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Hashimoto's Thyroiditis is a type of an autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland.

It is the most common form of thyroid disease in the United States, and it is also the most common form of thyroiditis in general. It tends to run in families, and is much more common in women than men. It is a chronic autoimmune condition that can cause an underactive thyroid gland or hypothyroidism. It is also associated with other conditions including diabetes, Addison's disease, rheumatoid arthritis, pernicious anemia, and premature menopause.

Thyroid gland function

Thyroid gland is a very small and butterfly-shaped gland located at the base of the neck, just below Adam's apple. It has an enormous effect on health because, as a part of the endocrine system, it produces hormones and controls body metabolism level and many other functions, from digestion to reproduction.

It produces three very important hormones:

    * T3 – Triiodothyronine
    * T4 – Thyroxine

They maintain the level of body usage of fats and carbohydrates, help control body temperature, influence heart rate and help regulate the production of proteins in body.

    * Calcitonin, a hormone that helps regulate the amount of calcium in your blood.

The quantity of Thyroxine and Triiodothyronine that are released is controlled by pituitary gland and hypothalamus the other two small glands located in the head. Thyroid-Stimulating Hormone or TSH is a hormone produced by the pituitary gland that stimulates the thyroid gland. Measurement of TSH level in the blood is considered a primary way to diagnose thyroid disorders.

Mechanism of the disease and histology

Hashimoto's thyroiditis or Hashimoto’s disease is a common thyroid gland disorder that can occur at any age, but it is most common in middle aged women. It is caused by an autoimmune reaction – a reaction of the immune system against the thyroid gland. Physiologically, these auto-antibodies are targeted against thyroid peroxidase and thyroglobulin, which is causing a gradual destruction of follicles in the thyroid gland.

This disease is characterized by:

    * an intense mononuclear cellular infiltrate into the thyroid gland
    * the presence of autoantibodies

There is a number of theories which try to explain the exact mechanism of pathogenic damage to the tissue during this form of thyroiditis.

    * Auto-reactive T cells or T-helper cells may cause tissue damage by releasing cytokines, either directly or by activating macrophages-cells whose role is to literally “eat” the antigen, and cause tissue destruction.
    * Auto-reactive antibodies could be directly responsible for the pathology, because they can interfere with iodine uptake and binding by thyroglobulin.
    * Inflammation may cause tissue damage by triggering apoptosis- programmed death in thyroid cells (thyrocytes)
    * Some experts believe that a virus or bacteria could trigger the auto-response, while others believe a genetic flaw may be involved

Signs and symptoms

Sometimes it can be very difficult to diagnose the Hashimoto’s thyroiditis just by looking at the symptoms because they are not unique. Symptoms do not occur suddenly because the disease progresses slowly over a number of years and causes chronic thyroid damage.

The most common symptoms are:

   1. Increased sensitivity to cold.         

   2. Constipation.
   3. Pale, dry skin.
   4. A puffy face.
   5. Hoarse voice.
   6. An elevated blood cholesterol level.
   7. Unexplained weight gain. 
   8. Muscle aches, tenderness and stiffness, especially in the shoulders and hips.
   9. Pain and stiffness in joints and swelling in knees or the small joints in hands and feet.
  10. Muscle weakness, especially in lower extremities.
  11. Excessive or prolonged menstrual bleeding (menorrhagia).
  12. Depression.

Incidence

About 0.3 - 0.5 cases per 1,000 people a year are diagnosed with Hashimoto’s disease. The problem is that the number of people diagnosed with Hashimoto's thyroiditis is increasing over time, mainly due to better diagnostic techniques. The female-to-male ratio is 20:1. The disease is most common in middle aged women, but it can affect all age groups, including children.

Diagnosis of Hashimoto’s thyroiditis

If a person notices some of the characteristic sings of this type of thyroid condition, it is best to contact general practitioner or endocrinologist, because using several diagnostic tools, the doctor can set the accurate diagnosis very quickly and start with the appropriate treatment. It is also recommended that the person should see a doctor for periodic testing of thyroid function if he or she had

    * previous thyroid surgery,
    * treatment with radioactive iodine or anti-thyroid medications, or
    * radiation therapy to your head, neck or upper chest

The two best diagnostic procedures are:

   1.      A blood hormone test

Simple blood tests can determine the amount of hormones produced by the thyroid and pituitary glands. If the thyroid gland is underactive, the level of thyroid hormone will be lower then normal. At the same time, the level of TSH is elevated because pituitary gland tries to stimulate thyroid gland to produce more thyroid hormone. Because the TSH test is the best screening test and much more sensitive than others, most doctors will first check TSH first and follow with a thyroid hormone test if needed.
 
 

T3
T4
TSH
Interpretation
Normal
Normal
High
Mild hypothyroidism
Low or normal
Low
High
Hypothyroidism
Normal
Normal
Low
Mild hyperthyroidism
 
High or normal
High or normal
Low
Hyperthyroidism
Low or normal
Low or normal
Low
Rare pituitary (secondary) hypothyroidism

 

   2.       The antibody test

Since Hashimoto's disease is an autoimmune disorder, its mechanism involves the production of abnormal antibodies. Antibodies found in these autoimmune disorders are completely different because they are targeted at different structures. A blood test may confirm the presence of such specific antibodies targeted against thyrocytes.

   3.       Histological examination

Histological examination of the gland is being done by removing small amounts of thyroid tissue, either with a needle biopsy or during surgery. The tissue sample is then sent to pathologists, who are able to see lymphocyte infiltration, using microscopes.

Complications of untreated Hashimoto’s thyroids

Several researches done in the past have proven that untreated Hashimoto’s thyroiditis can lead to several possible complications and health problems, such as:

   1.       Goiter

The constant stimulation of thyroid by the pituitary gland and high TSH levels may cause the gland to become enlarged. This condition where the thyroid gland is abnormally large is called goiter. Hypothyroidism is one of the most common causes of goiter. The gland is usually firm and rubbery but may range from soft to hard. It is easy to assume that, besides affecting appearance, goiter may also interfere with swallowing or breathing which can be potentially dangerous.

   2.       Mental health issues

Since depression may occur in Hashimoto's disease, treating it became the primary goal of many therapists. It is also proven that Hashimoto's disease can cause a decreas in sexual desire and can lead to decreased and slowed mental functioning.

   3.       Heart problems

High levels of low-density lipoprotein (LDL) cholesterol, found normally in heart patients, have been found in people with Hashimoto’s thyroiditis leading the experts to believe there could be some connection there. 

   4.       Myxedema

Long-term hypothyroidism can lead to this rare and possibly life-threatening condition, which is characterized by intense cold intolerance, drowsiness, profound lethargy and unconsciousness.

   5.     Birth defects

Babies born to women with untreated Hashimoto's disease may have

          * a higher risk of birth defects,
          * intellectual and
          * Developmental problems.

The good thing about this is that, if the condition is diagnosed within the first few months of pregnancy and with right therapy, the chances of normal development are great.

Treatment of Hashimoto’s thyroiditis

There are several types of Hashimoto’s thyroiditis treatment and the most common and effective is synthetic hormone therapy!

Treatment with synthetic hormones

Replacement therapy with thyroid hormone is very effective treatment and it usually involves daily use of the synthetic thyroid hormone called Levothyroxine (Levothroid®, Synthroid®).
 
All the symptoms are usually improving after only several days of usage. The cholesterol levels are also lowered. Another good aspect of this treatment is that Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. The only downside to this treatment is that it is usually lifelong.
It is very important that, during the treatment, the patient goes every 2-3 months on regular checkups with his doctor because dosing changes are usual in this therapy and so monitoring of dosage is very important.
 
Care must be taken if Levothyroxine is being used along with the next substances:

    * Iron supplements
    * Cholestyramine
    * Aluminum hydroxide,
    * Sodium polystyrene sulfonate
    * Sucralfate, an ulcer medication

Read More: Hashimoto's Disease & Hyperthyroidism

Complementary and alternative medicine

In the last couple of years, natural extracts containing thyroid hormone made from the thyroid glands of pigs are available and they have shown a great efficacy. The most common are:

    * Armour Thyroid Hormone and
    * Bio-Thyroid

Glandulars are dried concentrates of glands derived from animals. They have also shown great effectiveness. The only problem is that these products aren't regulated by the Food and Drug Administration, and their potency isn't guaranteed

  • www.mayoclinic.com/health/hashimotos-disease/DS00567
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