The Most Common Cause of Hypothyroidism is Often Missed (and Why You May Not Feel Better Even if You’re Taking Thyroid Hormone)

Hashimotos Disease Hypothyroid


Twenty-three years ago, when my efforts to lose weight just weren’t working like I felt they should have, I decided to test my thyroid hormones. It was then that I first discovered I had hypothyroidism.

I immediately dove into a study of treatment options, and for the next several years, I was faithful in doing all the things that I discovered to support my thyroid. The weight came off, and during those years, I felt great.

Back then, I was missing one key component in the management of my hypothyroidism.

Eventually, not addressing this crucial piece resulted in NOT feeling so great. Fortunately, through working with women in my practice in the years since, I’ve discovered new protocols for hypothyroidism that can help you.

During the summer of 1999, I was living in beautiful Evergreen, Colorado and I remember purchasing a large portable air-conditioning unit for my master bedroom. Homes didn’t have central air – the climate didn’t demand it. I was suffering because my night sweats had become unbearable. Almost all of the women I treated who had night sweats were in their 50s.

At 38, I was pretty sure I was too young to be going through menopause. I ordered the necessary lab tests – which showed I was not in perimenopause… And I had just put myself through an adrenal reset protocol. Not menopause, not adrenal dysfunction, so I blamed my anxiety on lack of sleep.

It’s hard to get good, restorative sleep when you wake up soaking wet two or three times every night.

I discovered that my anxiety and night sweats were symptoms related to my thyroid issues. I knew I had Hashimoto’s Thyroiditis, and I had been following protocols geared toward supporting my thyroid gland.

I was ONLY supporting my thyroid, though, and missing the key component: I hadn’t been directly or adequately addressing my immune dysfunction. So again, I got busy researching and studying, and then applying what I learned to myself and hundreds of other women.

In my practice, I end up meeting so many women suffering needlessly, all because the diagnosis of Hashimoto’s is missed, and therefore, they are not getting the proper care for their hypothyroidism.

In this article, we’ll cover these topics regarding Hashimoto’s Thyroiditis:

  • What exactly is Hashimoto’s Disease?
  • How it is diagnosed – and the lab test you MUST have
  • Why conventional medicine so frequently fails to diagnose the condition
  • The risks to if you’re not properly diagnosed
  • How the approach mainstream medicine uses does not offer the best management

In Part 1 of this series, we covered why hypothyroidism is one of the most common causes of FATIGUE in women.

In Part 2, discussed the two ways conventional lab tests fall short. I also shared the six tests needed to accurately diagnose your thyroid’s function:

  • Thyroid Stimulating Hormone (TSH) – produced by the pituitary gland
  • Free T4 (fT4) – Thyroxine
  • Free T3 (fT3) – Triiodothyronine
  • Thyroid Peroxidase Antibodies (TPO)***
  • Thyroglobulin Antibodies (TG)
  • Reverse T3 (rev. T3)

***TPO is the crucial test for detecting Hashimoto’s Disease.


What is Hashimoto’s Thyroiditis?

Hashimoto’s Thyroiditis is an autoimmune disease, which eventually ends up as hypothyroidism (a condition of its own). It is the leading cause of hypothyroidism in the U.S. As this autoimmune condition unfolds, the body attacks and destroys its own thyroid gland. It may also be referred to as Hashimoto’s Disease, autoimmune thyroiditis, or chronic lymphocytic thyroiditis. Antibodies (a component of your natural defense against invaders) go haywire, and end up mounting an attack on your body’s own cells. In the case of Hashimoto’s, the antibodies wage war against proteins in the thyroid gland. The destruction can result in an eventual inability to produce thyroid hormone, which your body requires.

At this time, experts agree that it is not a disease that can be cured, but one that can be tamed or put into remission… And that is best done with Lifestyle Medicine. The goal is to support the thyroid gland (and the person with the condition, of course) and to calm the immune system. More importantly, these lifestyle strategies and modifications, such as stress management, adequate sleep, eating healing foods, proper exercise, and key supplements, can prevent other, future autoimmune diseases from developing.

Drug therapies to suppress the immune system are way too aggressive for this condition.

The Lab Test You MUST Have

The diagnosis of Hashimoto’s Thyroiditis is straightforward (refer to the six tests above, and note the test highlighted in red). TPO antibodies will be present. Less often (but sometimes), TP antibodies will show up – so have both tested initially. No antibodies to your thyroid should be present.

Here’s an important caveat: if your condition is dormant when the test is run, the antibody tests will be negative. Whenever I see a patient with a history and all the symptoms suggestive of Hashimoto’s, however, I always repeat the test. On occasion, I’ve had to test up to four times before the antibodies showed up.

In the early stages of Hashimoto’s Thyroiditis, specifically during times when the immune system is calm, lab tests can look normal. This means you don’t have hypothyroidism… YET. If your TPO antibodies get evaluated, MOST of the time, they will be seen (you really shouldn’t have ANY antibodies present).

Other times, your hormone levels will actually test too high. This is because, when your immune system is attacking the cells of your thyroid, the gland will dump hormones into your bloodstream. As the immune system mounts its attack and the gland dumps excess hormone into the bloodstream, you may have symptoms of an overactive thyroid, or hyperthyroid. Common complaints with overactive thyroid are insomnia, night sweats, nervousness, feeling extra emotional, heart palpitations, and/or racing pulse.

In my case, these immune surges (or thyroid storms) were causing my anxiety and night sweats.

Potential Dangers of Missed Diagnosis

Here’s how you could be at risk:

If you’re taking synthroid or ANY thyroid hormone, your labs tests could look just fine – but if your doctor has never checked your antibodies, you’d have no way of knowing that your immune system is raging war on your thyroid gland. It’s possible that you’d feel okay.

So, the danger is this: if you aren’t aware that you have Hashimoto’s, then your immune system won’t be addressed. Even if your conventional doctor were to test your antibodies and discover that you have autoimmune thyroid disease, you won’t get care for your immune dysfunction. No protocols exist in conventional medicine for autoimmune thyroid issues, and if you’re like me, you might feel fine. I did for almost five years… But eventually I became symptomatic because I hadn’t yet discovered the protocols to care for my immune deregulation. Now I’m back to feeling amazing, thanks to the new protocols I’ve created.

Bottom Line: you must have your TPO Antibodies tested – as well as TP antibodies, though they are elevated much less frequently than TPO antibodies.

How Conventional Medicine Fails with Hashimoto’s

Hashimoto’s Thyroiditis is an example of a health condition where conventional medicine fails to provide adequate management for the patients who have it (mostly women). Even though it is the most common cause of hypothyroidism in the US, it is frequently overlooked – and the vast majority of doctors don’t ever test for it. If they did run the auto-antibody test (which they don’t), it wouldn’t change their treatment protocol. They just prescribe thyroid hormone medication.

The expectation is that the thyroid will continue to lose its ability to function properly, so they run tests to monitor hormone levels in the blood to make adjustments in medication. The current traditional healthcare system does not offer adequate care for Hashimoto’s because there is a lack of a model for successful treatment. The mechanisms of the auto-immunity are left unaddressed. I have yet to consult with a woman who has been properly tested, or whose condition is being managed appropriately… And you may very well be one of the women paying the price.

In his book, “Why do I still have thyroid symptoms when my lab tests are normal?” Datis Kharrazian shares his experience with how hypothyroidism is managed:

“As other hypothyroid symptoms pop up, the standard of care is to prescribe powerful medications, such as Prozac for depression or even drugs to slow the heart or suppress the adrenal glands. Another approach is to remove the thyroid gland, which doesn’t always work either, as some tissue is inevitably left behind and can still serve as a site for autoimmune attacks. Typically the immune suppressant prednisone is a standard treatment for autoimmune disease, but it’s too aggressive for Hashimoto’s. Instead, doctors wait for the thyroid to ‘burn out,’ meaning to lose function due to extensive tissue death. Then they prescribe thyroid replacement hormone.”

What Should You Do Today?

Get proper testing. On your initial test, ask for all six components as outlined above.

As I mentioned in part 2, if your doctor won’t order what you need, here’s what I suggest you do:

  • Explain that you don’t mind paying out of pocket if your insurance doesn’t cover the comprehensive testing. Sometimes that’s why doctors are hesitant to include all 5 components.
  • Find a doctor who will listen and work with you. Look for one trained in Integrative and/or Functional Medicine.
  • Have your blood work done yourself. Google “direct to consumer lab testing” to see the options in your area. Any Lab Test Now is an option people in our area use frequently. Once you receive your results, you can bring them to the practitioner you are going to be working with
    (remember, sometimes it’s necessary to REPEAT antibody testing a few times).

Watch for Part 4, because I’ll explain the treatment options for hypothyroidism – AND if it turns out that you have Hashimoto’s, you’ll learn how to address what’s going on with your immune system. You can sign up below to receive immediate notification when new articles are posted – that way you won’t miss a thing! 

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  • Kharrazian, Datis (2010-02-02). Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?: A Revolutionary Breakthrough In Understanding Hashimoto’s Disease and Hypothyroidism (Kindle Locations 693-697). Morgan James Publishing. Kindle Edition.
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