Hashimoto’s thyroiditis is the most common autoimmune chronic inflammation of the thyroid gland, the cause of which has not yet been determined. Women are about nine times more likely to be affected by Hashimoto’s thyroiditis than men, although the disease is usually well treatable.
What is Hashimoto’s thyroiditis?
The doctor examines the thyroid glands and palpates them for abnormalities. Hashimoto’s thyroiditis is the name given to a chronic inflammation of the thyroid gland that is due to a misregulation of the body’s defenses (autoimmune thyroid disease). Characteristic symptoms of Hashimoto’s thyroiditis are frequent fatigue, weight gain, as well as increased sensation of cold and edema (water retention). While Hashimoto’s thyroiditis manifests itself in the long term in an underactive thyroid (hypothyroiditis), an overactive thyroid (hashitoxicosis) may also be present at the beginning of the disease, which can be accompanied by irritability, sleep disturbances, palpitations, ravenous appetite, weight loss and a disturbed menstrual cycle, among other symptoms. Two subtypes are distinguished in Hashimoto’s thyroiditis. While the more common atrophic form is associated with thyroid cell atrophy, the rarer hypertrophic form of Hashimoto’s thyroiditis causes the thyroid gland to enlarge and form a goiter (goiter).
Causes
Hashimoto’s thyroiditis is caused by a dysregulated immune system that attacks the body’s own structures of the thyroid gland, triggering inflammatory processes there and causing lasting damage to the organ and its hormone production. The cause of this autoimmune dysregulation has not yet been clarified. In addition to a genetic predisposition, bacterial and viral infections with severe courses (shingles, mononucleosis), malfunctions of the adrenal cortex as well as environmental factors and stress are suspected as possible triggers for Hashimoto’s thyroiditis. Microchimerism, in which cells are exchanged between mother and child via the placenta, for example, and the intake of very high amounts of iodine or an iodine intolerance, which can cause a manifestation of Hashimoto’s thyroiditis if a predisposition is present, are also discussed. In addition, Hashimoto’s thyroiditis is also associated with diabetes mellitus type I as well as vitiligo (white spot disease).
Symptoms, complaints, and signs
Hashimoto’s thyroiditis usually begins insidiously with mild symptoms that are not associated with the thyroid gland. These include such things as unwanted weight gain despite unchanged eating habits, sluggishness of the bowels, and a decline in concentration and performance. Affected persons freeze easily, are constantly tired, listless and tend to be depressed. A lowered pulse rate and an increase in blood pressure are often noticeable. Other possible signs are very cool and dry skin, brittle nails and severe hair loss. Increased water retention in the tissues (edema) is noticeable by a doughy consistency of the skin. In women, cycle disorders can develop in the course of Hashimoto’s thyroiditis: Failure to ovulate may be the reason for an unfulfilled desire to have children. During pregnancy, the disease impairs the development of the baby and not infrequently triggers a miscarriage. Men often complain of potency disorders, and in both sexes the [[Sexual unwillingness|sexual desire[] may decrease. The symptoms of Hashimoto’s thyroiditis are varied, often only some of the aforementioned complaints occur. Initially, the disease may cause a brief hyperthyroidism characterized by severe nervousness, insomnia, increased sweating, tremors, ravenous appetite, palpitations, weight loss, and diarrhea. Occasionally, hormone levels fluctuate between hyperthyroidism and hypothyroidism during the course of the disease, with associated symptoms.
Diagnosis and course
An initial suspicion always arises in Hashimoto’s thyroiditis on the basis of the characteristic symptoms. The diagnosis is confirmed in the course of blood tests. Thus, in Hashimoto’s thyroiditis, the concentration of antibodies against certain thyroid enzymes, such as those of thyroperoxidase antibodies (TPO-AK) or thyroglobulin antibodies (TgAK), is usually elevated.Furthermore, an elevated TSH value (thyroid stimulating hormone) indicates hypothyroidism, as the body reacts to the hypothyroidism or the lowered thyroid hormone values with increased TSH secretion (marker for hypothyroidism). Thyroid ultrasonography can provide information about the size and structural changes of the thyroid gland. In the case of Hashimoto’s thyroiditis, the damage to the thyroid gland is reflected by an echo-poor and inhomogeneous sonogram. Scintigraphy and histologic (fine tissue) analysis of thyroid tissue are required to differentiate Hashimoto’s thyroiditis from Graves’ disease. Although Hashimoto’s thyroiditis is not curable, it has a mild course in most cases, while hypothyroidism and its accompanying symptoms can be well treated with medication.
Complications
Hashimoto’s thyroiditis predominantly affects women. Due to this disease, there is primarily a strong enlargement of the thyroid gland. In this process, this enlargement can lead to swallowing difficulties, so that an ordinary intake of liquids and food is usually no longer possible for the patient. Further symptoms and complications depend on whether the thyroid is hypothyroid or hyperthyroid. In general, Hashimoto’s thyroiditis has a very negative effect on everyday life and leads to complaints such as diarrhea, fatigue or hair loss. Likewise, it is not uncommon for swelling or sweating to occur, leading to a greatly reduced quality of life. The diagnosis of Hashimoto’s thyroiditis usually runs without complications and thus enables a very fast and above all early treatment of this disease. This mainly involves taking medications that alleviate the symptoms and restore the function of the thyroid gland to normal. There are no particular complications or side effects in this process either. In some cases, the patient is dependent on a special diet. Life expectancy is not affected by Hashimoto’s thyroiditis.
When should you see a doctor?
Hyperthyroidism or hypothyroidism should always be clarified by a doctor. If severe weight loss or gain occurs without an obvious and understandable reason, a doctor should be consulted. If attacks of ravenous appetite occur, this is considered worrying and must be investigated. In the case of mood swings, a noticeable appearance as well as psychological disorders, a doctor should be consulted. If there are recurrent interpersonal conflicts due to one’s behavior, problems with libido or sexual disorders, it is advisable to consult a doctor. In case of sleep disorders, abnormalities of the cardiovascular system or increased blood pressure, a visit to the doctor is necessary. Irregularities of the menstrual cycle or disorders of fertility should be examined and treated by a doctor. Swelling in the region of the thyroid gland is a warning sign that should be followed up immediately. People suffering from difficulty swallowing, sweating or hot flashes should consult a physician. In case of hair loss, recurrent diarrhea, constipation, or persistent lassitude, a physician should be consulted. Fatigue, hoarseness, dry skin, and sensitivity to cold should be presented to a physician. Also unusual is a low pulse, disturbances of attention and concentration. Decreased performance should be discussed with a doctor if it continues unabated for several weeks.
Treatment and therapy
Therapeutic measures in Hashimoto’s thyroiditis are aimed at treating the symptoms. As a result of organ damage, there is a hormonal imbalance that must be corrected with medication. Those affected by Hashimoto’s thyroiditis must therefore take thyroid hormones such as L-thyroxine (levothyroxine) or T3 and/or T4 orally in tablet form for the rest of their lives as part of a substitution therapy, whereby side effects or a reduced life expectancy are not usually to be expected if the dosage and setting are correct. The TSH value should be checked regularly, as the chronic course of Hashimoto’s thyroiditis can change the amount of hormone to be substituted, so that those affected may have to be readjusted with medication.A sonographic control of the thyroid gland should also be performed every 6 to 12 months. While the amounts of iodine ingested with food are considered harmless, additional intake of iodine (including iodine tablets) should be avoided in Hashimoto’s thyroiditis, as this can accelerate inflammatory processes in the thyroid gland. Some studies also indicate that additional intake of the trace element selenium may have a positive effect on the body’s immune processes and thyroid function.
Outlook and prognosis
Hashimoto’s thyroiditis is incurable. Early diagnosis significantly improves the prognosis. Lifelong use of thyroid hormones may allow affected individuals to live symptom-free lives. Despite T4 substitution, sufferers may experience symptoms of hypothyroidism. This is due to the steady decline in thyroid output, which requires the hormone dose to be adjusted at regular intervals. In the classic course, the thyroid gland grows but loses its function. The thyroid tissue is gradually replaced by connective tissue. In extreme cases, a goiter may develop, which must be removed by surgery. The atrophic form of the autoimmune disease is more common in Germany: it causes the thyroid gland to atrophy. In about 25% of patients, other autoimmune diseases occur. Typical secondary and concomitant diseases of chronic thyroiditis are intestinal diseases such as ulcerative colitis and Crohn’s disease, type 1 diabetes, vitiligo (white spot disease), lupus erythematosus (butterfly lichen), rheumatoid arthritis, Addison’s disease (hypofunction of the adrenal cortex) and endocrine orbitopathy. In rare cases, Hashimoto’s disease can progress to Graves’ disease. Cervical lymphoma is an extreme complication. If Hashimoto’s thyroiditis is not treated, marked hypothyroidism results. The severe symptoms manifest themselves in mental and physical performance reduction, massive hair loss, and uncontrolled weight gain, among other symptoms.
Prevention
Because the exact triggers of autoimmune Hashimoto’s thyroiditis are not yet known, the disease cannot be specifically prevented. However, triggering factors (high doses of iodine) should be avoided in the case of a possible genetic predisposition (familial clustering). Similarly, after infectious diseases with severe courses, the thyroid gland should be checked at the first symptoms to ensure early diagnosis and initiation of therapy in case of a possible manifestation of Hashimoto’s thyroiditis.
Follow-up
Patients diagnosed with Hashimoto’s thyroiditis should continue to receive endocrinologic care even after their metabolic status has normalized. This includes, among other things, regular monitoring of thyroid levels TSH and fT4/fT3. In addition, the thyroid tissue itself should be assessed. Here, palpation of the thyroid gland by the physician and also an ultrasound of the neck helps. Particularly with age, changes in hormone status or stressful situations can lead to a new episode with changes in thyroid levels. In consultation with the treating physician, the dose of L-thyrox should be adjusted again and again, depending on the metabolic situation. The patient should also be alert to symptoms that may be caused by Hashimoto’s. In case of newly appearing depressive moods, unexplained weight gain, hair loss or other unclear symptoms, a medical check-up should be performed. Consultation with the doctor about special situations, such as a planned pregnancy, is also always advisable. In order to keep hormonal fluctuations and changing metabolic states to a minimum, patients should pay attention to a balanced lifestyle. Above all, a restful and sufficient night’s sleep, a healthy diet and a reduction in stress can have a positive effect and prevent inflammatory episodes. Taking supplemental iodine or consuming large amounts of iodine in the diet should be avoided.
Here’s what you can do yourself
People affected by Hashimoto’s thyroiditis can independently make their lifestyles more comfortable by minimizing their consumption of grains. It is also important to include unroasted nuts and plenty of vegetables and fruits in the diet. Adequate fluid intake should also be ensured, but sugared drinks such as iced teas or soft drinks should be avoided.Light exercise, such as stretching, yoga or Pilates, can lift the mood of those affected. Sufficient intake of vitamin D should also be ensured. Sufferers who eat little meat and no offal can obtain vitamin D3 as gel capsules or as vegan drops with orange oil in pharmacies. In this way, the complaints known for the slow Hashimoto’s metabolism, such as sluggishness, dry skin and rashes, hair loss and brittle fingernails, cold hands and feet, difficulty falling asleep or irregularities of the female cycle can be improved or disappear. Thyroid hormone must continue to be taken regularly and as prescribed. The feel-good effect of a low grain and low sugar diet with Hashimoto’s thyroiditis can occur after just a few days. Patients who have previously eaten a lot of cereals should have their thyroid status checked again by the treating physician after the first measurable weight loss and feel-good results. In this way, the success of the treatment can be fully documented by a doctor.
