Autoimmune thyroiditis, also called Hashimoto’s thyroiditis, is a chronic inflammation of the thyroid gland in which the immune system turns against the body’s own thyroid tissue. It is therefore classified as an autoimmune disease and is the most common cause of hypothyroidism.
Autoimmune reaction against the thyroid gland
In autoimmune diseases, there is an error of the immune system, whereby some body cells are suddenly considered foreign. To fight the supposed foreign body, lymphocytes – a type of white blood cell – are used, mistakenly creating weapons against the body’s own tissues, called autoantibodies. In the case of autoimmune thyroiditis, these are the autoantibodies TPO-AK and Tg-AK. An inflammatory process is set in motion, whereby thyroid tissue is destroyed and less and less thyroid hormone is produced.
Autoimmune thyroiditis: causes still unclear
Ultimately, it is not yet clear why this attack by the immune system occurs. It is suspected that a previous bacterial or viral infection may act as a trigger. On the other hand, however, there is also a familial accumulation. Women are affected much more frequently than men, preferably between the ages of 30 and 50. Strikingly, the disease often accompanies other autoimmune diseases, such as white spot disease (vitiligo) or type 1 diabetes.
Autoimmune thyroiditis: symptoms begin insidiously
The disease begins almost imperceptibly and painlessly, so that those affected hardly notice the symptoms at first. In the beginning, due to the destruction of hormone stores, some sufferers go through a short-lived phase of hyperthyroidism, which then gradually turns into chronic hypothyroidism.
Symptoms of hyperthyroidism
Typical symptoms of hyperthyroidism are:
- Restlessness
- Insomnia
- Increased sweating
- Hair loss
- Weight loss despite increased appetite
- Trembling of the hands
- Diarrhea
- Rapid, irregular pulse
- Cycle disorders in women
Symptoms of hypofunction
The symptoms of hyperfunction are replaced by the signs of hypothyroidism, when less and less thyroid hormone is produced during the course of the autoimmune disease:
- Fatigue
- Lack of concentration
- Shaggy, dull hair
- Constipation
- Light freezing
- Hair loss
- Dry, cool, doughy skin
- Hoarseness
- Cycle disorders in women
Because the disease often occurs in women around 50 years, the symptoms can easily be mistaken for menopausal symptoms and thus misdiagnosed. In most cases, there is a shrinkage of the thyroid gland (atrophic form), more rarely an enlargement of the thyroid gland (goiter) is observed despite loss of function (hypertrophic form).
Autoimmune thyroiditis: diagnosis with blood tests and ultrasound.
When the symptoms lead to the doctor, the history and palpation findings of the thyroid gland point the way, but groundbreaking in the diagnosis are blood tests and ultrasound examination. In the blood test, the typical TPO antibodies are found in more than 90 percent of those affected and the Tg antibodies in 70 to 80 percent. An indicator of hypothyroidism is an elevated value for TSH (thyroid stimulating hormone) – a hormone of the pituitary gland – even if the thyroid hormone values are still within the norm. Ultrasound examination reveals typical changes associated with autoimmune thyroiditis. Only occasionally are further examinations, such as scintigraphy or the removal of a tissue sample, necessary to rule out other diseases.
Autoimmune thyroiditis therapy: replacement therapy.
Unfortunately, autoimmune thyroiditis is not curable to date. However, therapy can achieve normalization of hormone balance. This requires lifelong replacement of the missing thyroid hormone. Levothyroxine is initially prescribed in a low dosage, then increased until the individually appropriate amount is reached. This is indicated by the normalization of the TSH level (preferably around 1 µU/ml), which is monitored by regular blood tests. Therapy during pregnancy is of utmost importance in order to prevent physical and mental damage to the unborn child.The intake of the trace element iodine, should be avoided, as it further fuels the autoimmune process. According to studies, on the other hand, selenium has a positive effect on well-being and the level of antibodies.
