Two forms of progression
Hashimoto’s thyroiditis is also called chronic lymphocytic thyroiditis, chronic Hashimoto’s thyroiditis, or (more rarely) Hashimoto’s disease. Sometimes one also comes across the terms autoimmune thyroiditis, Hashimoto’s syndrome, Hashimoto’s disease or the abbreviated name Hashimoto.
It is an autoimmune disease. This means that the patient’s own immune system attacks the thyroid gland. Patients form so-called autoantibodies that destroy their thyroid gland. Doctors distinguish clinical cases (with symptoms) from cases in which people have autoantibodies in their blood but still no problems with their thyroid gland.
There are two courses of Hashimoto’s thyroiditis:
- In the classic form, the thyroid gland enlarges (goiter formation) but loses function.
- In the atrophic form, thyroid tissue is destroyed and the organ atrophies.
The atrophic form of Hashimoto’s thyroiditis is observed more frequently than the classic form. Hashimoto’s thyroiditis causes hypothyroidism in the long run.
Hashimoto’s thyroiditis: causes and risk factors
Hashimoto’s thyroiditis is an autoimmune thyroid disease in which the body begins to produce antibodies against thyroid proteins for as yet unknown reasons. This leads to chronic inflammation of the thyroid gland.
Thereafter, the damaged thyroid gland no longer produces sufficient hormones, resulting in hypothyroidism. In fact, Hashimoto’s thyroiditis is the most common cause of hypothyroidism.
Hashimoto’s thyroiditis may run in families. Although the exact origin is unclear, gene mutations seem to underlie Hashimoto’s disease. If other factors are added, for example infections (especially liver inflammation of type C/hepatitis C) or stress, this favors the development of the disease. An excess of iodine and smoking further increase the risk of disease.
Gender also appears to play a role in the development of the disease. Doctors assume that the female estrogens favor Hashimoto’s, whereas progesterone and testosterone counteract it.
Sometimes patients with Hashimoto’s thyroiditis also suffer from other autoimmune diseases such as Addison’s disease, type 1 diabetes, celiac disease or a severe form of anemia (pernicious anemia).
Hashimoto’s thyroiditis is a common disease, affecting about five to ten percent of the population, predominantly women (about nine times more often than men). The disease usually appears between the ages of 30 and 50.
Hashimoto’s thyroiditis: symptoms
- constant tiredness, weakness and fatigue
- disinterest and listlessness
- Concentration problems and poor memory
- Hoarseness
- Hypersensitivity to cold
- constipation
- weight gain despite unchanged eating habits
- dry skin and brittle nails
- brittle hair and increased hair loss
- cycle disorders and reduced fertility
- increased blood lipid levels
Initial stage with hyperthyroidism
In the early stages of the disease, patients may also have temporary hyperthyroidism. Possible symptoms include:
- restlessness, nervousness, irritability, mood swings
- Sleep disturbances
- palpitations and heart palpitations (tachycardia) up to cardiac arrhythmia
- increased blood pressure
- increased sweating
- warm and moist skin
However, these symptoms subside after some time and hypothyroidism develops.
Hashimoto’s encephalopathy
A disease of the brain may develop in association with Hashimoto’s thyroiditis. This Hashimoto’s encephalopathy leads to multiple neurological and psychiatric symptoms such as cognitive deficits, states of confusion, psychosis, transient drowsiness to coma, epileptic seizures and movement disorder (ataxia). Triggers are probably those autoantibodies that also inflame the thyroid gland.
Hashimoto’s thyroiditis: diagnosis
A subsequent blood test can detect a thyroid dysfunction. The concentration of the thyroid hormones T3 and T4 as well as that of TSH are measured. TSH is a hormone produced by the pituitary gland, which stimulates the thyroid gland to produce hormones. You can read more about the determination of thyroid hormones in the blood in the article Thyroid levels.
In addition, the blood sample is tested for autoantibodies against proteins of the thyroid gland. These indicate an autoimmune disease. In many Hashimoto’s thyroiditis patients, antibodies against two specific proteins are found, among others: Thyroperoxidase (TPO) and Thyroglobulin (Tg). Both play an important role in the production of thyroid hormones.
An ultrasound examination of the thyroid gland supports the diagnosis of Hashimoto’s as an imaging procedure. This is the typical finding in Hashimoto’s: thyroid gland smaller than normal and with a uniformly dark structure on ultrasound.
In rare cases, the doctor also does a thyroid scintigraphy. Patients with Hashimoto’s thyroiditis show decreased metabolism.
Using a fine-needle biopsy, the doctor can take a tissue sample of the thyroid gland to examine it more closely: In Hashimoto’s thyroiditis, significantly more white blood cells than normal can be found in the tissue.
Hashimoto’s thyroiditis: Therapy
There is no therapy for the cause of Hashimoto’s. However, symptoms resulting from the occurring hypothyroidism can be treated by replacing the missing thyroid hormone: Patients are given tablets containing the artificial hormone levothyroxine. It corresponds to T4 and is converted in the body into the more metabolically active T3.
If the disease has led to an enlargement of the thyroid gland (goiter), the organ (or parts of it) is removed. Hashimoto’s encephalopathy can usually be treated well with a high-dose cortisone (prednisolone). However, cortisone is useless against Hashimoto’s thyroiditis.
Some physicians also recommend taking selenium if thyroid levels of T3 and T4 are normal. However, studies are inconclusive.
Living with Hashimoto’s: Diet
Increased iodine intake may play a role in the development of Hashimoto’s thyroiditis and may also adversely affect the course of the disease. Therefore, patients with Hashimoto’s should avoid iodine in excessive doses.
This means that iodine tablets should not be taken and the iodine intake through food should be kept in check. For example, sea fish (such as mackerel, herring, pollock), seaweed and seafood are very rich in iodine.
Hashimoto treatment during pregnancy
Experts generally recommend that pregnant women take additional iodine. This also applies to Hashimoto’s patients, who should otherwise keep their iodine intake within limits. It is best for those affected to consult their doctor before taking the supplement.
Hashimoto’s in children and adolescents
If children and adolescents with Hashimoto’s thyroiditis develop goiter or hypothyroidism, the doctor will prescribe thyroid hormones.
Hashimoto’s thyroiditis: prognosis
The course of the disease in Hashimoto’s thyroiditis cannot be predicted. Only rarely does the disease regress spontaneously. Regular checks of thyroid levels are important. During pregnancy, but also in old age, the hormone requirement changes.
The destruction of thyroid tissue caused by inflammation cannot be reversed. The hypothyroidism that develops in the course of Hashimoto’s thyroiditis requires lifelong use of thyroid hormones. Most patients manage well with this and have no other limitations as well as a normal life expectancy.
