What is autoimmune thyroid disease (AITD)?

Thyroid conditions can be complicated and vary from temporary to lifelong. And, in many cases, the cause of your thyroid condition may be autoimmune in nature. So, how do you know if an autoimmune reaction is to blame for your thyroid condition? And are there factors that could leave you more at risk of developing autoimmune thyroid disease? 

In this blog, we discuss: 

• What is autoimmune thyroid disease? 
• What is Hashimoto’s disease? 
• What are the symptoms of Hashimoto’s disease? 
• What is Graves’ disease? 
• What are the symptoms of Graves’ disease? 
• How are autoimmune thyroid conditions diagnosed? 
• What are the risk factors for autoimmune thyroid disease? 
• Are Hashimoto’s and Graves’ disease curable? 
• How do you treat Hashimoto’s disease? 
• How do you treat Graves’ disease? 
• Where can I get support for an autoimmune thyroid condition? 
   

What is autoimmune thyroid disease?
 

Autoimmune thyroid disease (AITD) is any thyroid condition that is caused by certain antibodies attacking the thyroid gland.  

There are several types of autoimmune thyroid disease, including [1]: 

• Postpartum thyroiditis 
• Subacute thyroiditis  
• Painless thyroiditis 

And the two most common autoimmune thyroid diseases are Hashimoto’s disease and Graves’ disease.  
 

What is Hashimoto’s disease?
 

Hashimoto’s disease is one of the most common causes of hypothyroidism (an underactive thyroid). In its early stages, it’s possible for Hashimoto’s thyroiditis to cause temporary hyperthyroidism (an overactive thyroid), but this is uncommon [2].  

Hashimoto’s disease develops when the immune system makes thyroid antibodies that attack the thyroid gland, causing it to become damaged and unable to make enough thyroid hormones. This, in turn, can cause unwanted symptoms. 
 

What are the symptoms of Hashimoto’s disease?
 

In the early stages, it’s common for Hashimoto’s to have no symptoms. But, as the disease progresses, you are more likely to encounter symptoms.  

Symptoms of Hashimoto’s include [3]: 

• Weight gain  
• Fatigue  
• Joint and muscle pain  
• Slower heart rate  
• Constipation  
• Dry skin and hair  
• Irregular menstrual cycle  
• Fertility problems 
   

What is Graves’ disease?
 

Graves’ disease is the most common cause of hyperthyroidism (an overactive thyroid). As it’s an autoimmune disease, the body creates antibodies that attack the thyroid gland. Unlike Hashimoto’s disease, the attack on the thyroid gland causes an increase in thyroid hormones – speeding up many functions in the body and causing several unwanted symptoms [4].  
 

What are the symptoms of Graves’ disease?
 

With Graves’ disease, your symptoms may come and go over time and will differ from person to person.  

Symptoms of Graves’ disease include [4]: 

• Problems with your eyes and skin  
• Weight loss, despite an increased appetite  
• Increase in heart rate  
• Palpitations (a noticeably rapid, strong, or irregular heartbeat) 
• Mood swings, including an increase in anxiety  
• Insomnia  
• Shaky hands  
• Muscle weakness  
• Frequent bowel movements  
• Goitre (swelling of the thyroid gland) 
   

How are autoimmune thyroid conditions diagnosed?
 

The first step in testing for autoimmune thyroid disease is a blood test. At first, your doctor may only test your thyroid hormones, to see how your thyroid is functioning. If your doctor suspects an autoimmune thyroid condition, they may test for specific thyroid antibodies, including:  

• Anti-thyroid peroxidase (TPOAb) 
• Anti-thyroglobulin (TgAb) 
• TSH receptor antibodies (TRAb) 

Thyroid antibodies often indicate an autoimmune condition is at play. However, it is possible to have normal thyroid antibodies and still have Graves’ or Hashimoto’s.  This is why your blood test will be looked at alongside your medical history, risk factors, and any other test results (such as an ultrasound).  

What are the risk factors for autoimmune thyroid disease?
 

Certain factors may leave you more at risk of developing an autoimmune thyroid autoimmune.  

Risk factors include: 

• Being female 
• Having a family history of Graves’ or Hashimoto’s  
• Having another autoimmune condition, such as coeliac disease or type 1 diabetes  
• Smoking  

You can read more about risk factors of thyroid disease in our blog: am I at risk of a thyroid condition?
 

Are Hashimoto’s and Graves’ disease curable?
 

As Hashimoto’s and Graves’ disease are both autoimmune conditions, neither are curable. However, they can be treated to restore hormone levels to normal. Many people with Hashimoto’s and Graves’ disease lead long and healthy lives once their condition is well controlled. 

Your treatment will depend on whether you have Hashimoto’s or Graves’ disease.  
 

How do you treat Hashimoto’s disease?
 

Hashimoto's disease comes on slowly over many years. Initial blood tests might show only minor changes in your thyroid hormone levels. For that reason, your doctor might choose to monitor your bloods for a period rather than start treatment right away.  

Ultimately, as Hashimoto's disease causes overt hypothyroidism, you'll likely develop symptoms and need treatment in the form of replacement hormones (levothyroxine). 

As well as medication, it's important to look after yourself with a balanced (thyroid-friendly) diet and regular exercise.  
 

How do you treat Graves’ disease?
 

As Graves’ disease causes a hyperactive thyroid (overactive thyroid), the best way to treat it is through either medication, radioiodine therapy, or in some cases, surgery. Treatment for Graves’ disease often causes hypothyroidism which may then need to be corrected with levothyroxine.  

As with Hashimoto’s, a healthy lifestyle including a thyroid-friendly diet and regular exercise can help to manage your symptoms.  

Where can I get support for an autoimmune thyroid condition?

As well as causing physical symptoms, thyroid conditions often affect mood and mental health too. This is partly due to abnormal thyroid hormone levels, but it can also be due to the difficulties and adjustments of living with a long-term condition. Thankfully, there are lots of sources of support.  

• Thyroid Hub – from information on thyroid disorders to answering questions about whether thyroid conditions can go away by themselves, our Thyroid Hub is here to support you.  
• Thyroid UK – Thyroid UK is a charity that seeks to help you through your thyroid journey. Whether you are undiagnosed or diagnosed, it offers plenty of support and information. 
• British Thyroid Foundation – BTF is a charity that helps people who have been diagnosed and are living with a thyroid disorder. And it offers support based on patient experience. 

References 

1. Franco JS, Amaya-Amaya J, Anaya JM. Thyroid disease and autoimmune diseases. In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et al., editors. Autoimmunity: From Bench to Bedside [Internet]. Bogota (Colombia): El Rosario University Press; 2013 Jul 18. Chapter 30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459466/ 
2. Shahbaz, A. et al. (2018) ‘ prolonged duration of Hashitoxicosis in a patient with Hashimoto’s thyroiditis: A case report and review of literature’, Cureus [Preprint]. doi:10.7759/cureus.2804. 
3. Hashimoto’s disease - NIDDK (no date) National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease#:~:text=for%20Hashimoto’s%20Disease-,What%20is%20Hashimoto’s%20disease%3F,the%20front%20of%20your%20neck (Accessed: 31 May 2023). 
4. Graves’ disease - niddk (no date) National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease#:~:text=Graves’%20disease%20is%20an%20autoimmune,the%20way%20your%20heart%20beats (Accessed: 31 May 2023).