The 5 Stages of Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is a common painless, diffuse goitre that occurs primarily in middle-aged women. Patients often have normal thyroid function but hypothyroidism can develop. 

The thyroid parenchyma is diffusely replaced by lymphocyte infiltration and fibrotic reactions lymphatic follicles are often found. This process has received much attention as autoimmune phenomena have been demonstrated in most patients. 

The 5 Stages of Hashimoto

Patients with Hashimoto's thyroiditis have serum antibodies that react with unidentified proteins present in TG, TPO, and colloids. Additionally, many patients have cell-mediated immunity to thyroid antigens, which can be detected by several techniques. Cell-mediated immunity is also characteristic of experimental thyroiditis induced in animals by the injection of thyroid antigens and adjuvants.


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Hashimoto’s Stages 

Stage 1: Genetic Predisposition 

In the early stages, a person has a genetic predisposition to Hashimoto’s disease but has normal TSH and T3/T4 hormones because they have not been exposed to the necessary triggers. 

Genetic Predisposition

No thyroid antibodies or thyroid changes are found. Alternatively, we can call this stage 0, as there are no symptoms of the disease at this time. If you have thyroid disease, your relatives and children may be at this stage. If you have a family member with thyroid disease and you are reading this, you may be at this stage. This stage is the perfect time to start thinking about prevention.

Stage 2: Immune cell infiltration of the thyroid gland 

Hashimoto’s disease is characterized by an excess of lymphocytes (white blood cells) in the thyroid gland. In small amounts, these immune cells play an important purifying role, but too many of them in the organ cause problems.

The immune cells are to wipe out dead and diseased thyroid cells. Initially thought to be in good faith it eventually begins to attack healthy thyroid tissue. In the early stages of this Hashimoto's disease, thyroid antibodies are usually elevated.

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Testing for thyroglobulin or thyroid peroxidase antibodies can increase thyroid antibodies in the blood by up to 80-90%. However, although some people have no thyroid antibodies in their blood, ultrasound or biopsy of the thyroid gland does reveal changes in the thyroid gland that are consistent with Hashimoto's disease.

This stage can last for decades until sufficient damage occurs and blood tests can detect changes in thyroid hormone levels. At this stage, the levels of TSH, free T3, and free T4 are normal. You may also experience symptoms such as anxiety, fatigue, miscarriage/infertility, mood swings, obesity, and weight loss at this stage. This is because the body has a hard time keeping thyroid levels normal.

weight loss obesity

Physical function and nutrients, along with the function of the intestinal wall are always impaired at this stage. Unfortunately at this stage, Hashimoto's has not been diagnosed by conventional medicine in most patients. 

In such cases, they are usually told to be referred to a psychiatrist or even be advised to take antidepressants for “mood symptoms” This is an ideal step to start lifestyle interventions and approaches to the root cause to prevent disease progression and thyroid damage, as the body’s inflammation has just begun at this point. 

Broadly speaking, you need to identify the trigger and deal with the following to strengthen your body:

  • Food sensitivities
  • Nutrient depletions
  • Intestinal permeability 
  • Toxins
  • Adrenal dysfunction
  • Chronic infections

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Stage 3: Subclinical Hypothyroidism

At this stage, blood tests may show slightly elevated TSH levels (3-10 mu/L) and free T3 and free T4 levels are normal. An increase in TSH can increase thyroid inflammation, so a patient’s thyroid antibodies may be even higher than in stage 2. However, some people are still antibody-negative.

In the world of conventional medicine, this stage is controversial regarding therapeutic techniques. Doctors can take a “watch and see” approach, but if nothing is done, more symptoms will start to appear at this stage, eventually leading to frank hypothyroidism. Some people have been able to reverse the condition without drugs at this stage but don’t think too long about this stage because elevated TSH contributes to thyroid inflammation.

Adding a small amount of thyroid medication to lower TSH at this stage has been shown to reduce thyroid antibodies, which can make a big difference in symptoms, according to a pharmacist some people have an anti-drug dogma and prefer to do things naturally, unlike other drugs that act as artificial chemical messengers that block or activate pathways in the body, thyroid drugs share the same chemical structure as thyroid hormone, which is most of the symptoms associated with thyroid drugs usually result from improper administration.

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Stage 4: Overt Hypothyroidism

At this stage, the person is starting to have an underactive thyroid. Their thyroids are destroyed to the point that they are unable to make their thyroid hormones. Subjects have elevated TSH and low levels of free T3 and free T4. 

Thyroid antibodies can be even higher than in the early stages. This is the most common stage at which people are diagnosed, as they usually have a significant amount of thyroid symptoms at this time. 

This is also the stage when thyroid medication is needed to avoid serious health consequences. Even the most enthusiastic practitioners almost always recommend thyroid medication at this point.  Likely to be highly symptomatic, lifestyle changes and root cause approaches are important at this stage. At this point, you have probably had an inflammatory process in your body for almost 10 years, so you need to adopt the most aggressive treatment.

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Stage 5: Progression to other Autoimmune Disorders 

Having Hashimoto's puts a person at greater risk for developing other autoimmune conditions like celiac disease, psoriasis, Sjogren`s, rheumatoid arthritis, lupus, multiple sclerosis, and many others.

It is a progression of the autoimmune response as the immune system continues to be imbalanced, it may find additional glands and body tissues to attack, such as the small intestine in celiac disease, saliva and tear glands in Sjogren`s, and the joints in rheumatoid arthritis. 

At this stage, the person will have been likely treated with thyroid medications, so if they are receiving ideal treatment, their TSH, Free T3, and Free T4 numbers should be in a good range. But, unfortunately, thyroid medications and removing the thyroid gland do nothing to stop the disease progression.

If a person is not well controlled with medications, has an enlarged thyroid gland, out-of-control antibodies, Graves’ disease, thyroid nodules, or thyroid cancer, or is not able to have balanced thyroid hormones as they swing from hyper/hypothyroidism, some doctors may recommend surgical removal of the thyroid gland. 

Removing the thyroid gland will eliminate thyroid antibodies, but unfortunately, will not stop the autoimmune progression. In addition, those who have had their thyroid gland removed (or who have been treated with radioiodine) may experience the side effects of these treatments and should take thyroid medications for the rest of their lives. 

However, reversing autoimmunity is still possible as it significantly reduces and eliminates the symptoms of other autoimmune diseases. At this stage, it is recommended not only the basic approach of the Hashimoto protocol, but also many advanced protocols that help reverse autoimmunities, such as LDN, elimination diet, and treatment of infections.

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The thyroid gland is expected to recover function with advanced protocols such as low-level laser treatment until it is destroyed, surgically removed, or treated with iodine. Depending on the progression of other autoimmune diseases, additional organ-specific treatment may be required (e.g., specific exercise, medication, systematic light therapy for multiple sclerosis).

It is important to note that autoimmune diseases do not always start with Hashimoto’s disease. The first organs which are vulnerable to autoimmune damage are considered the “weakest link” when a person has a genetic predisposition or is damaged.

Hashimoto's disease is the most common. Although it is an autoimmune disease, the thyroid gland is not always the “weakest link” for everyone. People may start with another autoimmune disease, such as Celiac disease, and progress to Hashimoto's.


To conclude, people should be screened for Hashimoto’s through antibodies and/or ultrasound testing. This early detection of the autoimmune process will help a person prevent a myriad of unpleasant symptoms, as well as the progression of the destruction of the thyroid gland if the root cause of the condition is identified.



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