Hashimoto's Thyroiditis: Definition, Symptoms, Diagnosis and Treatment
- Publish Date: 2009/05/08 - (Rev. 2018/03/16)
- Author: Thomas C. Weiss
- Contact : Disabled World
Outline: Hashimotos Thyroiditis is a thyroid gland disorder that was discovered by Dr. Hakaru Hashimoto in 1912.
Hashimoto's Thyroiditis disorder is also known by the names, "Chronic Lymphocytic Thyroiditis," and, "Autoimmune Thyroiditis."
Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's activities. Hashimoto's disease was the first disease to be recognized as an autoimmune disease. It was first described by the Japanese specialist Hakaru Hashimoto in a paper published in Germany in 1912.
The exact causes of this disorder are not known. Hashimoto's Thyroiditis involves swelling of the thyroid gland that often results in reduced thyroid function, also referred to as, 'Hypothyroidism.' The disorder can affect people of any age, although it is most often experienced by women who are middle-aged. Hashimoto's Thyroiditis is caused by a reaction of the person's immune system against their thyroid gland. The disorder causes production of auto-antibodies and immune cells by the person's immune system that may damage their thyroid cells, compromising their ability to produce thyroid hormone. The person may experience hypothyroidism if they are unable to produce enough thyroid hormone to meet their body's requirements. Their thyroid gland has the potential to become enlarged and form a goiter.
Hashimoto's Thyroiditis is the most common form of thyroid disease in America. The disorder can take months or years to develop to the point where it is detected and is most common in families with a history of thyroid disease. Hashimoto's Thyroiditis may, on occasion, present as a part of a condition referred to as, Type I Polyglandular Autoimmune Syndrome (PGA I) in conjunction with fungal infections of the person's nails and mouth, adrenal insufficiency, and hypoparathyroidism. On rare occasion, the disorder can occur with additional endocrine disorders which are caused by the immune system, or may occur with either diabetes type 1 or adrenal insufficiency. When this happens, the condition is referred to as, 'Type 2 Polyglandular Autoimmune Syndrome (PGA II).'
Symptoms of Hashimoto's Thyroiditis
Persons with Hashimoto's Thyroiditis may not have symptoms for a number of years. They may go undiagnosed until they either receive abnormal blood test results, or an enlarged thyroid gland is discovered as a part of an examination. When people do begin to exhibit symptoms of this disorder, it may involve a painless swelling of the lower, front portion of their neck that becomes increasingly visible. The swelling can be associated with a pressure that is uncomfortable and involves their lower neck, and may make swallowing more difficult.
Enlargement of the thyroid as well as hypothyroidism caused by Hashimoto's Thyroiditis often progress in persons affected with the disorder. Their symptoms worsen over time and are similar to the symptoms of hypothyroidism in general - many of which are subtle. A number of the symptoms are ones that many people attribute to aging, although the symptoms can become more obvious and worsen over time. Most of the symptoms are related to a slowing of the metabolism in the person's body.
Symptoms of Hashimoto's Thyroiditis can include:
- Hair loss
- Puffy face
- Weight gain
- Sore muscles
- Dry, itchy skin
- Joint stiffness
- Muscle cramps
- Cold intolerance
- Difficulty learning
- Swelling of the legs
- Vague aches and pains
- Dry, brittle hair and nails
- Sensitivity to medications
- Decreased concentration
- Heavy and irregular periods
- Increased cholesterol levels
- Small or shrunken thyroid gland
- Enlarged neck or presence of goiter
Persons with severe hypothyroidism can experience puffiness around their eyes, a decreasing heart rate, a drop in their body temperature, and potential heart failure. Severe hypothyroidism can lead to a life-threatening coma referred to as, 'Myxedema Coma,' that may be initiated by stress, surgery, severe illness, or a traumatic injury. Myxedema coma can be treated with injected thyroid hormone, but requires immediate treatment and hospitalization. Untreated hypothyroidism may lead to enlargement of the person's heart, accumulation of fluid around their heart, or worsening heart failure. Hypothyroidism is treatable through thyroid hormone replacement.
Diagnosing Hashimoto's Thyroiditis
The process of making a diagnosis of Hashimoto's Thyroiditis involves examination of the person's family history as well as the person themselves. A doctor looks for both complaints and symptoms that are associated with the disorder and the presence of the disease in the person's family. There are some blood tests that can be performed to diagnose this disorder that also test the person's thyroid function in general. The following laboratory tests can be performed:
- Low Free T4
- High Serum TSH
- Low or Normal T3
- Thyroid Auto-antibodies
When a person has hypothyroidism their blood levels of thyroid hormones are usually decreased, although in early hypothyroidism their levels of thyroid hormones may still be within a normal range. If the person's thyroid gland is large or they are experiencing symptoms of pressure on their esophagus, a doctor might perform an ultrasound to see if their thyroid gland is pressing on either their trachea or esophagus. Imaging tests usually are not needed in order to make a diagnosis of Hashimoto's Thyroiditis.
Doctors who are experienced in both the diagnosis and treatment of thyroid diseases are able to detect a goiter that has been caused by Hashimoto's Thyroiditis through physical examination of the person and are able to recognize it by its characteristic symptoms, as well as the lab results. The Antithyroid antibodies test gives a doctor specific lab evidence of this disorder, although it is not always present in the results. TSH test results that are outside of the average range usually indicate that the person being tested has hypothyroidism. Low levels of free thyroxine in a person's blood indicate a thyroid hormone deficiency, although the values dictated for an average range could represent a deficiency in some people. If none of these tests are enough to help a doctor to make a diagnosis, a fine-needle aspiration of the person's thyroid may be performed, although it is not necessary for the majority of people with Hashimoto's Thyroiditis.
Treating Hashimoto's Thyroiditis
Medical science has not found a cure for Hashimoto's Thyroiditis at this time. People with this disorder often experience hypothyroidism as a result of the inflammatory process. It is not known how long a person with the disorder will continue to experience inflammation because of the disorder.
People with Hashimoto's Thyroiditis may be treated with hormone medications that replace the hormones their thyroid made before the process of inflammation began. There are two major thyroid hormones that are produced by the thyroid known as T3 and T4. Replacement of these hormones can help to ease symptoms that people with this disorder experience that have been caused by either a decreased amount of T3 or T4, or a complete lack of them.
People with Hashimoto's Thyroiditis who have developed a goiter or hypothyroidism can benefit from hormone therapy at proper dosages; the medication may ease the symptoms and decrease the size of the goiter. Levothyroxine is a medication that is administered through tablets; older persons are commonly started on lower doses with the dosage being gradually increased, while younger people are often started on the full dose. The thyroid medication acts slowly and can take up to several month before noticeable improvements begin to appear, or the person's goiter starts to shrink. Treatment is usually continued over the person's lifetime because of the progressive and permanent nature of Hashimoto's Thyroiditis. From time to time during the person's life the medication dosage may need to be adjusted.
Levothyroxine is a medication that must be monitored because a person's body is very sensitive to minor changes in thyroid hormone levels. The medication is available in twelve different strengths. Persons taking thyroid hormone medication need to be careful to take it consistently each day because if the amount taken isn't enough their thyroid gland could continue to enlarge, or their symptoms could continue. The person's serum cholesterol levels can also be affected with the potential to increase their risk for heart disease and atherosclerosis. If the person takes too much thyroid hormone medication, they can put too much strain on their heart, experience hyperthyroidism, as well as risk developing osteoporosis.
Women with Hashimoto's Thyroiditis who wish to become pregnant can still do so, although some women with this disorder have trouble conceiving. For some women, a selenium supplement has been used in attempts to decrease their antibody levels with the idea that lower antibody levels might lead to a greater level of success in conceiving. Women with Hashimoto's Thyroiditis who are attempting to become pregnant should have their thyroid hormone levels checked both before and during pregnancy to ensure that they are within an optimal range for pregnancy.
Most people with Hashimoto's Thyroiditis, as well as their family members, never experience another form of autoimmune disorder. These persons do have an increased risk of developing a number of other disorders. These disorders include:
- Graves' Disease
- Addison's Disease
- Pernicious Anemia
- Rheumatoid Arthritis
- Lupus Erythematosus
- Type 1 Diabetes Mellitus
- Premature Ovarian Failure
- Thrombocytopenic Purpura
- Hashimoto's disease is believed to be the most common cause of primary hypothyroidism in North America; as a cause of non-endemic goiter, it is among the most common.
- It occurs between eight and fifteen times more often in women than in men.
- Though it may occur at any age, including in children, it is most often observed in women between 30 and 60 years of age.
- An average of 1 to 1.5 in 1000 people have this disease.
- Hashimoto's disease is more common in regions of high iodine dietary intake, and among people who are genetically susceptible.
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