Hashimoto's Thyroiditis

Symptoms of Hashimoto's thyroiditis are the same as hypothyroidism.

Hashimoto's thyroiditis is an autoimmune condition that is a common cause of hypothyroidism. In Hashimoto's thyroiditis, the body mounts an immune reaction against its thyroid gland tissue, leading to inflammation of the gland (thyroiditis).

The thyroid is a butterfly-shaped gland located in the lower part of the neck, below Adam's apple. The thyroid gland wraps around the windpipe and has a shape that is similar to a butterfly - formed by two wings or lobes (lobes) and is attached by a middle part.

Hashimoto's thyroiditis is a condition caused by inflammation of the thyroid gland. It is an autoimmune disease, which means that the body inappropriately attacks the thyroid gland - as if it were foreign tissue. The underlying cause of the autoimmune process remains unknown.

• Hashimoto's thyroiditis tends to occur in families.
• It can be associated with other autoimmune conditions such as type 1 diabetes or celiac disease.
• Hashimoto's thyroiditis is 5 to 10 times more common in women than in men and most often starts in adulthood.

Blood drawn from people with Hashimoto's thyroiditis typically reveals an increased number of antibodies against thyroid-specific proteins, including thyroperoxidase and thyroglobulin. T lymphocytes, a type of cell involved in the inflammation process, invade the thyroid gland and cause silent, painless inflammation that destroys it; ultimately, the individual produces little or no thyroid hormone and becomes hypothyroid.

Hashimoto's disease may be due to genetic and environmental factors.

Risk factors for Hashimoto's disease include the following:

• Genetic factors
• Excessive iodine in the body
• Female gender
• Smokers
• People older than 50 years
• Radiation exposure
• Pregnancy and childbirth
• Hormonal imbalances such as in polycystic ovarian disease (PCOD)
• Excess stress
• Drugs, such as Lithium, used for treating mental health disorders

Hashimoto's thyroiditis symptoms include a lump in the front of the neck from the enlarged thyroid gland called a goiter.

Symptoms and signs of Hashimoto's thyroiditis resemble those of hypothyroidism generally and are often subtle. They are not specific (which means they can mimic the symptoms of many other conditions) and are often attributed to aging. Patients with mild hypothyroidism may have no signs or symptoms. The symptoms generally become more obvious as the condition worsens, and the majority of these complaints are related to a metabolic slowing of the body.

Common symptoms and signs of Hashimoto's thyroiditis include:

• Fatigue
• Depression
• Modest weight gain
• Cold intolerance
• Excessive sleepiness
• Dry, coarse hair
• Constipation
• Dry skin
• Muscle cramps
• Increased cholesterol levels
• Decreased concentration
• Vague aches and pains
• Swelling of the legs

As hypothyroidism becomes more severe, there may be puffiness around the eyes, a slowing of the heart rate, a drop in body temperature, and heart failure. In its most profound form, severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. This condition requires hospitalization and immediate treatment with thyroid hormone.

Hashimoto's thyroiditis can be easily treated with thyroid hormone replacement if it is diagnosed properly. Untreated hypothyroidism can lead to an enlarged heart (cardiomyopathy), worsening heart failure, and an accumulation of fluid around the lungs (pleural effusion) or heart (pericardial effusion).

People with Hashimoto's thyroiditis often initially experience a hyperthyroid phase (too much thyroid hormone), called hashitoxicosis, as thyroid hormone leaks out of the damaged gland as it is destroyed. Eventually, they become hypothyroid.

Other symptoms and signs include:

• Swelling of the thyroid gland (due to the inflammation), which can cause a feeling of tightness or fullness in the throat
• A lump in the front of the neck from the enlarged thyroid gland called a goiter
• Difficulty swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the esophagus

Hashimoto's thyroiditis is not a reason to avoid pregnancy. However, some women with Hashimoto's thyroiditis do have trouble conceiving. In addition to careful obstetric care, management of thyroid hormone replacement by an endocrinologist is helpful. Before conception and during pregnancy, levels of thyroid hormones need to be monitored and optimized by checking TSH levels, and if necessary, adjusting the medication dose. The target goal is usually within the range for nonpregnant women but at the higher end of the normal range.

As the level of thyroid hormone falls, the pituitary gland responds by releasing more thyroid-stimulating hormone (TSH).

To diagnose Hashimoto's thyroiditis, a physician should assess symptoms and complaints commonly seen in hypothyroidism, carefully examine the neck to look for enlargement of the thyroid gland, and take a detailed history of family members. Blood tests are essential to diagnose Hashimoto's thyroiditis. Specific blood tests determine the level of thyroid function.

During the early stage of thyroiditis, the levels of thyroid hormones (T3 and T4) may be normal. With chronic hypothyroidism, the thyroid hormone levels fall, and the level of thyroid-stimulating hormone (TSH) becomes high. The most useful assay for determining thyroid status is the measurement of TSH in the blood. As mentioned earlier, TSH is secreted by the pituitary gland. As the level of thyroid hormone falls, the pituitary gland responds by releasing more thyroid-stimulating hormone (TSH). The increase in TSH can precede the fall of thyroid hormone to low levels by months or years, so the first sign of hypothyroidism may be an elevated TSH level even when levels of thyroid hormones are normal.

The blood work mentioned above confirms the diagnosis of hypothyroidism but does not point to an underlying cause. The combination of the patient's clinical history, antibody screening (as mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem. If a pituitary or hypothalamic cause is suspected, an MRI of the brain and other studies may be warranted. These investigations should be made on a case-by-case basis.

The blood tests also usually include an analysis of antibodies (anti-thyroperoxidase antibodies) to aid diagnosis. If the anti-TPO antibodies are elevated at all, the diagnosis is made. Early on in the course of the disease, however, the patient may have negative antibodies.

If the gland is large, or there are symptoms of esophageal compression, an ultrasound may be performed to see if the gland is compressing either the esophagus (the food tube) or the trachea (the airway).

There is no cure for Hashimoto's thyroiditis. The timeframe of the autoimmune process and inflammation will continue is not predictable. In the vast majority of patients, hypothyroidism results from the inflammatory process.

Thyroid hormone medication can replace the hormones the thyroid made before the inflammation started. There are two major thyroid hormones made by a healthy gland (T3 and T4). Replacing one or both of these hormones can alleviate the symptoms caused by the absolute or relative lack of hormones as a result of Hashimoto's thyroiditis.

The treatment of choice for Hashimoto's thyroiditis is typically synthetic T4 or thyroxine (levothyroxine).

• Brand names for this medication include Synthroid, Levothroid, and Levoxyl. The medication must be taken indefinitely, and successful treatment alleviates the symptoms and signs of hypothyroidism.
• Without medication, there is very little chance the thyroid would be able to maintain hormone levels within the normal range, and symptoms and signs of hypothyroidism would occur or worsen.
• The dosage of levothyroxine may need to be modified after checking TSH levels once yearly. Adjustment of the dose may also be required in pregnant women.

Regular follow-up with your doctor is necessary to adjust the medication dosages and timely diagnose any complications that may occur. Follow-up visits will also help your doctor adjust your medications under special situations such as pregnancy.

Hashimoto's thyroid is a long-standing condition where the body produces damaging proteins against its thyroid gland.

These proteins produce symptoms such as irritability, body aches, weakness, dryness of mouth, and joint aches. In some patients, these symptoms may persist despite medical therapy, which normalizes the thyroid hormone levels. The symptoms are due to the overstimulated immune system that affects other body cells and the thyroid gland. Many studies have proven that these symptoms can be managed with total thyroidectomy.

Thyroidectomy normalizes anti-thyroid peroxidase (anti-TPO) antibody titers, reducing these by an average of 92 percent, thus providing symptom relief. Therefore, there is a 92 percent chance that the symptoms will lessen once the thyroid is removed. You will not exhibit symptoms of Hashimoto's disease without a thyroid gland.

Complete removal of the antigenic tissue through total thyroidectomy has been hypothesized to control general autoimmune response and relieve symptoms. However, most people with Hashimoto's disease do not require surgery.

Treatment of Hashimoto's thyroiditis involves the administration of prescription thyroid hormones. There is no scientific evidence that natural treatments can reverse hypothyroidism.

People with Hashimoto's thyroiditis do not need to follow a special diet. There is no evidence to suggest that specific foods have any effect on worsening or improving the condition.

Should Hashimoto's thyroid patients avoid gluten?

Avoiding gluten isn't currently a recommendation for people with Hashimoto's. But if you wish to avoid gluten to see if it improves your thyroid disease symptoms, there's probably no harm in doing so.

Hashimoto's and celiac frequently occur together. If you have celiac disease, it might be overlooked in the Hashimoto's diagnostic process. Your doctor might attribute all of your symptoms to thyroid disease. In short, if you're a Hashimoto patient who feels better when you don't eat gluten, you could be treating a hidden case of celiac disease.

The prognosis for someone with Hashimoto's thyroiditis is excellent with proper treatment. Restoration of thyroid hormone levels with medical treatment will reverse the signs and symptoms of hypothyroidism. Without treatment, hypothyroidism can worsen over years, potentially leading to organ damage and severe illness.

Thyroidectomy is a major surgery. It is performed under general or regional anesthesia. Like every procedure, it has potential complications.

Complications of thyroidectomy may include:

• Bleeding
• Infection
• Damage to the parathyroid gland (a neck gland that regulates calcium in the body)
• Underactive thyroid
• Airway obstruction
• Permanent hoarse voice due to nerve damage

Hashimoto's thyroiditis is an autoimmune condition in which the body perceives its tissue as foreign. There is no known way to prevent this condition.