidism, when TSH is elevated and FT4 is normal. Or Hashimoto's with overt hypothyroidism, when TSH is elevated and FT4 is low.
I explained what the number on your antibody test means and why its level is not a measure of "how sick you are" in the article Hashimoto's antibodies. A complete list of tests, including preparation for blood draws, can be found in the guide thyroid tests.
First, the part no one likes to hear: there is no cure that stops the autoimmune process.
However, there is a very effective treatment for its consequence, which is hypothyroidism.
If your hormone levels are normal and you only have positive antibodies, treatment is usually not necessary. Monitoring is performed, most commonly by checking TSH once a year or sooner if symptoms appear.
If your TSH is elevated, the decision depends on how high it is, how you feel, your age, and whether you are planning a pregnancy. For clear hypothyroidism, treatment is standard. For mildly elevated TSH, according to European guidelines, some endocrinologists wait and repeat the test, while others immediately prescribe a low dose. If you are planning a pregnancy, the thresholds are stricter, so discuss this with your doctor in time, not once the test already shows two lines.
The treatment is levothyroxine, a synthetic form of the T4 hormone, the same one your thyroid produces on its own. In Serbia, it is most commonly prescribed as Euthyrox or Letrox. I have been taking Letrox since my diagnosis.
The dosage is entirely individual and is determined by a doctor based on your weight, age, test results, and other medical conditions. After any change in dosage, TSH is checked in six to eight weeks. A few rules that are repeated in every medication leaflet:
I manage my check-ups and therapy in consultation with my doctor. This is not an area where I improvise, and I urge you not to improvise either.
To be precise: Levothyroxine is a medication for hypothyroidism. It is not a cure for Hashimoto's. It replaces a missing hormone, but it does not affect the autoimmune process itself.
More about the medication itself, side effects, and frequently asked questions can be found in the article Eutirox and Letrox.
No. Not in the sense that the antibodies and the autoimmune process disappear forever.
But it can be kept under control so well that you can live a normal life, work, exercise, have children, and not think about it every single day. That is symptom remission, and it is a valuable, achievable goal. The full, honest answer is in the article can Hashimoto's be cured.
Hashimoto's cannot be "cured" with tea. Or diet. Diet will not eliminate Hashimoto's and will not replace levothyroxine; I write this everywhere, and I will repeat it here.
However, diet is a lever you control every day. I’ve tested everything, from seven months of veganism to preparing for a bodybuilding competition. The advice to "eat healthy" never once helped me plan a Wednesday night. Concrete steps did.
What we know, in short:
What exactly I eat, what I’ve cut out, and why, is in the guide Hashimoto's Diet. Before you start any supplements, read supplements for the thyroid and be sure to let your doctor know what you are taking.
Schedule an appointment and request a TSH, FT4, and anti-TPO test if:
Do not wait for a scheduled appointment if you notice sudden neck swelling, difficulty swallowing or breathing, severe neck pain, or a rapid, irregular heartbeat.
Undiagnosed hypothyroidism is not harmless. In the long term, it raises cholesterol, puts a strain on the heart, and affects fertility and the course of pregnancy. The good news is that it can all be detected with a single blood test.
A diagnosis is just a piece of paper. Life with it is everything that comes after.
The first few months are usually spent finding the right dosage, going to initial check-ups, and asking a thousand questions for which Google provides fifty conflicting answers. What really helps is boring and simple: consistent medication, timely lab tests, an endocrinologist you trust, food that makes you feel good, and sleep.
For me, it wasn't one specific protocol that changed things the most. It was stopping the negotiation with my own body. Flare-ups still happen. I’ve learned to recognize them a few days in advance - by my sleep, by swelling, and by how hard it is to get out of bed. And I don't make any big decisions during the weeks when my body isn't cooperating.
A bad day is not a failure. It is part of the diagnosis.
If you want to start in the kitchen, in The Hashimoto Cookbook I have compiled 50 gluten-free and dairy-free recipes. With measurements, exact quantities, and a shopping list for those days when you don't have the energy to think about what to eat. If you are just starting out, begin with the free guide.
These are the articles women read most often after a diagnosis:
I am not a doctor or a nutritionist. This text is for informational purposes only, based on literature and my personal experience, and does not replace medical advice. It does not provide recommendations regarding medication dosages. All decisions regarding therapy should be made by your endocrinologist. Read the medical disclaimer.
Last content review: October 15, 2026.
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