Diagnosis of Hashimoto's Disease

Although many patients with Hashimoto's disease go a long time without noticing symptoms, as it progresses, they will start to develop and they'll need to see a doctor. We explain what the diagnostic process consists of.
Diagnosis of Hashimoto's Disease

Written by Maite Córdova Vena, 27 June, 2021

Last update: 27 June, 2021

The diagnosis of Hashimoto’s disease (or chronic lymphocytic thyroiditis) is achieved mainly through the physical examination of the person, the symptoms referred to in their appointment, and a blood test.

However, it’s possible that, in some cases, the doctor will request some complementary tests, especially if the person suffers from some other chronic pathology or the doctor suspects they may be.

Hashimoto’s disease is a form of chronic thyroiditis of autoimmune origin. This means that the immune system mistakenly attacks the thyroid gland and prevents it from properly producing thyroid hormones, which, in turn, affects the health of the entire body.

Not all people with thyroid disorders have symptoms, especially in the early stages. However, as you progress, you may start to notice several.

The symptoms of Hashimoto’s disease are diverse. However, when the person experiences persistent fatigue, for no apparent reason, dry skin, paleness and swelling of the face, intolerance to cold, unexplained weight gain, and constipation, then you should consult a doctor.

Although goiter is common in patients with Hashimoto’s disease, it isn’t present in all cases.

Self-appraisal

Diagnosis of Hashimoto's disease begins with clinical evaluation
Constant self-examination is important to detect enlargement in the anterior neck region.

Palpating the neck at home to try to detect nodules or goiter (neck enlargement) is an appropriate preventive measure, according to the American Association of Clinical Endocrinologists. It’s especially helpful for people who have a history of endocrine disease or who are aware that they’re part of a risk group.

However, they clarify that by itself, the self-evaluation of the neck isn’t enough to diagnose Hashimoto’s disease or other disorders. Keep in mind that the margin of error for a self-assessment is wide. Sometimes what a person may believe to be a nodule may not be.

Ultimately, although self-evaluation is recommended as part of a preventive strategy, it isn’t a substitute for a complete check-up.

In the consultation, in addition to conducting an interview, the doctor will give the person a complete exam that will include a neck evaluation.

Lab tests

As explained in the MSD Manual, Hashimoto’s disease can be accompanied by other chronic disorders, such as diabetes, pernicious anemia, rheumatoid arthritis, lupus, and others.

For this reason, the doctor may require some thyroid function tests to find out if the symptoms that the person experiences are part of Hashimoto’s disease or another underlying disorder.

Depending on the concentration of the thyroid hormones, thyroxine (T4), triiodothyronine (T3), and the thyroid-stimulating hormone (TSH) the functioning of the thyroid gland can be determined. This concentration can be verified through a blood test.

Thyroid-stimulating hormone (TSH) test

To this day, the TSH test stands as the best screening test for thyroid disorders. It’s so effective that it allows detection even before the person begins to notice symptoms.

  • Generally, TSH levels in the blood are high when the thyroid gland is underactive.

Free thyroxine test

The diagnosis of Hashimoto's disease requires complementary studies
Laboratory studies are important to evaluate the functional characteristics of the thyroid gland.

The free thyroxine (free T4) test isn’t always prescribed to check the level of active thyroid hormone in the blood. Generally, a second TSH test is ordered.

  • A person has primary hypothyroidism if they have high TSH and low free thyroxine.
  • In contrast, if the person has high TSH but normal free thyroxine, then they may have subclinical hypothyroidism.
  • Keep in mind that some patients may temporarily have high TSH levels due to other health problems.

Thyroid peroxidase antibodies

Experts indicate that, in order to determine the diagnosis of Hashimoto’s disease, the doctor will ask for a blood test to look for antibodies to thyroperoxidase (TPO), which are usually present in people with the disease.

Imaging tests

If the doctor suspects that the person has the disease, but they don’t have any antibodies in the blood, the doctor will probably ask for an ultrasound of the thyroid. This is a useful test to assess the condition of the gland and also to rule out other causes of an enlarged thyroid, such as nodules.

What to expect from a diagnosis of Hashimoto’s disease?

Once the doctor has confirmed the diagnosis of Hashimoto’s disease, they’ll most likely prescribe regular treatment and monitoring. The first is usually scheduled after 6-8 weeks of treatment. All this is carried out to improve how the body has responded to treatment, and whether or not it’s necessary to adjust the dosage of drugs, etc.

Attending scheduled check-ups (generally every few months) will be very useful in keeping the disease under control and enjoying a good quality of life.

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