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June 26, 2023 7 min read

Hashimoto's disease is a type of thyroid disorder that affects many people all over the world. It can cause a wide range of symptoms, from fatigue and weight changes to feeling depressed and anxious.

Doctors must rely on medical history and a series of thyroid test results to identify Hashimoto's disease. Among them, thyroid stimulating hormone (TSH) levels are a factor that cannot be overlooked. So what TSH levels indicate Hashimoto's disease? And what are the optimal TSH levels for Hashimoto's disease? In this article, we will discuss what a good TSH level for Hashimoto's Disease is as well as how it can be managed.

What is Hashimoto's disease?

Dealing with Hashimoto's disease

Hashimoto's disease is an autoimmune thyroid disease that occurs when your immune system, your body's defense system against harmful substances, mistakenly attacks your thyroid gland. This can result in a condition called hypothyroidism or underactive thyroid, in which your thyroid gland doesn't produce and release enough of its hormones.

The thyroid is the largest endocrine gland in your body, located in your neck. Its role is to produce thyroid hormones, including thyroxine (T4) and triiodothyronine (T3), which regulate your metabolism, heart rate, body temperature, and more. They affect almost every part of your body. That's why when your Hashimoto's disease cause hypothyroidism, you'll experience unpleasant symptoms like fatigue, weight gain, slow heart rate, and anxiety. Without enough thyroid hormones, your body can't function properly.

In addition to causing hypothyroidism, Hashimoto's disease also causes other autoimmune diseases such as vitiligo, Addison's disease, type 1 diabetes, celiac disease, etc. Conversely, people who have other autoimmune diseases can also develop Hashitomo's disease.

Are the symptoms of Hashimoto's disease the same as hypothyroidism?

Hashimoto's disease usually progresses slowly and may take years to develop. One of the first signs of this disease is usually a goiter (an enlarged thyroid). You will often feel a full throat and difficulty swallowing, although it is usually painless. Over time, it damages your thyroid function and leads to an underactive thyroid. Thus, the symptoms of Hashimoto's disease will be the same as hypothyroidism. These include:

  • Depression

  • Weight gain

  • Muscle aches

  • Cold intolerance

  • Dry skin

  • Thinning hair

  • Irregular or heavy periods

  • Fertility problems

  • Slower heart rate

  • Memory problems.

How is Hashimoto's disease diagnosed?

The symptoms of Hashimoto's disease are often similar to those of other thyroid dysfunctions. Therefore, your doctor will need to consider your medical history and physical exam results, as well as feel your thyroid gland to see if it's enlarged to detect the autoimmune disease. They may also order a thyroid panel (thyroid function tests) to make a diagnosis. These include tests for:

1. Thyroid-Stimulating Hormone (TSH)

TSH is a hormone released by your pituitary gland that controls the amount of thyroid hormone released by your thyroid gland. It's like an alarm to warn your thyroid whether to work more productively or to slow down. Therefore, TSH usually increases when thyroid hormone production decreases and vice versa. Elevated TSH levels in your bloodstream indicate hypothyroidism.

2. Thyroid Hormone T4

Another important test your doctor will do is a thyroid hormone T4 test. It measures how much free thyroxine (FT4) is in your blood. Low FT4 levels confirm the findings from a TSH test or indicate that something could be wrong with your thyroid.

3. Thyroid Peroxidase (TPO) Antibodies

Thyroid Peroxidase (TPO) Antibodies test helps determine if Hashimoto's disease is causing thyroid dysfunction and rule out other potential causes.

TPO is a protein that has a vital role in thyroid hormone production, while antibodies are proteins that your immune system makes to fight bacteria, viruses, and toxins. Normally, your immune system doesn't produce large levels of antibodies against TPO since it's a necessary part of your thyroid tissue. But when you have Hashimoto's disease, TPO antibodies are produced at higher levels because they recognize TPO as a "foreign invader" that needs to be destroyed.

What TSH levels indicate Hashimoto's disease?

In terms of TSH levels, the generally accepted normal reference range is between 0.5 and 5.0 mIU/L, with the exception of pregnant women, the elderly, and a few others.

A TSH level of 5 mIU/L or more is often a clear sign of hypothyroidism. Conversely, a TSH level below 0.4 mIU/L indicates hyperthyroidism or overactive thyroid.

Hashimoto's disease can cause overt or subclinical hypothyroidism. This means that TSH levels indicating Hashimoto's disease can vary depending on the type of hypothyroidism.

Overt hypothyroidism

Overt hypothyroidism is clear hypothyroidism, meaning you experience obvious symptoms like weight gain, cold intolerance, dry skin, and enlarged thyroid. It's usually characterized by an increased TSH level (usually above 4.5 mIU/L) and a decreased T4 level (usually below 0.8 μg/dL)

Subclinical hypothyroidism

Subclinical hypothyroidism is more subtle and often goes unnoticed as there may not be any outward symptoms. It occurs when your TSH level is higher than the normal range (over 5 mIU/L), but your T4 level is normal.

Although subclinical hypothyroidism can develop into overt hypothyroidism, there is controversy regarding whether subclinical hypothyroidism should be treated.

What is the optimal TSH level for Hashimoto's disease?

Getting thyroid function test.

For a long time, experts have used the normal reference range of TSH levels, which is between 0.5 and 5.0 mIU/L (milli-international units per liter). However, there are mixed opinions about the upper limit of normal TSH levels. Some researchers insist it should be 2.5 to 3 mIU/L. Additionally, the National Academy of Clinical Biochemistry (NACB) also states that 95% of people with good thyroid health have a TSH below 2.5 mIU/L.

A study was performed to test the hypothesis of the upper limit of normal TSH level, which is 2.5 mIU/L. The results showed that there was a high incidence of Hashimoto's thyroiditis in people with TSH levels between 2.6 and 2.9 mIU/L. Therefore, it's recommended to keep your TSH levels between 0.5 and 2.6 mIU/L.

The difference in opinion can be confusing. Not to mention the other factors that can influence your TSH levels, such as gender, age, and your specific condition. However, most doctors would consider a level between 0.5 and 3.0 mIU/L as "optimal."

How to get optimal TSH levels if you have Hashimoto's disease?

Maintaining optimal TSH levels is important in the treatment of Hashimoto-induced hypothyroidism. If your Hashimoto's disease causes overt or subclinical hypothyroidism, the treatment likely includes thyroid hormone replacement medicine. The purpose of this medication is to mimic the natural thyroid hormones in the human body by increasing your thyroid hormone levels and decreasing your TSH levels. Thus, it allows you to get optimal TSH levels.

When it comes to thyroid hormone replacement drugs on the market, you have a variety of choices. Some people prefer levothyroxine, the synthetic version of the hormone thyroxine (T4) because it's the standard treatment for hypothyroidism and the easiest to find on the market. However, many other hypothyroid patients choose Natural Desiccated Thyroid (NDT), also known as Desiccated Thyroid Extract (DTE), because it is derived from nature and is believed to be more effective.

A study comparing NDT and levothyroxine reported that almost half (48.6%) of the participants preferred NDT over levothyroxine. And only 18.6% preferred the LT4. The study also showed that NDT offers better relief from hypothyroid symptoms and promotes more weight loss.

Where can you find NDT products?

Although NDT is the first treatment for hypothyroidism and is found to be effective, NDT products can be difficult to find in pharmacies because many doctors consider them outdated.

One alternative is to buy desiccated thyroid online, such as VitaliThy. It's made from dried pig thyroid, which means it contains the full spectrum of hormones and minerals found in your thyroid, including T4, T3, T2, T1, and Calcitonin. This unique combination can provide additional benefits to your body that T4-only medications cannot do.

How do you treat Hashimoto's disease without hypothyroidism?

Hashimoto's disease doesn't always lead to hypothyroidism. Some people have TPO antibodies present in their blood even when their thyroid function test comes back normal.

If you have Hashimoto's disease without hypothyroidism, you don't need thyroid medication. However, your doctor will monitor your condition closely. You may also need to make some healthy lifestyle changes and take supplements to improve the underlying thyroid autoimmune condition, which may include:

  • Taking 100 to 200 mcg of selenium daily

  • Maintaining normal levels of vitamin D

  • Avoiding nicotine, including second-hand smoke

  • Increasing your intake of omega-3 fatty acids.

Can you take supplements to support your thyroid function?

What is a good TSH level for Hashimoto's disease?

Supplements can play an important role in supporting proper thyroid function and managing the autoimmune disorder, whether your Hashimoto's causes hypothyroidism or not. You can consider adding the following supplements to your daily routine, but be sure to consult with your doctor first.


Iron levels can play a role in your thyroid health. Research has shown a correlation between lower iron levels and a higher prevalence of subclinical hypothyroidism, as well as lower thyroid hormone levels. It's worth noting that Hashimoto's disease increases your risk of developing other autoimmune conditions that can negatively impact your body's ability to absorb iron, such as autoimmune gastritis and celiac disease. Thus, it's recommended to take an iron supplement or increase your intake of iron-rich food if you have Hashimoto's disease.


Selenium not only helps protect general health but also prevents thyroid disease. It can even lower the levels of TPO antibodies in your blood. Selenium is found in Brazil nuts, walnuts, and other nuts. On the other hand, it is also found in freshwater and saltwater fish such as herring, tuna, beef, and poultry.

Vitamin D

Although it is easy to maintain vitamin D levels in the body, it's estimated that more than 1 billion people worldwide are deficient in the vitamin, which may lead to autoimmune diseases like Hashimoto's disease. Supplementing your body with vitamin D can improve your TSH and calcium levels, as well as reduce TPO antibodies in your blood.

There are many ways to supplement your body with vitamin D, such as getting more sunlight, using supplements, or supplementing with foods like cod liver oil, eggs, cheese, margarine, salmon, tuna, milk, cereal, etc.


Hashimoto's disease is a common autoimmune disorder in which the immune system mistakenly attacks the thyroid gland, leading to a condition called hypothyroidism. Also known as underactive thyroid, hypothyroidism is a common health condition in which the thyroid does not produce enough of certain hormones.

People with Hashimoto's disease usually have an increased TSH level (usually above 4.5 mIU/L) and a decreased T4 level (usually below 0.8 μg/dL). These numbers are far out of the optimal thyroid levels, so you'll experience uncomfortable symptoms like cold intolerance, fatigue, low libido, and low heart rate. Therefore, you need to take thyroid hormone replacement medication to get your TSH and thyroid hormone levels back in check.

When it comes to thyroid hormone replacement, you may be faced with many different options. One of the best is VitaliThy, a natural desiccated thyroid you can buy online. It contains all the thyroid hormones that naturally occur in your thyroid gland, such as T4, T3, T2, T1, and Calcitonin. Thus, it can ease your hypothyroid symptoms effectively, allowing you to enjoy all that life has to offer - even when presented with obstacles like Hashimoto's disease.

Wojciech Majda
Wojciech Majda

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