Hashimoto’s thyroiditis is the most common cause of an underactive thyroid in the United States. The immune system slowly damages the thyroid, and many people eventually need thyroid hormone. Most do well with straightforward treatment; some need more careful attention, and that is where an endocrinologist helps.

When to see an endocrinologist

• You were just diagnosed and want a plan
• Your TSH keeps moving, or your dose keeps changing
• You feel unwell despite a normal TSH
• You are pregnant or planning a pregnancy
• You have a goiter or a nodule on ultrasound

How the diagnosis is confirmed

Hashimoto’s is diagnosed with blood tests — TSH, free T4 and thyroid peroxidase (TPO) antibodies — and sometimes a thyroid ultrasound. Positive antibodies with a normal TSH mean the condition is present but the thyroid is still keeping up; many people stay in this stage for years and are monitored rather than treated. Read more about how thyroid antibodies are tested and the spectrum from antibodies to hypothyroidism.

Treatment and dose fine-tuning

When the thyroid can no longer keep up, levothyroxine replaces the missing hormone. The right dose depends on body weight, age, other medicines, absorption and timing. We adjust gradually and recheck TSH six to eight weeks after each change. Treatment in depth.

Still tired on levothyroxine?

Fatigue has many causes, and not all are thyroid-related. We check whether the dose is right, look for anemia, vitamin B12 deficiency, sleep problems, depression and other autoimmune conditions, and review the evidence on combination T4/T3 therapy with you, which may help a minority of patients. Symptoms of Hashimoto’s · Still tired on levothyroxine? · Hashimoto’s and weight.

Pregnancy and fertility

Thyroid hormone needs rise early in pregnancy. Women with Hashimoto’s who are planning a pregnancy should have TSH checked beforehand and their dose increased as soon as pregnancy is confirmed. Hashimoto’s, pregnancy and fertility.

What we do not recommend

We do not recommend high-dose iodine, unregulated thyroid supplements, or treatment based on antibody levels alone. Diet changes can help overall health, but no diet has been shown to cure Hashimoto’s. Nutrition and Hashimoto’s.

Common questions

Can Hashimoto’s go away?

The antibodies usually persist, but many people never need treatment or stay stable on a fixed dose for years.

Is Hashimoto’s the same as Graves’ disease?

Both are autoimmune thyroid diseases, but Graves’ disease overstimulates the thyroid. See Graves’ disease.

Our physicians also maintain HashiExperts, a detailed guide to Hashimoto’s thyroiditis.

Request an appointment

We see patients with Hashimoto’s at our La Jolla, La Mesa and Poway offices. Request an appointment or call (858) 622-7200.

Sources: Jonklaas J, et al. Guidelines for the Treatment of Hypothyroidism. Thyroid. 2014;24:1670–1751. Alexander EK, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27:315–389. Written by Darius A. Schneider, MD, PhD; reviewed by Mba Uzoma Mba, MD, PhD. October 2026.