Key takeaway
It is the leading cause of hypothyroidism and is most common in middle-aged women.
What is hashimoto thyroiditis?
It often causes a painless goiter and develops slowly over years. Lifelong levothyroxine replacement is the standard treatment.
Key points to remember
- It is the leading cause of hypothyroidism and is most common in middle-aged women.
- Autoimmune destruction produces high anti-thyroid peroxidase (anti-TPO) and antithyroglobulin antibodies.
- Lab pattern is elevated TSH with low free T4 in overt hypothyroidism; a firm painless goiter is common.
- Symptoms reflect hypothyroidism: fatigue, cold intolerance, weight gain, constipation, dry skin, bradycardia, and depression.
- Treatment is lifelong levothyroxine, dosed to normalize TSH; an early transient hyperthyroid phase ('hashitoxicosis') can occur.
- It raises the risk of other autoimmune diseases and, rarely, thyroid lymphoma.
Signs & symptoms
- Fatigue, cold, weight gain
- Bradycardia, constipation, dry skin
- Goiter, hair loss, depression
Nursing priorities
- Administer levothyroxine on an empty stomach in the morning, 30-60 minutes before breakfast and other medications.
- Monitor TSH to titrate dose and assess for resolution of hypothyroid symptoms.
- Assess heart rate and cardiac status, starting low doses in older adults or those with cardiac disease to avoid angina/dysrhythmias.
- Provide a warm environment, encourage fiber and fluids for constipation, and support energy conservation.
- Watch for signs of overtreatment (palpitations, weight loss, heat intolerance, insomnia).
Labs & values
Elevated TSH (normal ~0.4-4.0 mIU/L)
Low free T4 in overt hypothyroidism (normal ~0.8-1.8 ng/dL)
Positive anti-TPO and antithyroglobulin antibodies
Patient teaching
- Levothyroxine is lifelong; never stop abruptly and take it consistently at the same time daily on an empty stomach.
- Separate levothyroxine from calcium, iron, antacids, and high-fiber foods by 4 hours as they reduce absorption.
- It may take 4-8 weeks to feel full effect; report palpitations, chest pain, tremor, or insomnia (signs of too much).
- Report worsening fatigue, weight gain, or cold intolerance, which may indicate an inadequate dose.
Red flags: report now
- Signs of myxedema coma in severe untreated hypothyroidism: hypothermia, bradycardia, hypotension, altered consciousness — emergency.
- Chest pain or palpitations after starting levothyroxine, especially in older adults with heart disease — report.
- Rapidly enlarging or hard fixed thyroid mass — evaluate for malignancy.
References
Clinical references for this topic
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