Hashimoto’s Flare-Up Symptoms, Causes, and Treatment Option
A Hashimoto’s flare-up can cause sudden Hashimoto’s symptoms, including cold sensitivity, joint pain, weight gain, constipation, and major fatigue. There are safe, effective, and natural treatment options for Hashimoto’s thyroid disorder, such as dietary and lifestyle changes.
Close to 1 in 8 women will experience a thyroid issue in their lifetime, and this rate of thyroid problems has no signs of slowing down. Having a thyroid hormone imbalance is something I see almost daily in my telehealth functional medicine clinic.
However, there is one thyroid problem that I see more than anything else: Hashimoto’s disease.
This autoimmune disorder can be debilitating. Conventional doctors may offer limited treatment options like non-biocompatible medications, such as levothyroxine (thyroid hormone replacement), which all have long lists of side effects.
In functional medicine, we know there is another way. Your body can heal naturally by us identifying and addressing the root cause of your symptoms.
Sometimes, Hashimoto’s flare-ups do happen, and symptoms can come back. In order to address a Hashimoto’s flare-up, let's first explore what Hashimoto’s is and what triggers flare-ups in the first place so that healing can begin from the inside out.
Tired of feeling controlled by chronic health challenges? Check out my Autoimmune Health Reset Program to address these challenges.
Symptoms Of A Hashimoto’s Attack
What is Hashimoto’s disease? Hashimoto’s thyroiditis is an autoimmune condition where your immune system attacks healthy thyroid cells. It is the most common cause of hypothyroidism (underactive thyroid), with research estimating that up to 90% of all hypothyroidism cases are autoimmune in nature. (1)
A Hashimoto’s flare-up happens if you generally have your symptoms of Hashimoto’s under control, but they suddenly reappear, leaving you feeling terrible. Flare-ups can look different for different people. Generally, a flare-up of Hashimoto’s can be similar to hypothyroidism and include these symptoms:
- Constipation
- Fatigue
- Weight gain
- Brain fog
- Poor concentration
- Brittle hair and nails
- Cold sensitivity
- Muscle aches and pains
- Anxiety or depression
- Pale and dry skin
- Hair loss
- Heavy periods
- Enlarged thyroid gland (goiter)
The number of times you experience a flare-up can vary depending on what triggered it in the first place. One flare-up may feel different from the last, depending on many factors, including diet, lifestyle, medications, hormones, environmental factors, and more.
Causes + Triggers
Since everyone’s biochemistry is different, Hashimoto’s flare-up triggers will be unique to you. Some people might seem to have a higher or lower threshold for certain triggers than you do.
Nutritional Deficiencies
Your thyroid hormones and immune system both rely on a delicate balance of key nutrients to function optimally. Nutritional deficiencies may lead to autoimmune problems, including reducing thyroid hormone levels.
Deficiencies in selenium, vitamin D, zinc, magnesium, and iron have been linked to poor immune function in people with autoimmune thyroid conditions. (2, 3, 4)
Iodine is a major nutrient needed for producing thyroid hormones. Therefore, an iodine deficiency can potentially trigger a Hashimoto’s attack. Be aware, though, that too much iodine may sometimes flare up Hashimoto’s symptoms.
Diet
You may be eating too much of certain irritating foods. Many of my patients with Hashimoto’s find that even a small amount of gluten can flare up their symptoms, with studies showing that the inflammatory effects of gluten can last up to 6 months in your body. (5)
If you are predisposed to an autoimmune condition, certain foods can cause your immune system to overreact, so it’s important to pay attention to any possible food intolerances that you may have.
A functional medicine practitioner can help you uncover the specific foods contributing to inflammation in your body. I have found that an anti-inflammatory diet often improves thyroid function.
Chronic Stress
Many of my patients discover that their thyroid problems start after a stressful time in their lives. Prolonged stress messes with your thyroid gland and immune system in a one-two punch.
Cross-sectional research has confirmed the stress-thyroid connection. (6)
Your primary stress hormone, cortisol, can block the conversion of T4 (the primary thyroid hormone, thyroxine) to the active T3 (the secondary thyroid hormone, triiodothyronine), confusing the delicate balance of thyroid hormones essential for good health.
Read Next: Warning Signs You Are Chronically Stressed + Exactly How To Chill Out For Good
Hormonal Imbalances
Autoimmune thyroiditis is inherently caused by thyroid hormone imbalances, but other hormonal changes can increase your risk of flare-ups of symptoms of hypothyroidism.
A recent study shows that hormone changes increase the chances of autoimmunity, especially during puberty. (7) Additionally, I’ve seen women experience hormone change-related autoimmunity during pregnancy, menopause, and other periods of hormonal alterations.
Exposure To Toxins
Our world has become increasingly toxic, resulting in greater harm to thyroid health and autoimmunity.
Studies have shown that chemicals and heavy metals can cause an autoimmune response against the thyroid. (8)
Check your home and workplace for risk factors of environmental toxins, including mold and heavy metals.
Read More: Autoimmune Disease: A Functional Wellness Guide To Symptoms, Causes + Natural Treatments
Treatment + Prevention
How can I manage Hashimoto’s flare-ups naturally? In mainstream medicine, you typically receive the same thyroid medication whether you have true primary hypothyroidism or autoimmune Hashimoto’s. In functional medicine, we aim to treat the root of your autoimmune thyroid problems through natural tools and lifestyle adjustments, such as stress relief, diet changes, and supplements.
Let’s cover the short-term and long-term treatment and prevention options for Hashimoto’s flare-ups.
Schedule a consultation at my telehealth clinic so you and I can identify and address your underlying causes of Hashimoto’s. Together, we can create a personalized treatment plan designed for you and your unique health needs.
For The Short-Term
If you’re experiencing a Hashimoto’s flare-up, here are my top short-term treatment suggestions:
- Eliminate food triggers from your diet. Certain foods, such as dairy, soy, gluten, and processed foods, may trigger a Hashimoto's attack. If you’re unsure about what foods to avoid, an elimination diet may be required.
- Reduce your stress levels. Since stress is a huge trigger for flare-ups, it’s critical to alleviate stress as much as possible for your immune and thyroid health. If you are in the middle of a flare-up, do mindfulness practices like meditation and deep breathing exercises to actively lower your real-time cortisol levels.
- Check your supplement cabinet. Top immune supplements include vitamin D, zinc, vitamin B complex, and selenium. Iodine may specifically help your thyroid health but don’t take too much.
Long-Term Solutions
Here are my long-term solutions to prevent future Hashimoto’s flare-ups:
- Learn to avoid stress. Take note of what things stress you out, whether it’s relationships or situations. Limit your exposure to these stressors to avoid a potential flare-up. Spend more time outside and get plenty of sleep — both are effective stress management techniques. (9)
- Adhere to an elimination diet. Unsure what foods are causing your Hashimoto’s flare-up? A one-time elimination diet helps determine which foods are optimal for your body. By eliminating a specific set of foods most likely to cause inflammation and slowly reintroducing them one at a time, you’ll see what foods your body loves and which are better kept off your grocery list.
- Invest in gut health. Since the majority of your immune system lives in your gut, I recommend investing in your gut health to support a healthy immune system and prevent autoimmune flare-ups. Probiotics are effective for many. Ask your healthcare provider about leaky gut syndrome.
- Steer clear of toxic products. Switch to non-toxic products — particularly beauty and personal care products that are absorbed directly into your skin — to help lower your toxin load, chronic inflammation, and detoxification pathways.
- Supplement wisely. If you know you are deficient in certain nutrients, consider dietary supplementation. While food is foundational, quality supplements can sometimes help overcome deficiencies.
- Avoid excess iodine. Iodine is necessary for thyroid hormone production. However, it’s easy to go overboard if you have Hashimoto’s disease. Avoid products fortified with iodine, like table salt, and opt for Himalayan pink sea salt instead.
Video Course: Mastering Autoimmune Conditions & Inflammation With Functional Medicine
Seeking Help From A Functional Medicine Expert
If you’re tired of constant flare-ups and living with the side effects of your medication, you’re not alone. The good news is that there is hope for healing before your Hashimoto’s progresses too far.
I have worked with countless patients experiencing thyroid issues and thyroid disease. A Hashimoto’s flare-up can be discouraging, but once you know what triggers your symptoms, you can make a plan to avoid flare-ups and overcome them if they do occur.
In my telehealth functional medicine clinic, we work with you to run more comprehensive thyroid blood tests with narrow reference ranges to identify your triggers, determine the root cause of your thyroid problems, and make a plan for long-term sustainable healing.
If you are ready to take that next step, consider a telehealth consultation to learn more about how we can help your Hashimoto’s symptoms with functional medicine.
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- Amino, N. (1988). 4 Autoimmunity and hypothyroidism. Baillière's Clinical Endocrinology and Metabolism, 2(3), 591-617.
- Gärtner, R., Gasnier, B. C., Dietrich, J. W., Krebs, B., & Angstwurm, M. W. (2002). Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. The Journal of Clinical Endocrinology & Metabolism, 87(4), 1687-1691.
- Baeke, F., Takiishi, T., Korf, H., Gysemans, C., & Mathieu, C. (2010). Vitamin D: modulator of the immune system. Current opinion in pharmacology, 10(4), 482-496.
- Zimmermann, M. B., & Köhrle, J. (2002). The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid, 12(10), 867-878.
- Mainardi, E., Montanelli, A., Dotti, M., Nano, R., & Moscato, G. (2002). Thyroid-related autoantibodies and celiac disease: a role for a gluten-free diet?. Journal of clinical gastroenterology, 35(3), 245-248.
- Puttaswamy, S. H., Nandibewur, N. P., Kumar, P., Venkataiah, V., & Pinjar, M. J. (2024). A Cross-Sectional Study of the Relationship Between Perceived Stress and Thyroid Function Among Apparently Normal Women in the Reproductive Age. Cureus, 16(3).
- Angum, F., Khan, T., Kaler, J., Siddiqui, L., & Hussain, A. (2020). The prevalence of autoimmune disorders in women: a narrative review. Cureus, 12(5).
- Langer, P., Kočan, A., Tajtaková, M., Petrík, J., Chovancová, J., Drobná, B., ... & Klimeš, I. (2007). Fish from industrially polluted freshwater as the main source of organochlorinated pollutants and increased frequency of thyroid disorders and dysglycemia. Chemosphere, 67(9), S379-S385.
- Jimenez, M. P., DeVille, N. V., Elliott, E. G., Schiff, J. E., Wilt, G. E., Hart, J. E., & James, P. (2021). Associations between nature exposure and health: a review of the evidence. International journal of environmental research and public health, 18(9), 4790.
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BY DR. WILL COLE
Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is also the host of the popular The Art of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, Gut Feelings, and The Inflammation Spectrum.
Gut Feelings
Healing The Shame-Fueled Relationship
Between What You Eat And How You Feel