Hashimoto's Thyroiditis

1 What is Hashimoto's Thyroiditis?

Hashimoto's thyroiditis is a condition in which your immune system produces antibodies against your thyroid gland resulting in inflammation known as chronic lymphocytic thyroiditis that often leads to an underactive thyroid gland (hypothyroidism).

In the United States, Hashimoto's disease has been found to be the most common cause of hypothyroidism.

Hashimoto

The middle-aged women are more likely to be affected by this condition. However, it can occur in both sexes at any age including children.

Thyroid function test is done to detect Hashimoto’s disease. It can be treated by thyroid hormone replacement which is quite effective.

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2 Symptoms

Initially there might be no signs or symptoms of Hashimoto's thyroiditis or there may be swelling at the front of your throat (goiter). The slow progression of Hashimoto's disease causes chronic thyroid damage leading to a drop in thyroid hormone levels.

The signs and symptoms are manifested due to an underactive thyroid gland (hypothyroidism). Signs and symptoms of hypothyroidism are as follows:

  • Fatigue and sluggishness
  • Increased sensitivity to cold
  • Constipation
  • Pale, dry skin
  • A puffy face
  • Hoarse voice
  • Unexplained weight gain — occurring infrequently and rarely exceeding 10 to 20 pounds, most of which is fluid
  • Muscle aches, tenderness and stiffness, especially in your shoulders and hips
  • Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet
  • Muscle weakness, especially in your lower extremities
  • Excessive or prolonged menstrual bleeding (menorrhagia)
  • Depression

See your doctor if you experience signs and symptoms:

  • Tiredness for no apparent reason
  • Dry skin Pale, puffy face
  • Constipation
  • Hoarse voice

You'll also need to see your doctor for periodic thyroid function test if you’ve had

  • Thyroid surgery
  • Treatment with radioactive iodine or anti-thyroid medications
  • Radiation therapy to your head, neck or upper chest
  • High blood cholesterol (hypothyroidism may be a cause).
  • Hormone replacement therapy for hypothyroidism caused by Hashimoto's disease.

3 Causes

Hashimoto's thyroiditis is caused when immune system produces antibodies that damage your thyroid gland.

The exact cause behind production of antibodies against thyroid gland is not well understood.

However, some scientists believe that virus or bacterium might trigger the immune response, while others believe it to be a genetic flaw.

Factors such as heredity, sex and age in combination may increase the chances of developing such disorder.

4 Making a Diagnosis

Diagnosis of Hashimoto's thyroiditis is made on the basis of signs and symptoms and levels of thyroid hormone and thyroid-stimulating hormone produced in the pituitary gland.

You may be referred to an endocrinologist to make further diagnosis. Following tests are significant in diagnosing Hashimoto's disease.

  • A hormone test: Blood tests are done to determine the amount of hormones produced by thyroid and pituitary glands. The underactive thyroid produces low level of thyroid hormone whereas, the level of TSH is elevated as the pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone. The level of TSH is checked prior to the thyroid hormone levels. TSH tests also help manage hypothyroidism.
  • An antibody test: Hashimoto's disease is an autoimmune disorder which involves the production of antibodies against thyroid gland. A blood test is done to confirm the presence of antibodies against thyroid peroxidase (TPO antibodies), an enzyme normally found in the thyroid gland which influences the production of thyroid hormones.

Above mentioned tests also help determine the right dosage of medication, both initially and over time.

5 Treatment

Treatment modalities for Hashimoto's thyroiditis may include observation and use of medications. With normal functioning of thyroid gland and no evidences of thyroid hormone deficiency your doctor may suggest a wait-and-see approach.

If you require medication, you may need to take it for rest of your life.

  • Synthetic hormones: Thyroid hormone replacement therapy is needed if Hashimoto's disease leads to thyroid hormone deficiency. Synthetic hormones such as hormone levothyroxine (Levoxyl, Synthroid) which is identical to thyroxine can be taken orally to restore the adequate hormone levels and reverse the symptoms of hypothyroidism.

The intake of medication may bring following changes.

  • Feeling less fatigued.
  • Gradually the elevated cholesterol level is lowered and may reverse weight gain.

It is recommended to check your TSH level every 6-12 months because the dosage of levothyroxine you need may change.

Monitoring the dosage

Right dosage of levothyroxine can be determined initially by checking TSH level after a few weeks of treatment.

Increase in level of thyroid hormone can accelerate bone loss, which may worsen osteoporosis or add to the risk of this disease.

Heart rhythm disorders (arrhythmias) may be the result of over treatment with levothyroxine.

If you have coronary artery disease or severe hypothyroidism, initially treatment is started with a smaller dose of medication which is then gradually increased. This helps the heart to adjust to the increase in metabolism.

With appropriate dose Levothyroxine causes no side effects. Keep your doctor informed if you are changing the brand to ensure that you are taking the right dosage. Try not to skip doses or miss the dose as it may lead to return of signs and symptoms.

Effects of other substances on levothyroxine

The absorption of levothyroxine is affected by certain medications, supplements and some foods. To ensure the proper absorption, levothyroxine can be taken at least four hours before or after other medications.
Consult your doctor in case you have had large amounts of soy products or a high-fiber diet or if any of the following:

  • Iron supplements
  • multivitamins containing iron
  • Cholestyramine (Prevalite), cholesterol lowering agent
  • Aluminum hydroxide, which is found in some antacids
  • Sodium polystyrene sulfonate (Kayexalate), used to prevent high blood potassium levels
  • Sucralfate, an ulcer medication
  • Calcium supplements

6 Alternative and Homeopathic Remedies

A few alternative remedies exist for Hashimoto's thyroiditis.

Natural extracts containing thyroid hormone derived from the thyroid glands of pigs are available. For example Armour Thyroid contains both levothyroxine and triiodothyronine.

Following are some points of concern about Doctors have a number of concerns about Armour Thyroid.

  • The level of T-4 and T-3 animals is different from that of humans.
  • Variation in the exact amount of T-4 and T-3 in each batch of a natural extract products can alter the level of hormones to an unpredictable extent.
  • Since T-3 is more potent than T-4, problems can arise even due to mild difference than the normal level. R

Researchers have investigated whether it is beneficial to replace some T-4 with T-3 to adjust standard hypothyroidism treatment. Most studies have concluded that addition of T-3 does not offer benefit over treatment with T-4 alone.

However, certain subsets of people, such as people undergoing thyroidectomy (surgical removal of thyroid gland) have been found to be benefited by T-3.

7 Risks and Complications

Following are some of the factors contributing to the risk of developing Hashimoto's thyroiditis.

  • Sex: Women possess higher risk to develop Hashimoto's disease.
  • Age: Hashimoto's disease can affects people o at any age but people of middle age are more affected.
  • Heredity: Someone in the family with Hashimoto's disease or any other autoimmune diseases increases the risk of other family members for the same.
  • Having another autoimmune disease: People with other autoimmune diseases such as rheumatoid arthritis, type 1 diabetes or lupus are at higher risk of developing Hashimoto's disease.

Various health problems arise due to an underactive thyroid gland (hypothyroidism) caused by Hashimoto's disease. Few are mentioned below:

  • Goiter: Goiter is a condition due to constant stimulation of thyroid gland to release more hormones. Hypothyroidism is amongst the most common causes of goiter.

8 Related Clinical Trials

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