How serious is Hashimoto’s disease? That depends on what your thyroid is doing. The immune attack itself is not life-threatening. The hypothyroidism it usually leads to is what turns serious, because every cell in your body needs thyroid hormone to work. Untreated, it can affect your heart, mood, metabolism, and pregnancy. Treated and monitored, it is manageable.

You got a prescription and a follow-up appointment in six weeks. Or you got told your numbers are fine for now and we are just going to keep an eye on things. Either way, nobody told you whether this is a small thing or a big thing, so you went looking for the answer yourself.

It is not at either end. It sits in the middle, and where you land depends on which of the two systems is involved.

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Health with Hashimoto’s is your free weekly podcast that sorts this autoimmune condition into thyroid or immune. Each episode is for informational and educational purposes. Please discuss any questions or concerns with your trusted healthcare professional. Some links may be affiliate links, marked as such, at no extra cost to you.

Hashimoto’s is two things, not one

Hashimoto’s is an immune system attack on your thyroid. When your thyroid is under attack, it typically cannot do its job. It cannot keep up, and you become hypothyroid.

So there are two systems in play. The thyroid that cannot keep up. And the immune system doing the attacking.

Medication can help handle the first one. The second one is all yours to work on.

That distinction is the whole reason I do this. I am the nurse who helps you sort your Hashimoto’s into thyroid or immune, and almost every question about how serious this is gets easier once you know which side you are asking about. If you want the longer version of that split, I covered it in what Hashimoto’s really is and why most doctors miss half the picture.

Why hypothyroidism is the serious part

Your thyroid makes a hormone. That hormone is the little key that turns on your cells. It is the ignition key.

If your cells do not have that ignition key, your cells cannot work. And if your cells cannot work, you have a real problem on your hands.

That is why the answer to this question is yes. It is serious. Not because your immune system making antibodies is going to end your life, but because of what happens downstream when your thyroid can no longer produce what your body needs.

I am not telling you this to scare you. I am telling you because you are the CEO of your own health.

Your doctor sits on your board of directors and advises you. Sometimes you take that advice and sometimes you do not, but you make the ultimate call. You cannot make a good call on information you were never given.

What untreated hypothyroidism does to your cells

I want to read you something from a book on my shelf. This is from The Underactive Thyroid by Dr. Sarah Myhill and Craig Robinson. (affiliate link)

They describe hypothyroidism as slow energy delivery. Then they walk through what slow energy delivery does, system by system.

According to Myhill and Robinson:

• Slow energy to the muscles. Short term, weakness and an inability to get fit. Long term, chronic fatigue syndrome, and myxoedema coma.
• Slow energy to the brain. Short term, brain fog and poor short-term memory. Long term, dementia.
• Slow energy to the sense organs. Short term, deteriorating vision, hearing, smell, taste, and touch. Long term, blindness, deafness, loss of smell, and numbness.

They keep going. Cell membranes, ion pumps, the immune system, bone marrow, heart, liver, kidneys, lungs, reproductive organs. Their short answer to what happens when hypothyroidism is missed is disease, degeneration, and premature death.

You hear “coma” and you might have stopped listening to anything after “myxoedema coma.” I understand that. But this is the education part, not the fear part.

I think about that book every time somebody tells me they want to get off their thyroid medication. People have all kinds of reasons and rationales for wanting to stop, and I am not going to pretend I do not worry about it.

Every single cell in your body needs thyroid hormone. If you are not getting it from medication and your thyroid is not making it on its own, that combination is the thing that concerns me.

Your antibodies can be elevated 10 to 15 years before symptoms

Thyroid antibodies can start climbing 10 to 15 years before you have symptoms, and years before your TSH ever reflects a problem.

Which means for a long stretch of time, your immune system was already attacking and nothing on a standard panel said so. Most doctors do not check antibodies. That is a pet peeve of mine and I have talked about it more than once, including in my episode on what ignoring Hashimoto’s antibodies does to hypothyroid patients.

Was it serious back then? Your immune system had gone haywire and was attacking your own body, so yes, it needed to be addressed.

It was not life-threatening. That is the difference.

If you could have known 15 years earlier, could you have stopped the progression? We cannot go back and find out. We can help the next person, and you can start on the immune side now instead of waiting for your labs to force the issue.

How serious is Hashimoto’s disease during pregnancy

Pregnancy depends on good thyroid levels. Hypothyroidism is one of the leading causes of miscarriage. Your body cannot carry a baby well when the thyroid is not up to par, and in many cases it has trouble getting pregnant in the first place.

Several of the books on my shelf talk about what happens to a developing baby when maternal thyroid hormone is not adequate. Myhill and Robinson put it this way: while in the womb, the baby’s initial development depends on the mother’s thyroid hormones, and the IQ of a child is inversely proportional to the mother’s TSH. They note that is one of the reasons obstetricians like to see a maternal TSH below 1.5.

I ask my clients about this. I ask my friends about this when they tell me they are pregnant. Keep a very close eye on your thyroid levels.

I have a personal reason for pressing on this. After interviewing a couple of different doctors on the podcast, I now firmly believe my Hashimoto’s started during my third pregnancy. I had strange postpartum anxiety that year, nothing like what I had experienced with my other babies, and that turns out to be something doctors commonly see in women who are developing Hashimoto’s and hypothyroidism.

After that third pregnancy, I had my first miscarriage. I had not had my thyroid tested since I was pregnant with my third son. I had no reason to know my levels were drifting.

Would testing have changed anything? I will never know. I am grateful for my fourth son, who was born five months after our miscarried baby’s due date and would not be here otherwise, so good did come out of it.

But I still think about it. If you are trying to conceive or currently pregnant, my conversation with Dr. Grace Charles on Hashimoto’s and fertility goes deeper on this.

The labs that tell you where you actually stand

You live in a very good time for this. You can order your own labs.

Someone can come to your house and draw them. You can walk into a phlebotomy place, or you can have your doctor order them.

And once you have the results, you have options. Levothyroxine or Synthroid. Generic T4. T4-T3 combination medications. Desiccated thyroid. There are even more options.

So when I say this can be serious, I am also saying it does not have to be.

Here is what I want to know when I look at a panel:

• TSH. The signal from your brain telling your thyroid to work harder.
• Free T4. The storage form of thyroid hormone.
• Free T3. The active form. This is the one your cells actually use.
• Reverse T3. Whether your body is putting on the brake instead of the gas. If your body is saying we do not need more ignition keys, we need more rest, this is where it shows up.
• Thyroid antibodies. Whether your immune system is still attacking.

All of it matters. I walked through how to read a panel like this in sorting your Hashimoto’s labs into thyroid or immune buckets.

Not panic, and not dismissal

Hashimoto’s is a real autoimmune condition. There is no treatment for autoimmune conditions, which means your immune system will keep attacking if you do not address the root causes behind it going haywire.

And when your thyroid hormone is not meeting what your body needs, it can affect your heart, your mood, your metabolism, your fertility, your pregnancy, and your quality of life. It does a lot.

Thankfully, hypothyroidism is one of the conditions we can usually monitor and treat very effectively.

So the goal is not panic. The goal is also not dismissal. We do not want either end of that.

We want the middle. An accurate diagnosis. Consistent treatment when you need it.

Regular follow-up. Knowing what your labs are doing. And looking beyond the thyroid when symptoms persist or when you have not done anything at all on the immune side.

How serious is Hashimoto’s disease for you specifically comes down to two questions. Is your thyroid keeping up, and is anything being done about the immune system that started this?

You can answer the first one with labs. The second one is the work.

The logo for Health with Hashimoto’s started as a Venn diagram that I turned into a flower. Your whole health is five parts. Body, mind, spirit, diet, and environment, and every one of them affects the others.

Your thyroid is affected by all of it. Which is exactly why monitoring it is your job, and your privilege, as the CEO of your own health.

Where to go from here

You now know the thing your appointment did not cover. Hashimoto’s is two systems. The immune side is what started this, and the thyroid side is what turns serious if nobody watches it.

That means there is something to do, and it is not panicking. Get a full panel.

TSH, free T4, free T3, reverse T3, and antibodies. Find out which side is asking for your attention right now.

I spent years as a nurse who could not make thyroid make sense in my own head. I could tell you exactly how to take Synthroid and nothing about what the thyroid was actually doing. Then I got diagnosed myself and had to figure it out from the inside, which is the story I told in my first episode.

We do not have to live in fear here. We get to live with hope, because there are things to do and most of them are simple and sustainable.

If you do not know where to start, start with the framework. Hashimoto’s Decoded: Thyroid or Immune is $27, seven short chapters and a workbook, under an hour start to finish, and you will walk out of it able to sort your own Hashimoto’s into thyroid or immune so you know what to do first.