Everything in one arc. Hashimoto's rewards getting properly diagnosed, getting your thyroid hormone genuinely optimised, and then working the levers that lower the immune load and make you feel like yourself. Here's the order that matters.
If you have the symptoms, insist on the real panel — TSH, free T4, anti-TPO and anti-Tg — not TSH alone, plus vitamin D, ferritin, and B12 to catch the mimics. A normal TSH doesn't rule it out. Catching it early, in the antibody phase, is where you have the most leverage — so push for the antibodies rather than accepting 'your thyroid's fine.'
If you're hypothyroid, get on levothyroxine and get the dose right: same brand, taken correctly (empty stomach, away from coffee/calcium/iron), aiming to feel well within a safe TSH range — not pushed too low. If you're still symptomatic on a good dose with a normal TSH, rule out the mimics, then discuss a supervised T4/T3 trial. Don't chase a cure at the expense of the hormone you actually need.
On top of the medication: don't megadose iodine; try selenium; screen for and treat celiac; correct your deficiencies (D, iron, B12); eat anti-inflammatory; move moderately; sleep; manage stress; and if things stay stubborn, consider a supervised LDN trial. Change one thing at a time and retest at 3 months.
The order that matters
Get fully tested → optimise the thyroid hormone → lower the immune load with the proven levers (no iodine, selenium, treat celiac, fix deficiencies) → experiment carefully, one change at a time. Diagnosis and a right-sized dose do most of the work; the levers are the margin.
The Hashimoto’s Guide