Hashimoto’s is a chronic health condition, which means managing it requires a continual balancing act. With an autoimmune condition, there will always be the tendency for your body to move in the direction of immune system imbalance and inflammation without proper maintenance.
Even if you are doing all the right things – exercising, eating the right foods, working with skilled providers – given the right circumstances, flare ups can happen.
If you experience a Hahsimoto’s flare, it does not mean you have failed. It is a situation you can pull out of with the appropriate steps and guidance. This article will teach you how to avoid flares, how to notice if one is happening, and importantly, how to get stabilized and maintain remission.
What is Hashimoto’s flare up?
A Hashimoto’s flare happens after the disease is initially addressed and becomes well managed, and then gets reactivated.
During a Hashimoto’s flare, the immune system becomes more activated and inflammation increases. This leads to more autoimmune attacks on the thyroid gland. So, many of the hypothyroid and inflammatory symptoms return, including:
- Brain fog
- Weight gain
- Increased cold sensitivity
- Dry skin
- Muscle or joint pain
- Puffy face or around the eyes
- Reduced exercise tolerance
- Irregular menstrual cycle or heavy flow
It is also possible to have a swollen thyroid gland during a flare.
The set of symptoms you experience may be unique to you. While you can have any symptoms related to hypothyroidism, generally the primary symptoms you experienced before diagnosis and treatment tend to be the same symptoms that return or worsen during a Hashimoto’s flare.
Many Hashimoto’s patients need more thyroid medications during a flare. With increased autoimmune activity, your thyroid will likely produce less natural thyroid hormone, so speak to your doctor about adjusting your medication dosage.
Your doctor may also check the following labs during a suspected Hashimoto’s flare.
- Thyroid Stimulating Hormone (TSH)
- Free T3 and T4
- Total T3 and T4
- Thyroid Antibodies that were previously elevated
- Complete Blood Count
- Comprehensive Metabolic Panel
- C-reactive protein (inflammation marker)
- Erythrocyte Sedimentation Rate or Sed rate (inflammation marker)
What causes Hashimoto’s flare up?
If you’ve been diagnosed with Hashimoto’s, you have to work harder than most people at maintaining health and wellness. When you have a medication and lifestyle regimen that works for you, you have to stay committed to maintaining it.
Slacking in any area, such as diet, exercise, or stress reduction practices, may be enough to throw off your immune system. When this happens, your thyroid will be one of the first places to be impacted and signal you to get back to your wellness routine.
Flares can also happen even when you haven’t outwardly changed anything. Any stress to the body or the immune system has the potential to trigger a flare up of Hashimoto’s. Especially if it’s a stress your body has to respond strongly to in order to adapt and overcome, like an infection.
These are some common things that can trigger a Hashimoto’s flare.
- Increased life stress or decreased stress management practices
- A major stressful life event
- Lack of sleep or insomnia
- Not enough exercise, in particular resistance training
- Too much exercise/physical overexertion
- Eating a known food sensitivity, especially if it has been avoided for a long time
- Medications that interfere with thyroid hormone medications
How to manage a Hashimoto’s flare up?
Managing a flare up is often as simple as buckling down on what worked before. The first step is to identify what may have triggered the flare in the first place. If it seems to be related to something in your lifestyle you’ve changed, it’s best to return to your previous lifestyle behaviors, which should begin to bring you back into balance over time.
If an illness like an infection seems to be the trigger, the flare may resolve after your body fights off the infection. However, your immune system can stay overactivated and require some natural interventions, like herbs or nutrients, to help calm the fire of increased inflammation and immune system imbalance.
If it’s not clear what has changed, it’s a good time to see a functional medicine doctor, look at labs, and get support for bringing the flare under control.
How long does a Hashimoto’s flare up usually last?
The length of a Hashimoto’s flare depends on the nature of the triggering event, how well the Hashimoto’s has been managed prior, and individual factors such as genetics and whether you have other underlying health conditions.
In a short term flare from increased life stress or not exercising enough, the flare may resolve within 2-4 weeks once those areas are addressed. However, in some cases, it can take months to get back on track. The best course of action is to find what keeps you in a steady state of wellness and commit to that indefinitely.
Infections are a unique trigger that can lead to a flare that takes many months to resolve, depending on the type of infections. Functional medicine or naturopathic interventions are likely to help speed up recovery in this situation.
How to put Hashimoto’s into remission?
Hashimoto’s is a fairly complex condition that requires a multi-pronged approach, which includes lifestyle and medical interventions. Instead of a cure, you reach remission with Hashimoto’s.
Remission is a healthy holding pattern where the immune system is not as active against the thyroid, thyroid medication dose stays stable, and symptoms are at minimum.
The 3 components of remission include:
- Your thyroid labs stay in optimal range
- There is minimal presence of antibodies
- You feel good and can function in day to day life. That means you don’t struggle with Hashimoto’s symptoms such as losing weight, extreme fatigue, joint pain, brain fog, and hair loss.
Components of getting into remission include:
Adjusting Dosages for Thyroid Medications
If you’re in the middle of a flare, ask your doctor to re-check your thyroid labs and see if you need to increase the dose to help you get out of the flare.
Doubling down on an anti-inflammatory diet
The foods you eat directly contribute to inflammation levels in your body and a healthy functioning immune system. So, the Autoimmune Paleo Protocol (AIP) is a great starting point. It eliminates both common inflammatory foods and helps you identify your own food sensitivity.
If you’ve been on AIP and have re-introduced some foods, it’s a good idea to go back to phase 1 again as you may have developed some new food sensitivities.
Intermittent fasting may also help regulate your metabolism and calm increased inflammation.
Stress is an environmental factor in the development of Hashimoto’s. Unmanaged stress can throw off your immune, nervous, and endocrine system, which can worsen Hashimoto’s symptoms .
If you’re in the middle of a flare, you’ll need to take it easy. Now is the time to eliminate major stressors, ask for help, and delegate. If you’re not already practicing stress management, consider introducing mindfulness meditation, counseling, biofeedback, breathing techniques, or simply getting into nature more regularly.
Sleep is critical for keeping your hormone and immune systems balanced [2,3].
Too little and too much sleep can be a problem over time. It’s a good idea to aim for 7.5 – 8 hours of sleep a night.
For trouble falling asleep, calming nutrients like L-theanine, magnesium, and melatonin may be helpful. Trouble staying asleep through the night is often related to cortisol imbalance. You may also benefit from progressive relaxation techniques.
Supplements to Consider and to Avoid
Certain nutrients will support Hashimoto’s remission, while others could trigger a symptom flare.
Supplements that Support Hashimoto’s Remission
- Vitamin D
- Vitamin C
- Vitamin E
- N-acetyl cysteine
- Iron if lab tests show low or borderline. Avoid if levels are within the normal range, because iron can increase inflammation.
- Adaptogens can help balance the immune system and improve your stress response, but very immune stimulating herbs should be avoided.
- Inflammation-balancing herbs and nutrients like omega-3 fatty acids and turmeric.
Supplements to Avoid
- Iodine can negatively impact Hashimoto’s if your levels are too high. However, if you have iodine deficiency, it may be recommended.
- Immune stimulating herbs, such as rhodiola, astragalus, or echinacea may stimulate the Th1 part of the immune system that is already overactive in Hashimoto’s.
In Thyroid Strong, we focus on building lean muscle mass through resistance training as a primary means to decrease inflammation and help maintain remission from Hashimoto’s.
Increased muscle mass helps normalize essential body processes such as energy metabolism, inflammation, and oxidative stress. Resistance training also has immune system modulating effects .
Safely increasing exercise tolerance and keeping long term motivation to exercise can be difficult for a healthy person and even more difficult with Hashimoto’s. That’s why in Thyroid Strong, I guide you step by step on exactly what to do and when, wherever you are at currently. The community of dedicated Thyroid Strong women is a community that will help keep you accountable and show up for yourself when you need it most.
By maintaining a solid lifestyle approach to your health, along with adequate thyroid replacement, you can put Hashimoto’s into remission and regain those parts of your life you had to leave behind because of it.
Join the Thyroid Strong program today and begin to take your health into your own hands.
In good health,
Dr. Emily Kiberd
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1 Mizokami, T., Wu Li, A., El-Kaissi, S. and Wall, J. R. (2004) Stress and thyroid autoimmunity. Thyroid 14, 1047–1055.
2 Kim, T. W., Jeong, J.-H. and Hong, S.-C. (2015) The impact of sleep and circadian disturbance on hormones and metabolism. Int. J. Endocrinol. 2015, 591729.
3 Irwin, M. R. (2019) Sleep and inflammation: partners in sickness and in health. Nat. Rev. Immunol. 19, 702–715.
4 Fortunato, A. K., Pontes, W. M., De Souza, D. M. S., Prazeres, J. S. F., Marcucci-Barbosa, L. S., Santos, J. M. M., Veira, É. L. M., Bearzoti, E., Pinto, K. M. D. C., Talvani, A., et al. (2018) Strength Training Session Induces Important Changes on Physiological, Immunological, and Inflammatory Biomarkers. J Immunol Res 2018, 9675216.