How to diagnose hashimotos

How to diagnose hashimotos

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.


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

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

Free thyroxine test

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.


  • 1 Department of Ultrasound, Suzhou Wuzhong Peoples’s Hospital, Suzhou, China, [email protected]
  • 2 Department of Ultrasound, Jiangyin Hospital Affiliated of South-East University, Jiangyin, China.
  • 3 Department of Ultrasound, Suzhou Wuzhong Peoples’s Hospital, Suzhou, China.
  • PMID: 27100487
  • DOI: 10.2741/4437

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  • 1 Department of Ultrasound, Suzhou Wuzhong Peoples’s Hospital, Suzhou, China, [email protected]
  • 2 Department of Ultrasound, Jiangyin Hospital Affiliated of South-East University, Jiangyin, China.
  • 3 Department of Ultrasound, Suzhou Wuzhong Peoples’s Hospital, Suzhou, China.
  • PMID: 27100487
  • DOI: 10.2741/4437


Hashimoto’s thyroiditis is a type of autoimmune thyroid disease with an increasing prevalence in past decades. Its diagnosisis mostly based on ultrasonography. Ultrasonography is a useful and essential tool to make this diagnosis based on the characteristics of the disease. In the differential diagnosis of thyroid nodules, ultrasound-guided fine-needle biopsy is an effective method to distinguish Hashimoto’s thyroiditis from other thyroid disorders. One exciting and recent advance is that non-invasive ultrasound-based methods have supplemented fine-needle aspiration to diagnose Hashimoto’s thyroiditis under more complex conditions. In this review, we discuss the recent advantages of ultrasonography in the diagnosis of Hashimoto’s thyroiditis.

February 6, 2018 by Megan

How to diagnose hashimotos

What is Hashimoto’s Thyroiditis?

Hashimoto’s is an autoimmune condition that causes the thyroid gland to be “attacked” by auto-antibodies. What this means is that the body produces an immune response against certain cells or components of the thyroid. This leads to destruction of the thyroid, and subsequent hypothyroidism.

There are two antibodies that are associated with Hashimoto’s

  1. Anti-Thyroperoxidase or Anti-Thyroid Peroxidase (anti-TPO): This is an antibody against the enzyme responsible for the production of thyroid hormone. Thyroperoxidase (TPO) enzyme is needed to oxidize iodine, allowing it to bind with tyrosine to form T4 and T3.
  2. Anti-Thyroglobulin (anti-TG): This is an antibody produced against the “building block” of thyroid hormone (thyroglobulin). Thyroglobulin (TG) is the protein produced by the thyroid gland and acts as the precursor to T4 and T3.

Diagnosing Hashimoto’s

Hashimoto’s is diagnosed through a blood test that assesses for the presence of these antibodies. The presence of anti-TG without anti-TPO is not sufficient for a diagnosis of Hashimoto’s.

Anti-TG is not often tested due to its low specificity and sensitivity in Hashimoto’s patients. One study conducted on over 2000 Hashimoto’s patients found that only 36% of patients were positive for anti-TG, while 99% were positive for anti-TPO.

In order for Hashimoto’s to be diagnosed, anti-TPO must be above a certain level. If anti-TPO is detected at a low level, this may increase the risk of developing Hashimoto’s in the future. Often, anti-TPO levels may be high despite a normal thyroid panel (TSH, T4 and T3). This makes it challenging to diagnose, as symptoms may not be present until thyroid hormone production is impacted enough to affect the ability to continue to produce sufficient amounts.

What Causes Hashimoto’s?

The cause of many autoimmune conditions is largely unknown. In some, such as Hashimoto’s, there is a genetic component. This means that if you have a relative with Hashimoto’s, it increases your chances of also developing it. Autoimmune conditions have also been associated with chronic viral infections, chronic inflammation, disturbances in the gut microbiota, and certain vitamin and nutrient deficiencies.

Hashimoto’s is the most common cause of hypothyroidism – in fact, approximately 80-90% of cases are caused by this autoimmune condition! It is also a lot more common in women than in men (us women are very complex creatures). If you have been diagnosed with hypothyroidism, but do not feel as if your symptoms are well managed despite treatment, make sure to ask about being tested for Hashimoto’s!

So What Do We Do?

Treating Hashimoto’s looks a little different from treating primary hypothyroidism (from a Naturopathic perspective). Conventionally, the treatment is often the same as in primary hypothyroidism – Levothyroxine or Synthroid. However, my treatments will involve a lot of dietary support, a focus on managing inflammation, targeted nutrients, and immune regulation. Stay tuned for a more in-depth review of what the research is finding to be the most effective strategies!