The thyroid gland is responsible for making the thyroid hormones that control how the body uses energy. When a person has Hashimoto’s disease, their immune system begins to attack its own thyroid gland. This autoimmune reaction causes the thyroid gland to become swollen and irritated. When this happens, the thyroid cannot make hormones as it should. Hyperthyroidism is a condition in which the thyroid gland produces more of its hormones than it should.
What should you know about Hashimoto's disease, its symptoms, and its treatment?
What is Hashimoto’s disease?
Hashimoto's disease is sometimes also known as Hashimoto’s thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis. This is a serious autoimmune disease that requires proper medical care.
In Hashimoto's disease, antibodies react to the proteins in the thyroid, causing a gradual destruction of the gland itself. The condition also affects the thyroid's ability to produce the thyroid hormones the body needs. The thyroid gland is found low in the neck and is shaped like a butterfly. It produces two hormones; thyroxine (T4) and triiodothyronine (T3).
These hormones are released into the bloodstream, controlling the speed of all the body’s functions or metabolism. In patients with hypothyroidism the output of these hormones is reduced, resulting in a decrease in metabolism. This causes various non-specific symptoms.
A general muscle slow-down leads to tiredness, while reduced body metabolism causes dry skin, hair loss, constipation and weight gain. Joints commonly swell up, while shortness of breath may develop due to the condition's effects on the heart. In women, periods may become heavy, and slower brain activity might result in memory loss or poor concentration. Youngsters may fail to grow and may not do well at school, although some people have no symptoms of Hashimoto's disease at all. However, a doctor may notice only a slow pulse or another minor change in appearance on physical examination of these patients.
If the thyroid gland is enlarged, the doctor may identify the condition as Hashimoto’s disease, named after the Japanese physician who first described this combination of abnormalities.
How does Hashimoto’s disease occur?
The body sometimes produces substances called antibodies, which are defense chemicals activated in response to invaders. Antibodies are usually made only to deal with foreign substances such as viruses, bacteria, and things like pollen. In patients who have hypothyroidism, the antibodies and the cells that make them are directed against the body's own cells, in this case the thyroid cells. This is called auto-immune destruction, and is almost impossible to prevent or reverse, so once thyroid cell damage occurs in this way, it is usually permanent.
Symptoms of Hashimoto’s disease
Symptoms that those people afflicted with Hashimoto’s disease may have are varied. Because the thyroid gland may become swollen due to Hashimoto’s disease, a patient may have a feeling of fullness or tightness in the throat. Trouble swallowing food or liquids is also common. A patient might notice a swelling or bump (goiter) in the front of the neck. Tiredness, forgetfulness, depression, coarse dry skin, slow heartbeat, weight gain, constipation and intolerance to cold are also symptoms of Hashimoto’s disease. Many people with this disease have no symptoms at all, and ordinary blood test may just show that the thyroid hormones are out of balance without correctly pinpointing the underlying problem.
Who gets Hashimoto’s disease?
Although Hashimoto’s disease can affect people of all ages, it is most common in women between 30 and 50 years of age. If someone in your family has had thyroid disease, you may have an increased risk for Hashimoto’s disease, but no one is entirely sure why people get this disease.
Treatment of Hashimoto’s disease
There is currently no known cure for Hashimoto’s disease, but your doctor can treat your low thyroid function, which is why a patient probably will not suffer any long-term effects from this condition. Thyroid medicine can replace the hormones that the thyroid gland usually makes. How long a patient needs to take the medicine will depend on the blood test results.
For most people, thyroid hormone medicine causes no problems or side effects at all. Taking thyroid medicine and having regular blood tests to see how the thyroid gland is working can help prevent symptoms like tiredness, weight gain, and constipation. Tablets of synthetic thyroxine (T4) are the usual treatment for Hashimoto’s disease, and they are taken once daily. If you forget a dose once in a while no harm should follow, though you should try to follow your doctor's instructions closely.
It is interesting that the body can make all the triiodothyronine (T3) which it needs from this T4, and it does not need to be given separately in most cases. However, because T3 works more rapidly, in some situations your doctor may decide to commence T3 out of preference. Moreover, thyroid extract is no longer recommended. Although it contains a mixture of T4 and T3, the content is not very consistent and giving mixtures of T4 and T3 at the same time has also not been shown to have any advantages. Thyroxine is often started in doses as low as 25 micrograms a day, and the dose is gradually built up every month or two to give the body a chance to adjust.
The doctor will use a regular examination, a blood test, and perhaps a heart examination to decide about the final thyroxine dose. The final dose that patients will take regularly is usually between 50 to 200 micrograms a day. You should always check the strength of thyroid tablets each time they are dispensed, since mistakes can happen. Some symptom improvement usually occurs within 2 weeks of starting treatment but it takes 4 to 6 weeks of daily tablets to get the full benefit of a particular dose.
The older you are, the longer the doctor will take to build up the dose of thyroid hormones; you will start on a low dose, and move up gradually. Most symptoms will improve, but occasionally chest pain or shortness of breath develops. If this happens, the doctor needs to be told straight away. If your under-active thyroid was picked up by chance in a screening test, you may not feel much better after this treatment. If the thyroid gland was enlarged before treatment, it may get much smaller after the treatment of Hashimoto’s disease.
If too much thyroxine is taken, palpitations, trembling and sweating may appear. Even without these symptoms, mild over-dosage over several years may weaken the bones, making them more likely to be painful and to fracture. With the sensitive tests now available, it is possible for the doctor to be absolutely certain whether the dose being taken for treating this condition is correct or not.
Hashimoto’s disease and hyperthyroidism
A tendency to develop auto-immune thyroid disorders is commonly inherited. Some people develop an under-active thyroid following an overactive thyroid condition earlier in life. The condition in which your thyroid gland is overactive is called hyperthyroidism. About one person in every 100 develops this quite common condition caused by hyperthyroidism. Both thyroid operations and the use of radioactive iodine for an overactive thyroid often result in an under-active thyroid state later in life.
That is why we could see the connection between Hashimoto’s disease and hyperthyroidism. In fact, sometimes certain foods and medicines (especially those containing iodine) can cause this thyroid condition. A particular type of under-active thyroid occurs 4 to 6 months after childbirth, approximately once in every 15 pregnancies. This so-called post-partum thyroiditis may cause temporary or permanent thyroid under-activity, which is sometimes preceded by a temporary overactive state. In many cases, the onset of Hashimoto’s disease and the elevation of antibodies will be accompanied by a variety of symptoms. These symptoms are fatigue, weight changes, depression, hair loss, muscle or joint aches and pains, infertility, and recurrent miscarriages, among other symptoms.
Many conventional endocrinologists will not treat Hashimoto’s disease if the thyroid function tests are in the normal range, despite these symptoms being present. However, in some cases Hashimoto’s involves a slow but steady destruction of the gland that eventually results in the thyroid’s inability to produce sufficient quantities of thyroid hormone. This is the condition known as hypothyroidism.
Along the way, there can be periods in which the thyroid sputters back to life, even causing temporary hyperthyroidism, and then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto’s disease. That is why we cannot say that Hashimoto’s disease is just refers to hypothyroidism. Ultimately, the thyroid slowly becomes less able to function, and when hypothyroidism itself can be measured by blood tests, many practitioners will finally treat it exclusively with thyroid hormone replacement drugs.
However, there are some endocrinologists, osteopaths and other practitioners, who believe that Hashimoto’s disease, as confirmed by the presence of thyroid antibodies, along with its symptoms, is enough to warrant treatment with small amounts of thyroid hormone. The practice of treating patients who have Hashimoto’s thyroiditis but a normal range of thyroid function tests is supported by study. In that study, German researchers reportedly used levothyroxine treatment for cases of Hashimoto’s autoimmune thyroiditis where TSH had not yet elevated beyond the normal range. The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto’s disease reduced the various markers of autoimmune thyroiditis. They speculated that such treatment might even be able to stop the progression of Hashimoto’s disease, or perhaps even prevent the development of hypothyroidism.