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Internal Medicine

Hashimoto's Thyroiditis (Chronic Lymphocytic Thyroiditis)

A chronic autoimmune disease in which the immune system attacks the thyroid gland and causes inflammation. By damaging the gland that regulates metabolism, it is the most common cause of an underactive thyroid (hypothyroidism).

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ℹWhat is Hashimoto's Thyroiditis (Chronic Lymphocytic Thyroiditis)?

Hashimoto's thyroiditis is a chronic autoimmune disease in which the body's immune system attacks its own thyroid gland and causes inflammation. By damaging the gland that regulates metabolism, it is the most common cause of an underactive thyroid (hypothyroidism).

Normally the immune system protects the body against bacteria and viruses. In Hashimoto's thyroiditis, it mistakes the thyroid for a foreign organ and starts producing antibodies against it, namely anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg). These antibodies drive chronic inflammation of the gland. Over time the thyroid tissue is destroyed and the gland can no longer produce enough T3 and T4 for the body's needs. This is called hypothyroidism.

Hashimoto's thyroiditis may cause no symptoms at first; signs and symptoms appear as the gland is damaged and hormone levels fall. No treatment can completely stop the autoimmune antibody attack. Treatment replaces the missing hormone.

Common Symptoms

Weakness and marked fatigue
Persistent tiredness and lack of energy as metabolism slows.
Weight gain
Hypothyroidism slows metabolism considerably, so weight is hard to lose even with dieting.
Skin and hair changes
Dry skin, hair loss and brittle nails.
Brain fog
Forgetfulness, poor concentration and sometimes a depressed mood.
Cold intolerance
Marked sensitivity to cold because metabolism is slowed.
Bowel and digestive problems
Persistent constipation.
Gynaecological problems in women
Irregular periods and heavy menstrual bleeding (menorrhagia).
Goitre
With too little thyroid hormone, the gland works harder to make more and enlarges. This enlargement can cause swelling in the neck.

Diagnosis Methods

Thyroid-Stimulating Hormone (TSH)
The pituitary keeps secreting TSH to drive the failing thyroid, so serum TSH is raised.
Free T3 and Free T4
Both hormone levels are usually low.
Thyroid Antibodies (Gold Standard)
Raised anti-TPO and anti-Tg levels confirm the autoimmune origin of the disease, that is, Hashimoto's thyroiditis.
Thyroid Ultrasound
The gland looks heterogeneous, with ill-defined patchy areas, which reflects inflammation of the thyroid.

Treatments

Thyroid Hormone Replacement
Synthetic T4 (levothyroxine; brands include Tefor, Levotiron and Euthyrox) replaces the hormone the body can no longer produce. It should be taken on an empty stomach and not at the same time as blood pressure medication.
Selenium Supplementation
In some cases, doctors may recommend selenium to help lower antibody levels.
Diet
Gluten sensitivity is common in Hashimoto's thyroiditis, so a gluten-free diet may ease digestive complaints.

Second opinion for Hashimoto's Thyroiditis (Chronic Lymphocytic Thyroiditis)

A second specialist's review of your Hashimoto's Thyroiditis (Chronic Lymphocytic Thyroiditis) diagnosis or treatment plan can clarify your next step. On eKonsey this review is done online.

When is a second opinion useful?

  • When the diagnosis is unclear or more than one possibility was discussed
  • When surgery or a long-term treatment was recommended
  • When the response to treatment is not what you expected

About second opinions

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Frequently Asked Questions

Last updated: October 15, 2026

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