Making an unambiguous diagnosis still overwhelms most doctors

To get an accurate diagnosis, it is important to find a doctor (endocrinologist) who is familiar with thyroid disorders and does not limit thyroid diagnostics to TSH.

Unfortunately, my experience has shown that very few doctors have a comprehensive knowledge of the thyroid gland and especially Hashimoto’s thyroiditis. For the diagnosis of Hashimoto’s thyroiditis it is important to control the concentration of various hormones (TSH, free T3 and free T4) in the blood.

Most doctors only control the TSH value because in their opinion it is sufficient to rule out or confirm hypo- or hyper-functioning. But this is a fallacy and in such a case, you should look for another doctor. Important is the overall picture or the relation between TSH, fT3 and fT4, as well as the level of anti-thyroid peroxidase antibodies (TPO-AK), thyroglobulin antibodies (TAK) and microsomal antibodies (MAK).

In addition, the thyroid gland should be scanned by the doctor to detect any enlargement in advance. The thyroid gland also should be examined by ultrasound for size, shape and condition of the tissue. Only when these factors are illuminated, it is possible to diagnose the hashimoto correctly. If your doctor is not familiar with this autoimmune disease or has too little interest and time, you should change the doctor.

Due to the slowing down of the metabolism and the accompanying gastrointestinal problems associated with Hashimoto’s thyroiditis, massive nutrient deficiencies often develop, which should also be controlled and treated. These include vitamin B6, B12, selenium, zinc, magnesium, calcium, potassium, iron, ferritin and all sex hormones. Further information can be found in the chapter: Therapy.

Important laboratory values in blood sampling tests

  • fT3 (free triiodothyronine)
    The T3 or triiodothyronine, produced by the thyroid gland, is the most effective and metabolically active hormone of the thyroid gland. Triiodothyronine is composed of bound T3 and free fT3.
  • fT4 (free levothyroxine)
    The T4 is also produced by the thyroid gland and consists of a bound part (T4) and a free, metabolically active part (fT4).
  • TSH (Thyroid Stimulating Hormone)
    TSH is produced by the pituitary gland and regulates the release of the body’s required levels of T3 and T4.
  • TPO-AK (anti-thyroid peroxidase antibodies) and MAK (microsomal antibodies)
    TPO-AK and MAK are antibodies that attack and destroy the thyroid inner wall, the so-called thyroid peroxidase.
  • TAK (Thyroglobulin Antibodies) or TG-AK
    Thyroglobulin is a protein of the thyroid gland, and involved in the thyroid hormone synthesis of thyroxine and triiodothyronine. Increased antibodies against thyroglobulin indicate autoimmune thyroid disease.
  • TRAK (TSH receptor autoantibodies)
    TSH receptor autoantibodies attack the TSH receptors, provoking an uncontrolled stimulation of the receptors and thus the thyroid gland. TRAK are responsible for the clinical symptoms of Graves’ disease.

These blood values ​​should always be examined and determined in the blood in order to be able to correctly diagnose Hashimoto’s thyroiditis.

Using ultrasound to diagnose Hashimoto

Hypoechoic thyroid gland in ultrasound - An indication of Hashimoto's thyroiditis
Hypoechoic thyroid gland in ultrasound – An indication of Hashimoto’s thyroiditis

Ultrasound imaging (sonography) makes it possible to show an image the thyroid gland, poses no dangers and is completely painless. In this way, the structure and size of the thyroid gland can be determined quickly and reliably.

But also a change of the thyroid gland over a longer period of time can be documented and observed very well in this way.

A healthy thyroid gland is shown bright (echogenic) on ultrasound. But the surrounding muscles and also nodes and cysts, are displayed more dark (hypoechoic).

A typical Hashimoto’s thyroid gland usually is hypoechoic as well. This also applies to a thyroid gland with Graves’ disease. Unfortunately, on ultrasound it is not possible to distinguish between hormone-producing hot or non-hormone-producing cold knots. But this is possible with the help of scintigraphy.

Scintigraphy: The visual representation of nodules and functional status of the thyroid gland

Scintigram: Hashimoto type A with disseminated autonomies before radioiodine therapy
Scintigram: Hashimoto type A with disseminated autonomies before radioiodine therapy

With scintigraphy, the functional state of the thyroid gland is depicted. This can be achieved with the help of a small amount of radioactive nuclides.

For that, usually technetium is injected into the patient’s bloodstream to assess the activity of the existing thyroid tissue.

This examination usually takes between 15-30 minutes and is absolutely painless.

The technetium, like iodine, has the property of briefly accumulating in the thyroid gland. Due to the low radioactivity, technetium releases a measurable amount of gamma radiation. This radiation can be visualized in the scintigraphy and colorize active and less active thyroid tissue. In this way, hot or cold knots, among other things, can be revealed.

Measurement of basal body temperature indicates a hypothyroidism

According to the American thyroid expert Broda Barnes, the fastest and most cost-effective way to unmask hypothyroidism, is the measurement of axillary basal body temperature. He recommends staying in bed in the morning immediately after waking up and measuring body temperature with a digital fever thermometer under the armpit. You should be careful not to measure too short. You should wait at least five minutes before you press the button for the measurement.

According to Dr. med. Barnes a hypothyroidism should be present when the morning basal temperature is below 36.4 ° Celsius. If the temperature fluctuates more than 0.1 ° C daily, this indicates a weak adrenal gland. If the measured values ​​are elevated, it does not mean that you have an hyperactive thyroid. Increased body temperature values ​​can have many different causes. In women in the second half of the cycle, hyperthyroidism would be suspected as low as 37.2 – 37.4 ° C.

Are depression and a strained psyche a hint for Hashimoto?

Especially if the psyche is going crazy and depression is spreading, then you should know that Hashimoto’s hyperthyroidism can be the cause of these problems.

Since most physicians and endocrinologists often do not have much experience with Hashimoto, it is usually enough for them when thyroid levels are normal. The fact that most Hashimoto patients experience an improvement in their well-being only in the higher normal ranges, is not understandable for most doctors and is often dismissed as nonsense.

If the patient relies on such statements of the doctor, usually follows a long-term treatment with antidepressants. This could be avoided if the patient as well as his doctor had a more extended knowledge of the thyroid gland and the norms. In this regard, there is still plenty of information and education work needed. In the leaflet of almost every antidepressant it is already mentioned to make an thorough examination of the thyroid gland, before taking. Unfortunately, no case is known to me, where this was done.

Important tips for a visit at your doctor

  • Make a note of any questions you would like to ask the doctor before you go to the doctor. So you can prevent forgetting something and possibly having to make a new appointment.
  • Insist that in addition to the TSH, the free values, the fT3 and fT4, as well as all antibodies are determined. Only then a correct Hashimoto diagnosis or the exclusion of a hypofunction is possible. If the doctor does not want to accept that because he believes the TSH is sufficient, it’s best to seek out another doctor right away.
  • Always insist that copies of the specific blood values are handed out, staple them carefully and make a note of the current health conditions on the lab copies. So even after many months, you still have a good overview of the past blood values ​​and the associated condition.
  • If you are already taking thyroid hormones, you should take them AFTER each blood draw. If you take the hormones in the morning before drawing the blood, the blood values ​​will be distorted towards the top and are not meaningful.

Image source:

  • ultrasound: © Ghazi-Michael Ayed
  • scintigram-hashimoto: © Ghazi-Michael Ayed
  • hashimoto-diagnosis: © Ghazi-Michael Ayed