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What Are Thyroid Flares or Thyroid Flare-Ups?

Originally published on 12th May 2016
Last updated on 7th June 2024

Author’s Note: I originally wrote this article in May 2016, when there were no other mentions of thyroid conditions ‘flaring up’ anywhere at all. I searched online, in books and asked my doctor, but there was no recording of what I experienced. So I did what I do best: I recorded my own experience of what a flare felt like to me, and it resonated with thousands of you! And now the term ‘thyroid flare’ or ‘thyroid flare up’ is well-used. This article is where it was birthed!

Rachel Thyroid Flare Up

I began referring to days when my hypothyroidism or Hashimoto’s symptoms were particularly bad as a ‘bad thyroid day’. However, after a while, I felt that the term ‘thyroid flare’ or ‘thyroid flare up’ felt more accurate.

Other people may use ‘Hashimoto’s flare’, ‘Hypothyroidism flare up’ etc. but they all have the same basis.

I’ve had thyroid flare days when my thyroid condition hasn’t been under control but also when it has!

My hypothyroidism is stable and levels are optimised, and the Hashimoto’s is currently in remission, yet I still experience thyroid flares from time to time.

What Is a ‘Thyroid Flare Day’?

A thyroid flare is defined by an increase in symptoms of your thyroid condition, usually due to one of the causes listed below. A flare usually lasts for somewhere between one day to a few weeks. The most common amount of time reported is a few days.

If you’re feeling that your flare is lasting for much longer than this, then it may not be a flare up, but a permanent dropping of your thyroid hormone levels. So please have this investigated.

After all, flare ups are not associated with a drop in thyroid hormone levels, but are more a reaction to overexertion which takes your body a day or two to recover from. Read more here.

Some people call an increase in thyroid antibody levels (after having them low for quite some time) a flare up. And others also use the term to describe a change in thyroid hormone levels. I tend not to. I think this is confusing!

Symptoms can differ from person to person, though the most commonly reported in a flare up are:

Related post: Thyroid Patients Explain How Their Flare Ups Feel

What Causes a Flare Up?

These are the most common triggers according to thyroid patients:

  • DrinkingΒ alcohol (even just one drink can trigger a flare in some)
  • Eating a lot of sugary or processed food / not giving your body enough nutrient dense food. (for example, it may follow the Christmas period when a lot more processed food is consumed and replaces more nutrient-dense and a wider range of foods)
  • Consuming a food your body does not like – an allergen, intolerance or sensitivity etc. (such as gluten or dairy)
  • Mental or physical overexertion – See the spoons post. (may occur after a busy vacation / holiday, lots of social events or busy work period)
  • High amounts of stress
  • Not sticking to a predictable sleep routine (see tips for this here)
  • Viral, bacterial, fungal infections (illnesses caught from family members, ear infections,tonsillitis etc.)
  • Being on your period or due to start on your period (hormonal fluctuations)
  • Pregnancy (more hormonal fluctuations, plus it’s easier to overexert yourself!)

I asked the thyroid community to share the causes of their flare ups here.

Rachel Migraine

If you’re stuck in a flare cycle (you experience them a lot), it may be because you’re doing something like this:

1. Over exercising.
2. Doing all the things (saying ‘yes’ to everything).
3. Running yourself in to the ground tired.
4. You’re forced to stop exercising and running around because your body collapses.
5. You’re forced to rest and recuperate.
6. When you feel better, you go back to number 1 again. It repeats over and over.

So in order to prevent or reduce future flares, we need to break this cycle!

How Can I Avoid Flare Ups in Future?

Each time you experience one, try to pinpoint which things (such as those listed above) may have contributed to it. Did you encounter any of these in the run up to your flare starting? Obviously the main thing to do here is then avoid them in future if possible, so as to reduce the chances of another flare.

Key areas that can help:

  1. Some people find relief from flare-ups when they eliminate a food allergy, intolerance or sensitivity, such as gluten. Around 90% of people with hypothyroidism have the autoimmune diseaseΒ Hashimoto’s, which is the cause for their hypothyroidism. [1] And a lot with Hashimoto’s seem to do better on a gluten-free diet. Read more here.
  2. You can also look at quieting the immune response by lowing your thyroid antibodies if you have Hashimoto’s, which may even lead to the condition being in remission. By lowering thyroid antibodies, we’re told that this puts the condition under control and means it is better managed, reducing symptoms and flare ups. See this article for ways to do this. My Hashimoto’s going in to remission has drastically reduced the amount of flares I get from once a month to once or twice a year.
  3. Supporting your immune system and body as a whole with good nutrition, supplements such as Vitamin C, D and Selenium, adequate sleep and keeping stress levels low where possible can also help.
  4. Ensuring you are also addressing any adrenal dysfunction is also very key, as “hypothalamic-pituitary axis dysfunction” often goes hand in hand with hypothyroidism. Read more about this here.
  5. Having your thyroid levels and nutrient levels tested regularly and ensuring they are all optimised is also key to feeling well with thyroid disease.
  6. Learning how to manage your ‘spoons is often key.

What Should I Do in a Flare Up?

First and foremost, it is important to say that if you’re feeling incredibly unwell, then you should always see your doctor in case something more serious is going on. If what you initially think is a flare actually carries on for weeks or months, it is probably more likely a sign for a thyroid medication dosage adjustment or need for other investigations.

How To Manage Flare Ups When They Happen

The bad thyroid days are a part of having hypothyroidism that I have learned to accept with time, but I did, at one point, think I would be able to make a 100% recovery back to full health, without any flare ups ever again. But you know what? No one person is in perfect health every single day of their lives. And so it’s perfectly normal to expect flare ups in symptoms from time to time.

Now I realise it’s OK and normal to have bad health days. My health is always going to require close monitoring to try and keep it on track as much as possible.

  1. On a flare day, try to rest, keep warm, read or put on a film, drink lots of warm drinks such as hot water and lemon, or herbal tea, and keep yourself well-hydrated as much as possible.
  2. Choose nourishing food, consider bone broths and if you can’t cook and must order takeaway, consider the many ‘healthy takeaway’ options now available. More nutrient-dense food that is going to help your body recover quicker can really help how you feel.Β I avoid sugar and caffeine.
  3. If you want to call a friend or two for some company, do. But if you don’t feel sociable, then that’s OK too.
  4. Where you can, try to listen to your body and let it have whatever it needs to get over the flare. I often like to try and get in the bath (if I have the time) as this helps my body loosen up, but hot water bottles can also really help with this too, especially if you’re sat at a work desk for example.
  5. On days where I have had to work or otherwise didn’t have the luxury of just resting in front of the TV or in bed, I have compromised. I can try to limit how much work or other commitments impede my recovery from a flare. For example, seeking permission to work from home, working altered hours until the flare has passed, replacing walking to and from work with transport to save energy, or otherwise speaking to my line manager about suitable adjustments.
  6. If making changes surrounding my work isn’t an option, at the very least I can supportΒ  recuperating outside of work as much as possible. I limit how much unnecessary activity I do and maximise resting and recuperation time instead. We have to say “no” sometimes.

Related Post: Surviving Thyroid Flare Ups When You’re a Parent

It’s OK to not be 100% well everyday. It’s OK to look after yourself.

Don’t over-do anything if you can, as it is likely to make it worse.

What are thyroid flare ups like for you?

You can click on the hyperlinks in the above post to learn more and see references to information given.

References:

[1] https://www.ncbi.nlm.nih.gov/pubmed/3066320

Be Your Own Thyroid Advocate Book CoverSee also:

The bookΒ Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired,Β which builds on this article in detail.

Thyroid Superhero: A Kid’s Guide To Understanding Their Grown-up’s Hypothyroidism,Β which helps children to understand their caregiver’s thyroid medication, flare days, symptoms and more.

About Author

Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing email newsletters and speaking on podcasts and at events about the many aspects thyroid disease affects and how to overcome these. She is well-recognised as a crucial and influential contributor to the thyroid community and has a large social media presence. Her bestselling books include "Be Your Own Thyroid Advocate" and "You, Me and Hypothyroidism".

14 Comments

  • Jana
    December 15, 2023 at 1:11 am

    I haven’t had a flare in YEARS! And here I am in the holiday spirit, eating gluten and sugar like it won’t affect me when BAM full blown flare up! Fatigue, dry itchy skin, brain fog, chills and even ringing ears. I gave up gluten over a decade ago but recently added it back in on occasion and it didn’t seem to bother me. But there is a threshold , which I learned the hard way. Back to no gluten and eating healthy! I’m hoping this doesn’t too long. Thanks for validating what I felt sure was going on.

    Reply
  • Jeanie
    July 1, 2022 at 10:41 pm

    Does anyone get both hot & cold at the same exact time?!

    Reply
  • Olga
    February 21, 2021 at 11:01 pm

    Would anyone know if there is possibility the perimenopause could trigger a flare that cannot seem to go away?
    I have had Hashimoto’s for many years now and have successfully controlled it through diet and natural supplementation, healthy sleep, and movement. Occasional flare up here and there over the years, but like you ladies say, it is not uncommon.
    Now, I am in an absolute hell and nothing, absolutely nothing is helping. It’s been three months since it began, it began with a period, but then that was irregular (wouldn’t end, then wouldn’t start…). I wasn’t sure if the hormones were affecting the autoimmune or the autoimmune cause the hormonal imbalance. But it seems that there’s nothing I can do that worked for me before, almost like a whole new thing.
    I am calling my doctor this week to get blood work done, but in the meantime incredibly stressed about this new turn of events, and searching for answers. I’m 45, the only thing I can think of is the beginning of menopause.

    Reply
    • Tracey
      February 3, 2022 at 10:49 am

      I’m the same. Feel like I’m losing my mind. I was over medicated and the doc has dropped my meds but my mental health is suffering and he proscribed me anti depressants which I really don’t want to take.
      My hormones seem to fluctuate all day. I feel good one minute and horrible the next

      Reply
  • Floor
    January 3, 2021 at 2:37 pm

    I am in the middle of one, that is how I found your website… After a week of sleeping 8 hours each night but still feeling tired, this morning I just felt absolutely exhausted, muscle pain and very cold. Just trying to get me through the day and accept it, which is hard since I had planned a nice Sunday with our newborn.

    Reply
  • Carol Wade
    January 2, 2021 at 6:00 pm

    Can anyone explain why my TSH went from 1.46 to 27.32 in three months time? I had an episode of extreme pain over my entire body except for my hands and feet. This went on for days…I could not turn over in bed without help, could hardly walk, etc. Went and had blookwork… conclusion…audioimmune disorder.

    Reply
  • Megan
    September 10, 2020 at 1:28 am

    It’s been a couple of years since I had a full on flare up. I’d forgotten how awful it is. My current one was triggered by the stress of a breakup shortly followed by losing my job, a wonderful couple of months πŸ™‚ The thing is you end up in a cycle if you’re not careful which I am trying to escape now. The stress & anxiety from life’s events triggers a flare, then the symptoms of the flare make the anxiety worse due to the hormones being out of balance and then you revisit the life events which are now hormonally charged as well. It becomes very difficult to grab a hold of something to calm the system down. I find in these moments mediation doesn’t work as I can’t focus at all. Running, my usual way of dealing with stress is difficult because the body is tired & I have insomnia. I also find I have a f*%k it attitude to food & my diet which I am usually so on top of slips & I eat sugar & am not so on top of gluten which I never touch usually which I know makes the whole thing worse.

    To anyone going through a flare up & to those of you newly diagnosed who haven’t quite got it under control yet. Remember the good days! I have had a diagnosis of Hashimotos since 2013 & I have a very physically demanding lifestyle & job & sure it’s a pain in the butt sometimes but the majority of the time I am in a good place. It took a couple of years to find balance in diet & the right medication but the good days exist and are possible. Don’t let your healthcare provider tell you otherwise you know your body and you’ll know it a helluva lot more as you walk this journey & learn what foods your body (dis)likes & sleep etc which is pretty awesome really.

    Reply
  • Lewis Housten
    March 5, 2020 at 11:35 am

    I absolutely hate this condition. Thanks for writing this post. I’ll save it for future reference.

    Reply
  • Emily Milliman
    January 21, 2020 at 3:43 pm

    Reading this today as I experience what I think is a thyroid flare up day after over exerting myself physically and getting too stressed at work. It is so hard to cancel plans and push everything out of your life for a day, but sometimes I just have to do it. We are stronger for having this health challenge. I think the fact that it seems invisible and that I look β€œfine” most days is the hardest part!

    Reply
  • Cheryl
    December 12, 2019 at 1:17 am

    Just happened to see this. It is so true about these flares.
    I was and had been a high functioning healthcare professional.
    Now, I pray and try to push through.
    I have Hashimoto’s, POTs, Dysautonomia, MCAS, and possibly Graves.
    I’m alone, I have no family support, friends have there own problems.
    Invisible illness. I fear what will happen to me if I can’t push through.
    Thank you for sharing this.

    Reply
    • Emily
      January 21, 2020 at 3:45 pm

      Thx for sharing. Our society is really fast paced and sometimes our bodies have ways of telling us to slow down. It can be hard to listen, but knowing others are going they the same thing helps me a lot!

      Reply
  • Susan Mckay
    May 26, 2019 at 7:47 pm

    I have this condition, and during the months before I was diagnosed I hurt many relationships with family and friends. I am still trying to piece back my family and life…it has been 8 years of finding a diagnosis and recovery physically…now the hardest part is the emotional recovery. People think I am making an excuse for my behavior….but until they have walked in the shoes of someone who suffers from this condition, they will never know the pain and agony we have gone through and struggle with every day.
    I hope anyone who has experienced this takes comfort in knowing YOU are a good person…you have had a bad health experience… don’t be so hard on yourself.

    Reply
    • Rachel Hill
      May 28, 2019 at 12:35 pm

      An important message Susan. Thank you for sharing.

      Reply
    • Cindy
      March 31, 2022 at 7:13 am

      Susan I know all to well how u feel . My family thinks I don’t want to be around them . My dad called me crying and ask me why didn’t I love him anymore. I have alot of health issues and it’s really hard for me to get out . I feel like when I am around then that they r judging me. I’m having a really bad flare up . Just wish they could understand. For I love love and need there support. I thought I was the only one who felt this way then I read what u wrote. Thanks for sharing.would love to text some time

      Reply

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