Hashimoto's disease or Hashimoto's thyroiditis is an autoimmune disorder where our own immune system starts attacking the thyroid gland. The thyroid gland is located at the base of our neck and its function is to produce hormones which help in balancing the different activities of our body. Hashimoto's disease results in inflammation and this condition is also termed as chronic lymphocytic thyroiditis. It commonly results in hypothyroidism, which means an underactive thyroid gland. Middle-aged females are at a higher risk; although anyone can be affected with it. Treatment comprises of thyroid hormone replacement therapy.
Causes of Hashimoto's Disease or Hashimoto's Thyroiditis
Hashimoto's disease is a medical condition where the body's own immune system starts producing antibodies, which attack and damage the thyroid gland. The exact cause for this is not clear. According to research, a bacterium or a virus is thought to be responsible; whereas some researchers believe there may be a genetic error at play. There are various factors which determine the chances of a person developing this condition such as age, sex, and heredity factors.
Risk Factors for Hashimoto's Disease or Hashimoto's Thyroiditis
- Women are at a higher risk for having Hashimoto's disease.
- Middle age individuals are more prone to develop Hashimoto's disease.
- The risk for developing Hashimoto's disease is more if there is a family history of thyroid problems or autoimmune disorders.
- Having a previous autoimmune disorder/disease (rheumatoid arthritis, lupus, type 1 diabetes etc.) increases the likelihood of having Hashimoto's disease.
Signs and Symptoms of Hashimoto's Disease or Hashimoto's Thyroiditis
Initially, signs or symptoms may not be visible; there may be some swelling in the anterior region of the throat where the thyroid gland is present. Hashimoto's disease gradually progresses over the years and leads to chronic thyroid damage. Signs and symptoms chiefly comprise of hypothyroidism (underactive thyroid gland). Common symptoms of hypothyroidism are:
- Weakness, tiredness, lethargy.
- Hypersensitivity to cold.
- Dry skin and pallor.
- Facial bloating or puffiness.
- Voice hoarseness.
- Unintentional weight gain.
- Pain in the muscles along with stiffness and tenderness; particularly in the hips and shoulders.
- Joint pain and stiffness with swelling in the knees or joints of hands and feet.
- Weakness of the muscle weakness, particularly in the legs.
- Menorrhagia, which is prolonged or excessive menstrual bleeding.
- Anxiety and depression.
Investigations for Hashimoto's Disease or Hashimoto's Thyroiditis
- Hormone tests/ blood tests are done to check the quantity of hormones produced by the pituitary and thyroid glands. If there is underactive thyroid, then the thyroid hormone level is low.
- Concurrently, TSH or thyroid stimulating hormone level is increased, as the pituitary gland works at stimulating the thyroid gland for producing a higher amount of thyroid hormone.
- An antibody test is done to check for abnormal antibodies.
- A sensitive TSH test is helpful in diagnosing the thyroid disorders at an earlier stage, even before the patient has developed any symptoms.
Treatment for Hashimoto's Disease or Hashimoto's Thyroiditis
Depending on the patient's condition, treatment comprises of observation and medications. If the patient is not suffering from any hormone deficiency and if the thyroid function is normal, then there is no need for medications right away and your physician may propose a wait-and-see approach. If the thyroid is not functioning normally; and if the patient has symptoms, then medications are started and more often than not, they are needed to be taken for lifetime. The following medications are given:
Synthetic Hormones for Hashimoto's Disease or Hashimoto's Thyroiditis
As there is deficiency of the thyroid hormone, replacement therapy is done with synthetic thyroid hormone, such as levothyroxine (Synthroid, Levoxyl etc.) which is a synthetic thyroid hormone. Synthetic levothyroxine is same as thyroxine, which is naturally produced by the thyroid gland. Synthetic levothyroxine helps in restoring normal hormone levels and reverses or negates the hypothyroidism symptoms.
Depending on the TSH level, which should be checked every six to 12 months, the dosage needs to be changed accordingly. It is very important to monitor the dosage of levothyroxine. To do this, your physician will be checking your TSH level within a few weeks of starting the treatment, as excessive thyroid hormone causes increase in bone loss, resulting in increased risk of osteoporosis. Overdose of levothyroxine can also lead to arrhythmias (heart rhythm disorders).
In patients with CAD or coronary artery disease, the doctor will start the treatment with a low dose of the medication and slowly increase the dose, so that the heart can adapt to the metabolism. When used in the right amount of dosage, there are literally no side effects from Levothyroxine. It is important to continue with the same brand and let the doctor know if you have changed the brand. It is also important to take the dose regularly and not miss any doses or abruptly stop the medicine, as this will result in recurrence of all the signs and symptoms of this disease.
There are some supplements, medications and food groups which can affect the way levothyroxine is absorbed. To avoid this, levothyroxine should be taken at least a minimum of four hours after or before taking other medications. It's important to let your doctor know if you are taking any huge amounts of a high-fiber diet or soy products or any of the following things:
- Supplements, such as calcium and iron; and multivitamins containing iron.
- Medication for lowering the level of blood cholesterol, such as Prevalite (cholestyramine).
- Antacids which contain aluminum hydroxide.
- A drug used for preventing high blood potassium levels, i.e. sodium polystyrene sulfonate.
- Sucralfate, which is medication given for treatment of ulcers.