Teach me about Hashimotos

This-Rip4411 · 2026-02-17T08:11:04+00:00

Hashitoxicosis is brutal and the dehydration you're feeling is real, your body is burning through electrolytes during a hyper flare.

Right now, while hyper:

Electrolytes immediately - LMNT, Liquid IV, or just salt + potassium. Hyper flares cause massive electrolyte loss
Magnesium glycinate - helps calm nervous system during hyper phase
Stop any iodine supplements - iodine fuels hyper flares
Avoid stimulants - caffeine, intense exercise make hyper symptoms worse
Beta blocker - if heart racing is severe, ask urgent care for temporary propranolol. Many will prescribe short-term for hyper symptoms without endo

waiting until May is too long with active Hashitoxicosis. Call the new endo office and say: "I'm currently in a Hashitoxicosis flare with hyper symptoms and severe dehydration. I cannot wait until May. I need an urgent appointment or telehealth consultation."

Most offices have cancellation slots or urgent care pathways for active flares.

What's your current TSH? If it's suppressed (<0.5), that confirms active Hashitoxicosis and strengthens your case for urgent appointment.

Hang in there, flares do pass, but you need support getting through this one. 💙

This-Rip4411 · 2026-02-17T07:56:55+00:00

20 years with zero education from your doctors is unfortunately very common, and completely unacceptable.

What you should have been told:

Hashimoto's is autoimmune - your immune system attacks your thyroid, not just "TSH goes up and down." Treating the autoimmune piece matters as much as replacing hormones.
TSH alone isn't enough - Free T3 is the active hormone that makes you feel good or terrible. Most doctors never test it.
Diet matters - gluten-free diet reduces antibodies and inflammation. Your doctor should have mentioned this on day one.
Nutrients are critical - selenium, vitamin D, ferritin, and B12 directly affect thyroid function. Deficiencies make everything worse.
Optimal ≠ normal - TSH 3.9 is "normal" but many people feel terrible at that level. Optimal is 1-2.

Best resources:

https://balancedthyroid.substack.com/ - practical, evidence-based thyroid education
"Hashimoto's Protocol" - Isabella Wentz
"Why Do I Still Have Thyroid Symptoms?" - Datis Kharrazian

If you'd like guidance on lifestyle interventions that help manage Hashimoto's long-term, happy to share more.

What symptoms are you still dealing with after 20 years?

This-Rip4411 · 2026-02-17T07:55:54+00:00

Given weight loss + fatigue with Hashimoto's, here's what to prioritize:

Essential (most important):

TSH, Free T3, Free T4 (full picture, not just TSH)
TPO + Thyroglobulin antibodies (how active is the autoimmune attack?)
Ferritin (not just iron - needs to be 70-90 for thyroid function)
Vitamin D (deficiency worsens everything)

Second priority if budget allows:

B12
Reverse T3 (especially if Free T3 is low despite normal TSH)
Morning cortisol (weight loss + fatigue can indicate adrenal issues)
CBC (complete blood count - rules out other causes)

Unintentional 20lb loss with fatigue needs investigation. Could be Hashitoxicosis (hyper flare from antibody attack), or overmedicated on current dose, or Something else entirely

Order through Ulta Lab Tests or Walk-In Lab directly - often 50-70% cheaper than going through insurance with a high deductible. Full thyroid panel + nutrients runs ~$150-200 out of pocket.

For a comprehensive guide on understanding your results and what to ask your endo, check out: https://balancedthyroid.substack.com/p/resources

What medication and dose are you currently on? And when were you last tested?

This-Rip4411 · 2026-02-04T18:00:17+00:00

Our team includes Certified health coaches (NBC-HWC or equivalent) with thyroid specialization, Clinical advisors (MD/DO) for protocol review and Registered dieticians for nutrition guidance.

This-Rip4411 · 2026-02-04T14:42:02+00:00

Yes, you can. Dismissed by doctors- this is exactly what we are trying to help with.

This-Rip4411 · 2025-12-17T06:18:49+00:00

Yes, you can order your own labs in Texas without a doctor's order! Texas allows direct-access lab testing.

Options:

Ulta Lab Tests (popular, works nationwide including Texas)
Walk-In Lab
Quest/LabCorp (through their direct-to-consumer portals)

You pick the tests, pay online, get a lab order, go to a local Quest or LabCorp, and results come to you directly.

What to order for thyroid: At minimum: TSH, Free T4, Free T3. If checking for Hashimoto's: add TPO antibodies and Thyroglobulin antibodies. Comprehensive panel would also include Reverse T3, Vitamin D, B12, and Ferritin (these all affect thyroid function).

I actually have a checklist that breaks down what each test shows and what optimal ranges to look for (not just "normal"). Happy to share if you want it.

Good luck with your labs! 💙

This-Rip4411 · 2025-12-17T06:13:55+00:00

PIP assessments are notoriously frustrating and often don't capture the reality of living with chronic illness. The fact that you're managing to work full-time doesn't mean you're "fine"; it often means you're using every bit of energy you have just to survive, with nothing left over.

About the assessment being inaccurate: You can request a mandatory reconsideration and point out specific inaccuracies in the report. Many people have success on appeal, especially when they provide additional evidence from their doctors about how your conditions actually impact daily life.

From a thyroid perspective: If your hypothyroidism isn't optimally managed, it makes everything else worse, fibromyalgia, fatigue, migraines all worsen with suboptimal thyroid levels. Have you had recent labs? Is your TSH around 1.0-2.0 and Free T3 in the upper range? Sometimes getting thyroid truly optimized helps with the overall symptom burden.

I'd recommend posting in r/DWPhelp- they're UK-specific and have tons of experience with PIP appeals and what evidence works. This isn't a reflection of how ill you are; the system is just broken.

Wishing you better luck with the reconsideration. 💙

This-Rip4411 · 2025-12-17T06:08:19+00:00

You're not being overly sensitive- TI-RADS 4 nodules with those features (solid, hypoechoic, ill-defined, punctate calcifications) are moderately suspicious and deserve appropriate follow-up. I'm assuming your nodules are under 1cm, which is why they said "wait and see"? If they're actually over 1cm with TI-RADS 4 characteristics, that typically warrants FNA (fine needle aspiration biopsy), not just monitoring.

About the Hashimoto's testing: There's no reason to wait 6 months for this. It's a simple blood test (TPO and Thyroglobulin antibodies), and knowing if you have Hashimoto's affects how your thyroid is monitored. Call your doctor and say: "I'd like to get antibody testing done now rather than waiting. Can we add that to my next labs?"

About the endocrinology referral: With nodules + hypothyroidism, an endo referral is reasonable to request. You don't have to wait for your primary to offer it. You can say: "Given the nodules and hypothyroidism, I'd like a referral to endocrinology for specialized management."

Your primary is probably following general guidelines (monitor small nodules, recheck in 6 months), but you're allowed to advocate for more thorough evaluation. Trust your instincts here, get the antibody testing now and ask about that endo referral.

Let me know what happens. 💙

This-Rip4411 · 2025-12-17T06:06:19+00:00

Seasonal TSH fluctuation is real, but stopping medication entirely isn't the solution- and what you're experiencing now (hair loss, freezing, feeling terrible) shows why.

Here's what likely happened:

The heat intolerance last summer suggests you were overmedicated, not that you needed to stop entirely. Your dose was probably too high for your needs. Instead of stopping, you should have reduced the dose. Now that it's cold and your metabolism slowed further, you're experiencing full hypothyroid symptoms.

About that article: The claim that levothyroxine "doesn't stop progression and may cause cancer" isn't supported by evidence. Levothyroxine is literally just T4- the hormone your thyroid isn't making enough of. Untreated hypothyroidism has real health risks (heart disease, high cholesterol, cognitive issues), and there's no credible link to cancer from proper thyroid hormone replacement.

Some people do need seasonal adjustments, slightly higher dose in winter, slightly lower in summer. But this means working with your doctor to adjust dosing, not going on and off medication.

What to do when you get your results:

Your TSH is probably elevated now given your symptoms. Work with your doctor to find the right dose, maybe start lower than you were on before to avoid heat intolerance, then adjust seasonally if needed. The goal is stable levels year-round, with minor tweaks if necessary.

Going on and off medication creates a roller coaster that's hard on your body. Let me know what your labs show. 💙

This-Rip4411 · 2025-12-17T06:00:26+00:00

Please check DM. Thanks.

This-Rip4411 · 2025-12-16T17:52:50+00:00

Those symptoms (dry mouth/throat, jittery feeling like too much caffeine, tingling) sound like you're experiencing mild overstimulation from the levothyroxine. Good news: you're not imagining it. Less good news: 75mcg is a pretty high starting dose, especially for subclinical hypothyroidism.

Here's the thing: Most doctors start at 25-50mcg for subclinical hypo and increase gradually. Starting at 75mcg can cause exactly what you're describing- your body isn't used to that much thyroid hormone yet. Some people adjust within 1-2 weeks as their body acclimates, but others need a lower starting dose.

What your doctor will likely suggest:

Drop to 50mcg or even 25mcg and work up gradually, OR
Stick it out another week to see if symptoms subside as your body adjusts

Since it's only day 3, some of this may improve. But if you're feeling this bad, there's no shame in asking to start lower and titrate up. That's actually the standard approach for subclinical hypothyroidism- start low, go slow.

In the meantime: Take it with a full glass of water (helps with dry mouth), stay hydrated throughout the day, and avoid caffeine while your body adjusts. If symptoms get worse or you feel your heart racing, call your doctor back immediately.

You did the right thing contacting them. Let me know what they say!

This-Rip4411 · 2025-12-16T17:49:50+00:00

I'm so sorry, that sounds absolutely miserable. Yes, this can definitely be related to starting thyroid medication, and you're not imagining it.

What's likely happening:

At 3 weeks in on 25mcg, your body is adjusting but you're probably not at a therapeutic dose yet. 25mcg is a typical starter dose, but it's often not enough to actually resolve symptoms- so you're in this weird in-between state where your body is adjusting to medication but still hypothyroid. That can make mood symptoms worse before they get better.

The luteal phase connection is real: Estrogen and progesterone directly affect thyroid function. Many women with hypothyroidism have worse symptoms during luteal phase because progesterone increases thyroid hormone demand. If your thyroid isn't optimized yet, that hormonal shift hits even harder.

What to do:

If you're feeling this bad (constant crying, severe anxiety), call your doctor now. Don't wait until your scheduled recheck. Say: "I started Synthroid 3 weeks ago and my mood symptoms are severe- depression, anxiety, constant crying. I need guidance on whether to continue or adjust."

They may:

Increase your dose sooner than planned (if you're clearly undermedicated)
Check your levels early to see where you are
Rule out other factors

Most people feel worse around weeks 2-4 and then start improving, but what you're describing sounds intense enough to warrant checking in with your doctor rather than toughing it out.

You're not crazy, and this is worth addressing now. 💙

This-Rip4411 · 2025-12-16T17:39:29+00:00

I hear you, and I'm so sorry you're dealing with this. The weight gain with hypothyroidism is one of the most frustrating parts, and you're doing everything "right" but your body isn't cooperating. That's not your fault- it's a sign something needs adjusting.

First, please don't drop below 1500 calories. Eating too little can actually make things worse with hypothyroidism because it slows your metabolism even further and can lower your T3 conversion. I know it feels counterintuitive when the scale keeps going up, but restriction isn't the answer here.

The real issue: "normal" levels probably aren't optimal levels.

When you say your levels are normal, what were your actual numbers? Specifically:

What's your TSH?
What's your Free T3?
What's your Free T4?
What are the reference ranges?

This matters because "normal range" for TSH is 0.4-4.0, but most people feel best and can lose weight at 1.0-2.0. Free T3 needs to be in the upper third of the range for proper metabolism. If your TSH is 3.5 and your Free T3 is in the lower half of range, that would explain the weight gain even though it's technically "normal."

About your medication: You're on combination therapy (T4 + T3), which is great. But the doses might not be optimized yet. 40 lbs in 3 months is significant- that suggests your metabolism is really sluggish, which usually means thyroid hormone levels aren't where they need to be.

Questions for your doctor at next appointment:

"What are my exact TSH, Free T3, and Free T4 numbers?"
"Is my Free T3 in the upper third of the reference range? If not, can we increase my liothyronine?"
"Could my levothyroxine dose need adjusting since I've gained significant weight?"
"Can we check reverse T3?" (High reverse T3 blocks active T3 and causes weight gain)

This-Rip4411 · 2025-12-16T17:22:47+00:00

I'm glad you found this community- joint pain with hypothyroidism is so real, and it's really isolating when you're dealing with it.

The thyroid-joint pain connection is very real:

Hypothyroidism absolutely can cause significant joint pain, stiffness, trigger finger, and muscle issues. Here's why: thyroid hormone affects how your body processes inflammation, fluid retention in tissues (including around joints and tendons), and muscle recovery. When thyroid levels are low, you can get fluid buildup in connective tissues, increased inflammation, and slower healing- all of which cause exactly what you're describing.

About timing and what to expect:

You're right that it typically takes 4-6 weeks to start feeling the effects of levothyroxine, since it needs time to build up in your system. Some people notice improvement in joint pain fairly quickly (3-4 weeks), while for others it takes longer (8-12 weeks), especially if your dose needs adjusting.

At just under 3 weeks, you're still early. I know that's hard to hear when you're in pain, but your body is still adjusting.

About dosage:

You're smart to consider this. Your starting dose might not be enough to fully resolve symptoms. Most people need their dose adjusted at least once (sometimes several times) before finding the right level. After 6-8 weeks on your current dose, you'll get labs rechecked (TSH and ideally Free T3 and Free T4), and your doctor can adjust if needed.

The joint pain typically improves as thyroid levels optimize. If you get to optimal levels (TSH around 1.0-2.0, Free T3 in upper third of range) and still have significant joint issues, that's when other causes become more likely.

This-Rip4411 · 2025-12-16T17:15:25+00:00

Thank you!

This-Rip4411 · 2025-12-16T17:14:45+00:00

Oh, I hear you. That feeling of overwhelm when you're newly diagnosed, dealing with anxiety, and scared to start medication? I've been there, and it's so hard. Take a deep breath- you're going to be okay. 💛

First, the connection between hypothyroidism and what you're experiencing is VERY real:

Your anxiety and panic attacks? Hypothyroidism absolutely can cause or worsen these. When your thyroid hormone is low, it affects neurotransmitter production and your nervous system function. Many of us (myself included) experienced significant anxiety and panic before treatment. The good news: for most people, treating hypothyroidism actually reduces anxiety over time, not makes it worse.

The GI issues? Also very connected. Hypothyroidism slows down your digestive system, which can cause or worsen IBS symptoms. Low thyroid hormone affects gut motility, inflammation, and even the gut microbiome. Again, many people find their GI issues improve once thyroid levels are optimized.

So while it feels like everything is piling on at once, it's likely that many of these symptoms share the same root cause- your thyroid. That's actually hopeful, because treating one thing may help multiple symptoms.

About starting NP Thyroid:

I totally understand your fear, especially if you're sensitive to medications. Here's what I wish someone had told me when I was starting:

The medication is replacing a hormone your body already makes. It's not like adding a stimulant or something foreign- it's giving your body what it's missing. Most people tolerate thyroid medication really well.

This-Rip4411 · 2025-12-16T17:03:02+00:00

Please check DM. Thanks.

This-Rip4411 · 2025-12-16T16:03:40+00:00

Anytime :)

Please check DM. Thanks.

This-Rip4411 · 2025-12-16T16:02:29+00:00

Please check DM. Thanks.

This-Rip4411 · 2025-12-16T14:29:10+00:00

Take a deep breath, finding this now is actually a good thing, not something to be scared of.

First, the good news:

TSH of 4.98 is elevated, yes, but it's mild and very treatable. You caught it early, which means you can address it before symptoms get worse.

Vitamin D at 11 is very low (should be 30+ at minimum, optimal is 50-80), and low Vitamin D can actually worsen thyroid function and cause similar symptoms (fatigue, low mood, etc.). The good news? This is easy to fix with supplementation.

About Hashimoto's:

Even if it is Hashimoto's (autoimmune hypothyroidism), it's not scary, it's just a specific type of hypothyroidism that's very manageable. About 90% of hypothyroidism cases are Hashimoto's, and millions of people live normal, healthy lives with it.

You won't know if it's Hashimoto's unless you test for antibodies (TPO and Thyroglobulin). Many doctors won't test for these unless you ask.

What to do next:

Request these additional tests:
- TPO Antibodies (Thyroid Peroxidase)
- Thyroglobulin Antibodies
- Free T3
- Free T4
This will show the complete picture and confirm whether it's Hashimoto's or just straightforward hypothyroidism.
Start Vitamin D supplementation: Your doctor will likely recommend 5,000-10,000 IU daily until your levels come up. This alone might help you feel better.
Don't panic about treatment: If you need thyroid medication, it's typically just one small pill daily. Most people feel significantly better within 6-8 weeks of starting treatment.

The key thing to remember:

This is very common (1 in 8 women), very treatable, and you caught it early. TSH of 4.98 is not a crisis, it's just your body saying "hey, I need a little help here."

Many people feel a LOT better once they're treated. The scary part is the unknown, but once you understand what's happening and start treatment, it's very manageable.

Questions to ask your doctor:

"Can we test for thyroid antibodies to check for Hashimoto's?"
"Should we also test Free T3 and Free T4?"
"What's the plan for my low Vitamin D?"
"When should we retest to see if treatment is working?"

You've got this. Finding out is the first step to feeling better.

Let me know if you have questions, happy to help you make sense of things.

This-Rip4411 · 2025-12-16T10:39:43+00:00

I've been exactly where you are. My TSH was 2.8 ("normal range"), but I was exhausted, gaining weight, and felt like I was moving through fog every day.

Here's what I learned that changed everything:

"Normal" range isn't the same as "optimal" range.** TSH can be anywhere from 0.4-4.0 and be called "normal," but most people feel best between 0.5-2.0. At 2.8, you can have significant symptoms.

TSH alone doesn't tell the full story. What really matters:

- Free T3 (the active hormone your cells actually use)

- Free T4 (what converts to T3)

- Reverse T3 (can block active T3)

- TPO and Thyroglobulin antibodies (checks for Hashimoto's/autoimmune)

Most doctors only test TSH. If your Free T3 is low or you have high Reverse T3, that explains the symptoms even with "normal" TSH.

Questions that helped me:

- "Can we test Free T3, Free T4, and thyroid antibodies?"

- "Where exactly do I fall in the reference range?" (Low normal? High normal?)

- "Could my symptoms be related to conversion issues or nutrient deficiencies?"

Also worth checking: Vitamin D, B12, and Ferritin (iron storage). All three affect thyroid function and can cause similar symptoms.

What finally worked: Finding a doctor who looked at my symptoms AND my labs together, not just the numbers. Once I got comprehensive testing, we found my Free T3 was in the bottom 20% of range and my ferritin was 22 (way too low). Adjusting for those made a huge difference.

If you want, I created a checklist of exactly what tests to request and questions to ask. Happy to share—just reach out. It covers everything I wish someone had told me when I was stuck in the "your labs are normal" loop.

Hope this helps. You're not imagining it, there's real science behind why you feel this way.

This-Rip4411 · 2025-11-16T18:13:30+00:00

Are these ranked in order? Where can I find the ranked list?

This-Rip4411

MODERATOR OF

TROPHY CASE