Hashimoto’s Thyroiditis: Why So Many People Are Still Struggling
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the United States, affecting an estimated 14 to 20 million people. Despite how common it is, this condition remains widely misunderstood, frequently underdiagnosed, and often incompletely treated. Many individuals spend years being told their labs are “normal” while continuing to feel profoundly unwell.nd out
One of the biggest reasons for this disconnect is that Hashimoto’s is not simply a thyroid hormone deficiency. It is a chronic autoimmune disease. When the immune system mistakenly targets the thyroid gland, hormone production may eventually decline, but the autoimmune process itself often begins long before standard thyroid labs become abnormal. How we define Hashimoto’s matters because the definition drives treatment.
What Hashimoto’s Thyroiditis Is
Hashimoto’s thyroiditis, or autoimmune thyroiditis, is an autoimmune condition in which the immune system produces antibodies that attack thyroid tissue. Over time, this immune-mediated inflammation damages the gland, impairing its ability to produce adequate thyroid hormone and ultimately leading to hypothyroidism.
This autoimmune activity can be present for years before thyroid hormone levels fall outside conventional reference ranges. During this time, many people experience symptoms that are dismissed, minimized, or attributed to stress, aging, or lifestyle. Hashimoto’s is also known for its fluctuating nature, with periods of relative stability followed by symptomatic flare-ups, which further complicates recognition and diagnosis.
Common symptoms of Hashimoto’s include:
Persistent fatigue that does not resolve with rest
Weight gain or difficulty losing weight
Cold intolerance
Hair thinning or hair loss
Constipation
Depression, low motivation, or apathy
Brain fog and difficulty concentrating
Muscle and joint pain
Throat or neck discomfort
Because thyroid hormone influences nearly every system in the body, symptoms are often widespread rather than isolated to one organ system.
Why the Thyroid Has Such a Wide Reach
The thyroid gland may be small, but its hormones regulate metabolism, cardiovascular function, digestion, neurological activity, reproductive hormones, and temperature regulation. When thyroid signaling is disrupted, whether from inadequate hormone production or ongoing immune-mediated inflammation, the effects ripple throughout the body.
This is why Hashimoto’s is rarely just about feeling tired or gaining weight. It can affect mood, cognition, cholesterol metabolism, menstrual cycles, gut motility, and inflammatory balance. Treating it as a narrow endocrine issue misses the broader physiological reality.
The Labs That Diagnose Hashimoto’s (and the Ones That Don’t)
Most people evaluated for thyroid concerns receive only a TSH and sometimes a free T4, if they are lucky. These tests can identify overt hypothyroidism, but they do not diagnose Hashimoto’s. They measure hormone output, not immune activity.
Hashimoto’s is diagnosed by identifying thyroid-directed autoantibodies, which indicate that the immune system is attacking the gland itself.
The primary labs used to diagnose Hashimoto’s are:
Thyroid peroxidase antibodies (TPO antibodies)
Thyroglobulin antibodies (Tg antibodies)
It is entirely possible, and very common, for someone to have normal TSH and thyroid hormone levels while having elevated antibodies and significant symptoms. This can occur for up to 7 years before changes in TSH and thyroid hormones fall out of range on conventional lab ranges. This represents early or evolving autoimmune thyroid disease, a phase that is often overlooked in traditional care.
Why Thyroid Antibodies Are So Often Ignored
Many patients are surprised to learn that their thyroid antibodies were never tested, even after years of symptoms. The reason is not oversight so much as philosophy.
In conventional medicine, there are no medications specifically designed to lower thyroid antibodies. Standard treatment focuses on replacing thyroid hormone once levels fall below the range. Because antibody levels do not change medication decisions in most conventional models, they are often considered clinically irrelevant.
From a functional and integrative perspective, this is where the greatest opportunity lies. Antibodies are not just markers; they reflect ongoing immune dysregulation. Ignoring them means ignoring the autoimmune process itself.
What Conventional Treatment Does Well—and Where It Stops
Thyroid hormone replacement, most commonly levothyroxine, is highly effective at correcting hormone deficiency. It can normalize TSH, prevent severe hypothyroid complications, and improve certain symptoms.
What it does not do is address the immune system. Hormone replacement does not reduce antibody levels, halt immune-mediated thyroid destruction, or identify the triggers that initiated the autoimmune response. This is why many people remain symptomatic despite “normal” labs and appropriate dosing.
This gap between lab normalization and lived experience is one of the most frustrating realities for people with Hashimoto’s.
A Functional Medicine Approach to Hashimoto’s
My approach to Hashimoto’s is grounded in the understanding that autoimmune disease is systemic, not organ-isolated. The goal is not to replace conventional care, but to complement it by addressing the immune dysfunction driving the condition.
Here are some thyroid lab warning signs that your thyroid needs more attention. These are just my personal reference ranges. Your medical provider may not interpret them the same, but this may help YOU determine if a second opinion is worth your time
TSH is great than 2.00
Free T3 is lower than 3.0
Free T4 is less than 1.1
If any of your markers meet this criterion, ask for
reverse T3
TPO antibody
anti-thyroglobulin antibody
plasma selenium
24-hour urinary iodine
If your provider will not order them, contact me or seek out a functional medical provider in your area.
Depending on the lab used, antibody reference ranges vary, so I will not list them here. Regardless of my reference ranges, if the lab flags them as high, it’s a concern and needs to be addressed.
Rather than focusing solely on hormone replacement, a functional approach looks at the broader terrain in which autoimmunity developed and continues to operate.
Core pillars of this approach include:
Supporting immune regulation rather than immune suppression
Assessing and healing gut-immune dysfunction
Correcting nutrient deficiencies that influence thyroid and immune signaling
Identifying chronic infections, environmental exposures, or toxic burdens that perpetuate immune activation
Addressing stress physiology and neuroendocrine imbalance
When these areas are addressed, many patients experience improved energy, fewer flares, better cognitive clarity, and greater symptom stability, whether or not they remain on thyroid medication.
Why Antibodies Still Matter After Diagnosis
Lowering thyroid antibodies is not about chasing perfect numbers. It is about reducing inflammatory load, slowing thyroid tissue damage, and creating a more stable internal environment. Antibody trends can offer valuable insight into whether the immune system is calming or continuing to escalate.
Many patients notice that as immune activity improves, their symptoms become more predictable, less severe, and easier to manage. This is especially important for long-term thyroid preservation and overall autoimmune health.
Living Well With Hashimoto’s
Hashimoto’s does not have a one-size-fits-all solution. But it does respond to thoughtful, layered care that respects both the immune system and the patient's lived experience.
Some fundamental herbs and nutrients that support Hashimoto’s Thyroiditis include:
Methanoselenium
Iodine
Zinc
myo-inositol
NAC, N-acetyl cysteine
Nigella sativa (black cumin)
Probiotics- particularly with bifidobacterium strains and Lactobacillus reuteri
Turmeric/curcumin
Irish moss
Broccoli extract
polyresveratrol/ resveratrol
Other things to address: poor sleep, insulin resistance or poor blood sugar regulation, weight gain, food allergies or sensitivities such as gluten or dairy, poor lymphatic movement, poor digestion, high alcohol consumption
Please consult your physician before taking any of the above products to ensure they are an ideal fit for you and that these nutrients do not interact with any current medications or medical conditions you may have.
Hashimoto’s thyroiditis does not have to be a lifelong struggle. With proper testing, a deeper understanding of autoimmunity, and a comprehensive approach to immune health, many people regain a sense of stability and vitality they were told was no longer possible.
Being told to “just live with it” is not the same as being given a plan. Education, advocacy, and whole-body support change outcomes.
I have worked with many women struggling with the symptoms with no answers. If you want to have a provider on board that actually runs the tests, interprets them differently, and addresses the root cause, you are in the right place.
Here to empower you with the knowledge of health,
Dr. Meg Holpuch
Disclaimer: The information provided on this blog is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. The content shared here is not meant to replace or supersede the guidance or recommendations of your personal healthcare provider. Always consult your physician or qualified healthcare professional before making any changes to your diet, exercise routine, supplement regimen, or overall health plan. Your health and well-being are unique, and decisions regarding your care should always be made in consultation with your trusted healthcare provider.
