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Your doctor says you have hypothyroidism and this explains feeling like crap, the crazy weight gain, and your distressing hair loss. But how do you know if Hashimoto’s is causing your hypothyroidism? Hashimoto’s is an autoimmune disease, meaning the immune system is attacking and destroying the thyroid gland.

Hashimoto’s is responsible for more than 90 percent of hypothyroid cases. Chances are strong it’s the cause of your low thyroid function too.

But if your doctor does not want to screen for Hashimoto’s or if you would like to be sure, here are some tips to help you figure out if you have Hashimoto’s hypothyroidism.

You feel worse despite taking your thyroid medication

One of the most common signs of Hashimoto’s is you still have symptoms despite taking your thyroid meds. In fact, your doctor prescribes ever increasing doses as your thyroid function deteriorates. You may even notice no difference if you forget to take your meds. Why don’t thyroid meds help in many cases of Hashimoto’s? Because the immune system continues to attack and destroy the thyroid gland even though the meds may make your TSH levels look normal.

You swing back and forth between low thyroid and high thyroid symptoms

Swinging back and forth between under active and over active thyroid function is another common sign of Hashimoto’s. One week you suffer from fatigue, headaches, constipation, depression, and low libido. The next week you have insomnia, a racing heart, anxiety, and tremors. This is because a flare up that damages thyroid tissue causes excess thyroid hormone to spill into the bloodstream. You may be misdiagnosed with anxiety or even bipolar disorder.

If you run blood tests during these surges and crashes you will see TSH also peaks and dips. TSH may even test as normal for short periods as its moves between these swings. This can lead to a misdiagnosis if you drew your blood during that time.

You have pernicious anemia, celiac disease, or other autoimmune diseases

Autoimmune diseases such as Hashimoto’s are the result of an imbalanced immune system. It’s very common for people with one autoimmune disease to develop more. This is because the imbalanced system becomes overly sensitive and loses tolerance to new tissues in the body.

If you have hypothyroidism and other autoimmune diseases, chances are you also have Hashimoto’s. Pernicious anemia (an autoimmune disease that causes B12 deficiency), celiac disease, or a gluten intolerance are all commonly linked to Hashimoto’s.

If you think you might have Hashimoto’s, see if any of these symptoms apply to you.

Under active thyroid symptoms

• Feeling tired or sluggish
• Feeling cold — hands, feet, all over
• Require excessive amounts of sleep to function well
• Weight gain despite adhering to a low-calorie diet
• Gaining weight easily
• Difficult, infrequent bowel movements
• Depression and lack of motivation
• Morning headaches that wear off as the day progresses
• Outer third of eyebrow thins
• Thinning of hair on scalp, face, or genitals, or excessive hair loss
• Dryness of skin and/or scalp
• Mental sluggishness

Over active thyroid symptoms

• Heart palpitations
• Inward trembling
• Increased pulse rate, even at rest
• Feeling nervous and emotional
• Insomnia
• Night sweats
• Difficulty gaining weight

Confirming Hashimoto’s

Symptoms are important but a blood test provides the proof you may need to convince doctors or family members. Look for these markers:

Thyroid peroxidase antibodies (TPO Ab). In most cases of Hashimoto’s the immune system attacks TPO, an enzyme that triggers thyroid hormone production.

Thyroglobulin antibodies (TGB Ab). You should also test for antibodies to TGB, which the thyroid uses to produce thyroid hormones.

Thyroid stimulating hormone antibodies (TSH Ab). This test can identify Graves’ disease (hyperthyroidism), although sometimes TSH antibodies can be elevated in Hashimoto’s. On lab tests, this marker is often labeled thyroid stimulating immunoglobulin (TSI). If your autoimmune thyroid condition is advanced, you have multiple autoimmune diseases, and/or you react to bioidentical thyroid meds but not synthetic, you may also have antibodies to T4 and T3.

When your test comes back negative despite massive symptoms

Don’t despair if your test comes back negative even though you have all the classic symptoms. Because the immune system and inflammation wax and wane, you may have had your blood draw during a time the immune system is not attacking the thyroid gland. However, if you’re test is positive this confirms Hashimoto’s hypothyroidism and that the immune system should be a target for therapy. Ask my office for more advice on managing Hashimoto’s hypothyroidism using functional medicine.