What is Hashimoto’s Thyroiditis/Disease?

The thyroid gland produces hormones that influences almost all metabolic processes in your body.

Proper functioning of this butterfly-shaped gland is vital for our health, but just like other organs in the body thyroid is also prone to damage, diseases, deficiencies, and other negative scenarios.

Thyroid disorders can range from simple goiters to cancer.

One of the most common disorders affecting this gland is Hashimoto’s thyroiditis, which is also the subject of this article.

Here, you’ll find everything you need to know about this disease.

What is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis, also known as Hashimoto’s disease, is an autoimmune condition and one of the most common causes of hypothyroidism (an underactive thyroid gland).

Other terms used for this condition include chronic lymphocytic thyroiditis and chronic thyroiditis.

In this disease, a patient’s immune system attacks the thyroid and causes chronic inflammation.

In fact, the term thyroiditis itself refers to inflammation of the thyroid gland.

Over time, this chronic inflammation impairs the thyroid’s ability to produce hormones, leads to the gradual decline of the gland, loss of function, and the sequence of events culminates with underactive thyroid i.e. hypothyroidism.

History

The disease was named after the Japanese physician Hakaru Hashimoto who was born on May 5, 1881 and died on January 9, 1934.

In 1907, Hashimoto was one of the first graduates who received a bachelor’s degree from the Fukuoka Medical College of Kyoto Imperial University.

In addition, he received tutelage and training from Professor Miyake at the Department of Surgery at the same college.

Professor Miyake was the one who taught Dr. Hashimoto the technique of microscopically assessing excised thyroid glands.

At the age of 30, in 1912, Hakaru Hashimoto reported a new disease in a German journal of clinical surgery called Archiv für Klinische Chirurgie.

The report of a new thyroid disease consisted of 30 pages along with five illustrations and discussed histological alterations in thyroid tissue, results of his examination of thyroid tissue samples taken from four women.

Hashimoto explained that characteristics of the new disease were similar to those of Mikulicz’s disease such as infiltration of lymphoid and plasma cells, degenerated thyroid epithelial cells, the formation of lymphoid follicles with germinal centers, and others.

The physician was confident he discovered a new disease and named it struma lymphomatosa.

Hashimoto died without receiving recognition for his discovery, but later the disease was named after him[i], in his honor.

How common is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis is a common thyroid disorder and is estimated as one of the most common causes of hypothyroidism in Americans.

According to the available statistics, the incidence of this disorder is 1.3% in 5000 children between 11 and 18 years of age.

When it comes to adults, the incidence rate is 3.5% per 1000 per year in women and 0.8% for men[ii].

In the Appalachian region, the incidence of Hashimoto’s might be as high as 6%.

Figures show that at least 14 million people in the US have this autoimmune disease[iii].

On a global level, the most common cause of hypothyroidism is iodine deficiency but Hashimoto’s thyroiditis poses as the most frequent cause of spontaneous hypothyroidism, particularly in areas where iodine intake is sufficient.

The annual worldwide incidence of the disease is 0.3% to 1.5% per 1000 people.

What causes Hashimoto’s thyroiditis?

As mentioned above, Hashimoto’s is an autoimmune disease meaning your immune system creates antibodies which attack thyroid gland and damage it.

The exact cause that propels this action of the immune system is unknown.

That said, scientists speculate a bacterium or a virus might trigger the response.

Genetics is also another one of the potential causes of Hashimoto’s.

In most cases, the combination of genetic and environmental factors leads to the formation of the disease.

Since the disorder is more prevalent among women, scientists theorize that hormones could also play a role in the onset of Hashimoto’s.

Risk factors

Everyone can develop Hashimoto’s thyroiditis, but some factors increase your risk of developing the disease.

Common risk factors associated with Hashimoto’s are:

  • Age – middle-aged individuals are more likely to develop Hashimoto’s than those in other age groups
  • Gender – the incidence of the disease is 10-15 times higher in women compared to men
  • Heredity – chances of developing the disease are significantly higher if a family member also dealt with thyroid or other autoimmune diseases
  • Another autoimmune disease – if you have another autoimmune disease like lupus, type 1 diabetes, or rheumatoid arthritis, you are more likely to develop this thyroid disorder as well
  • Radiation exposure – individuals who are exposed to excessive levels of environmental radiation are more prone to Hashimoto’s
  • Other factors include: consumption of too much iodine, intake of certain medications, viral infections

Symptoms of Hashimoto’s thyroiditis

Most patients don’t even notice signs and symptoms of Hashimoto’s at first, but some people do develop a goiter (swelling at the front of your neck). By the way, if you’ve gotten this far and don’t know what some terms mean like goiter, check out our common thyroid questions and answers article here.

The disease doesn’t progress rapidly.

Instead, it gradually develops over the years and induces chronic thyroid damage.

Slow progression of the disease explains why many patients don’t notice symptoms at the beginning.

The most common signs and symptoms associated with Hashimoto’s are[iv]:

  • Brittle nails
  • Decreased concentration
  • Depression
  • Dry, pale skin
  • Excessive sleepiness
  • Hair loss
  • Increased sensitivity to cold
  • Joint pain and stiffness
  • Memory problems
  • Muscle aches, tenderness, and stiffness
  • Muscle weakness
  • Puffy face
  • Slowed heart rate
  • Sluggishness and fatigue
  • Swelling of the legs
  • Tongue enlargement
  • Vague pains and aches
  • Weight gain

Complications associated with Hashimoto’s

It is highly important to see your doctor when you notice symptoms mentioned above. As the disease progresses it is easier to notice these signs.

Prompt diagnosis and adequate treatment help manage symptoms of Hashimoto’s and prevent complications linked with the disease.

If left untreated, Hashimoto’s can cause numerous complications and increase your risk of[v]:

  • Addison’s disease
  • Autoimmune hepatitis, or nonviral liver inflammation
  • Goiter
  • Heart problems due to higher LDL (bad) cholesterol levels
  • Mental health problems
  • Myxedema (a life-threatening condition that occurs due to long-term hypothyroidism)
  • Rheumatoid arthritis
  • Thrombocytopenic purpura (disorder which affects the blood’s ability to clot)
  • Type 1 diabetes
  • Vitiligo (a skin condition indicated by development of white patches of the skin)

How is Hashimoto’s thyroiditis diagnosed?

When you see the doctor, mention all symptoms or physical and mental health changes you experienced, even though you may think they’re meaningless.

If your symptoms coincide with those of hypothyroidism, the physician may already assume you have Hashimoto’s thyroiditis.

To rule out other health problems with similar symptoms, the doctor will perform different diagnostic tests including:

  • TSH test – usually the first test performed and its purpose is to detect amounts of TSH (thyroid stimulating hormone) in the blood and it is the most accurate measure of thyroid gland activity. If results show TSH levels are above normal, a person has hypothyroidism
  • T4 test – measures the amount of thyroid hormone found in the blood. If levels of T4 are below normal, a patient is hypothyroid
  • Antibody Tests – These are the two main tests doctors use to diagnose Hashimoto’s. Make sure to get both the Thyroid peroxidase antibody (TPO) and Thyroglobulin antibody (TGAb) tests.
  • Ultrasound – to evaluate size and texture of thyroid and a pattern of typical autoimmune inflammation
  • CT scan – to examine the placement and extent of a large goiter and to analyze the goiter’s impact on nearby structures

Our article on normal thyroid levels may help after taking these tests.

Treatment of Hashimoto’s thyroiditis

Not every patient with Hashimoto’s requires treatment.

In instances when the thyroid is functioning normally, the doctor may recommend the wait-and-see approach. Or perhaps they may recommend natural approaches including diet changes.

On the other hand, if the function of thyroid gland is impaired and it produces an insufficient amount of hormones you will need to take medications.

The most common medication for patients with Hashimoto’s is levothyroxine, a synthetic version of the hormone T4.

Regular use of this drug supports adequate levels of thyroid hormones and allows you to manage symptoms associated with the disease.

Brand names of this medication are Synthroid, Levoxyl, and Levothroid.

There is no “one size fits all” rule when it comes to levothyroxine. In order to determine the adequate dosage, the doctor will check TSH levels a few weeks into the treatment.

Not only will this help find the right dosage, but it will also prevent common consequences linked with excessive thyroid hormone such as bone loss.

In order to make sure levothyroxine does its “job”, the body has to absorb it properly.

That said, some supplements and medications impair the absorption of this drug. Doctors usually recommend taking levothyroxine about four hours before or after taking other medications.

The following factors affect absorption of levothyroxine:

  • Aluminum hydroxide
  • Calcium supplements
  • Cholestyramine (medication used to lower blood cholesterol)
  • High-fiber diet
  • Iron supplements (including multivitamins that contain iron)
  • Soy products
  • Sucralfate (medication for ulcer)

It is also possible your doctor may recommend getting on Natural Desiccated Thyroid such as Armour Thyroid. Note there are significant differences between Armour Thyroid and Synthroid.

Hashimoto’s thyroiditis FAQ

Is it possible to prevent this disease?

Since the exact cause of Hashimoto’s thyroiditis is unknown, it would be impossible to pinpoint to a certain preventative measure that could block development of this disorder.

Are there some natural treatments of Hashimoto’s thyroiditis?

Regular use of levothyroxine is the most commonly used treatment for Hashimoto’s thyroiditis.

While making lifestyle adjustments is always a good thing for your health. Some patients have reported success with certain natural methods (seen in this article.) It might be worth trying for you.

That said, it is always better to consult with your doctor first.

Do Hashimoto’s thyroiditis patients have to adhere to a special diet?

You do not have to, but a number of patients have reported feeling significantly better after following certain autoimmune thyroid diet ‘protocols.’ You might want to look it up and try something similar.

As for general diet ideas, you should make healthy eating choices and avoid junk food or other unhealthy options.

Common symptoms of the disease include weight gain and higher LDL cholesterol levels, so a great way to keep them in check is through a healthier diet.

Is it safe for me to get pregnant if I have Hashimoto’s thyroiditis?

Although some women experience difficulties conceiving due to Hashimoto’s, the disease itself shouldn’t be a reason to avoid pregnancy – though hypothyroidism may, if severe enough.

Before conception and during pregnancy, it is essential to monitor TSH levels. Your doctor may adjust the medication dose, if necessary.

Conclusion

Healthy functioning of the thyroid gland is vital for our overall wellbeing.

This hard-working gland is prone to diseases and disorders with Hashimoto’s thyroiditis one of the most common issues affecting the thyroid.

Hashimoto’s is an autoimmune disease, meaning the immune system attacks the thyroid and impairs production of hormones.

Generally, Hashimoto’s is more prevalent among women than in men. Progression of the disease is slow and most patients don’t recognize symptoms immediately.

This thyroid disorder is primarily treated with the help of levothyroxine.

References

[i] Hashimoto’s thyroiditis: history and future outlook, Hormones.gr http://www.hormones.gr/840/article/article.html

[ii] Hashimoto thyroiditis: U.S. National Library of Medicine ghr.nlm.nih.gov https://ghr.nlm.nih.gov/condition/hashimoto-thyroiditis

[iii] Eschler, Deirdre Cocks, Alia Hasham, and Yaron Tomer. “CUTTING EDGE: THE ETIOLOGY OF AUTOIMMUNE THYROID DISEASES.” Clinical reviews in allergy & immunology 41.2 (2011): 190–197. PMC. Web. 18 Aug. 2017.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129418/

[iv] Shankar O, Balraj N, Rakesh G. Clinical study of Hashimoto’s thyroiditis. IAIM, 2016; 3(2): 98-103.

http://iaimjournal.com/wp-content/uploads/2016/02/iaim_2016_0302_15.pdf

[v] Hashimoto’s disease, National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

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