What is Hashimoto's Disease?
Autoimmune diseases affect at least 23 million Americans and that number continues to rise every year. While most people think about rheumatoid arthritis and Type 1 Diabetes when talking about autoimmune diseases, it is actually a family of more than 80 chronic and often debilitating conditions that sometimes result to life-threatening complications. One of the lesser-known autoimmune diseases in the world is Hashimoto’s disease.
Understanding Hashimoto’s Disease
Also known as chronic lymphocytic thyroiditis or Hashimoto’s thyroiditis, Hashimoto’s disease is a type of autoimmune disease that gradually causes damage to the thyroid gland. Hashimoto’s disease was named after Japanese physician Hakaru Hashimoto who first described the disease in 1912. In 1957, the condition was formally recognized as an autoimmune disorder.
The thyroid gland
The thyroid gland is a type of endocrine gland located in the neck that is responsible for secreting two hormones in the blood: triiodothyronine (T3) that contains three atoms of iodine and thyroxine (T4) that contains four. The T4 is usually converted to T3 and together with the T3 already converted by the thyroid gland, these two hormones are responsible for a lot of activities in the cells and tissues of the body.
They mostly influence metabolism in the cells or the rate at which the cells in the body works, which means that if too much of these hormones are secreted, the cells will work faster than normal, which results to a condition called hyperthyroidism where the organs of the body may behave more aggressively. On the other hand, too little secretion or hypothyroidism cause the cells and organs to slow down, which leads to abnormalities within the body’s functions.
In Hashimoto’s disease, the body’s immune system creates antibodies that attack the thyroid gland and causes significant damage to it. This results to an insufficiency in the secretion of thyroid hormones, which often leads to hypothyroidism.
The prevalence
According to studies, Hashimoto’s disease has an annual global prevalence of 0.3-1.5 cases for every 1,000 individuals. It is also eight times more prevalent in women than men, most of whom are in the age of 40 to 60 years old, although it also affects women in their teenage and young adulthood years. In the United States, five out of 100 people are affected with Hashimoto’s thyroiditis. The disease also affects at least 5% of Caucasians at some point in their life.
The causes and risk factors
After years of studies, medical experts still don’t have a clear explanation on what causes the body to make antibodies that attack the thyroid gland. Some experts suggest that a genetic flaw could cause this abnormal mechanism in the body while others believe that it could be triggered by a bacteria or viral infection.
What scientists know for sure, however, is that there are some risk factors that would make an individual more predisposed to getting Hashimoto’s thyroiditis.
Family history
Most patients who suffer from Hashimoto’s disease have a history of the same disease in their family. However, researchers are still working on finding the specific genes involved in this condition.
Gender
Hashimoto’s disease is more common in women than men and it also affects them differently. When a woman develops hypothyroidism related to Hashimoto’s thyroiditis, she will start having problems like:
- Issues with menstruation. The thyroid hormone plays a role in regulating the menstrual cycle. Hypothyroidism can either lead to irregular menstruation or periods that are longer and heavier than normal.
- Fertility problems. According to studies, almost half of women who have hypothyroidism due to Hashimoto’s disease have a hard time getting pregnant as a result of irregular menstrual cycle. This is why patients who want to get pregnant needs to undergo treatment for hypothyroidism first before addressing their fertility issues.
- Risks during pregnancy. If a woman is diagnosed with hypothyroidism while pregnant, it puts here child at risk for birth defects due to the body not being able to supply enough thyroid hormone to support the development of the baby’s brain and nervous systems. Untreated Hashimoto’s disease could even lead to miscarriage and other complications.
Exposure to radiation. Patients who have been exposed to high levels of environmental radiation are at a higher risk for developing Hashimoto’s thyroiditis.
Other autoimmune diseases. Patients who have an existing autoimmune disease such as type 1 diabetes, rheumatoid arthritis or lupus make them predisposed to developing Hashimoto’s disease. Some of the medical conditions related to Hashimoto’s thyroiditis include:
- Vitiligo is a medical condition that results to non-pigmentation of the skin.
- Addison’s disease is a long-term endocrine disorder where the adrenal glands don’t produce enough steroid hormones.
- Type 1 diabetes mellitus is a condition where the body produces a high amount of blood glucose.
- Autoimmune hepatitis is an autoimmune condition where the immune systems targets and damages the liver.
- Rheumatoid arthritis is a disorder affecting the joints due to the body’s defective immune system.
- Lupus is a chronic autoimmune disease where the body’s immune system attacks normal, healthy tissues.
- Pernicious anemia is characterized by vitamin B12 deficiency caused by a lack of intrinsic factor (IF) in the gastric mucosa.
- Celiac disease is an autoimmune disease affecting the digestive system where an individual cannot ingest any gluten because it will cause significant damage to the small intestines.
- Sjogren’s syndrome is a medical condition where the immune system attacks parts of the body by mistake, especially the glands that products saliva and tears resulting to dry mouth and eyes.
The signs and symptoms
People who have Hashimoto’s disease may not experience any signs and symptoms during the first stages of the disease. But if left undiagnosed and untreated, the disease could progress slowly after a few years and the patient will start to notice a swelling at the front of his throat usually known as goiter. Some of the most common signs and symptoms of Hashimoto’s thyroiditis include:
- Fatigue and extreme tiredness
- Weight gain
- Constipation
- Increased sensitivity to cold
- Brittle nails and hair loss
- Pale, dry skin
- Prolonged and excessive menstrual bleeding
- Muscle pain, weakness, stiffness and tenderness
- Tongue enlargement
- Puffy face
- Memory lapses
- Depression
A large, inflamed and lobulated thyroid gland is still the most common sign of Hashimoto’s thyroiditis, although some patients still show no signs of any enlargement until the later stages of the disease. This enlargement is mainly due to the fact that the thyroid gland is exerting more effort to compensate for the lack of necessary hormones like T3 and T4.
Diagnosing and treating the disease
A majority of patients with Hashimoto’s disease only seek consultation when they start to notice an enlargement of their thyroid gland. But doctors suggest that when you feel tired for no reason, constipated, have dry skin or notice that your face is becoming puffy, you have to seek medical help right away.
The diagnosis
Upon consultation, the doctor will conduct a thorough physical exam, especially on the neck to see any prominent thyroid enlargement. Blood tests will also be conducted to see any abnormalities in your blood, especially the presence of antithyroid antibodies called thyroperoxidase antibodies (TPO), which is present in almost all individuals suffering from Hashimoto’s disease. And since the disease is closely related to genetics, you will also be interviewed for your medical and familial history. Once the results come out positive and you are diagnosed with Hashimoto’s disease, you will then be recommended to start treatment. In some cases, however, a patient could manifest other signs and symptoms of Hashimoto’s thyroiditis but there are no antibodies present in their blood.
This is when a doctor might order an ultrasound of the thyroid where an image will show the size of the thyroid gland and the other abnormalities that are related to Hashimoto’s disease in order to make a diagnosis. An ultrasound can also help rule out other thyroid-related conditions such as thyroid nodules that are small lumps that may look like an enlargement. Proper assessment and tests are crucial to the prognosis for Hashimoto’s disease, especially since the initial hypothyroidism could be mistaken for other conditions like chronic fatigue syndrome, cyclothymia, depression and fibromyalgia.
The treatment
The treatment for Hashimoto’s thyroiditis will depend on the extent of the damage caused by the disease to the thyroid. If you got diagnosed early in the disease where there’s no evidence of hypothyroidism just yet, the doctor may not give you any medications and just monitor to see if the condition gets worse because in some cases, the enlargement of the thyroid doesn’t progress to hypothyroidism.
You may not also require treatment if you have elevated TPO antibodies but your TSH and free T4 thyroid function tests come out normal.
If you have slightly elevated TSH levels or mild hypothyroidism, you’ll also not be required to take any medication. But a repeat blood test will be done 3-6 months after the first test to see if these levels are still elevated or if it got worse. But if you have consistent elevated TSH and low thyroid hormone levels, a doctor would recommend that you start treatment right away.
Thyroid hormone replacement is the most common treatment for Hashimoto’s disease. Desiccated thyroid extract, levothyroxine and triiodothyronine are some of the most popular thyroid hormone replacement agents used by most doctors. You will usually be required to take a tablet in the morning before you eat to keep your thyroid hormones at normal levels.
After 6 to 8 weeks from the start of treatment, the doctor will require a set of blood tests to see if there is any improvement in your thyroid hormone levels. This will also help determine if the doctor needs to make adjustments to your dosage.
A blood test will be conducted every time your dose needs to be adjusted and once you’ve reached the right dosage, you’ll be asked for a repeat blood test after six months and then, after a year. Doctors will usually want to maintain your TSH levels under 3.0 mIU/L to control the disease from causing more damage to your thyroid.
You also need to watch what you eat if you have Hashimoto’s thyroiditis. Avoid foods with large amounts of iodine such as seaweed or kelp to keep your condition from getting worse. It’s very important to talk to your doctor about any food limitations and you also need to ask about any medications that you’re taking, especially cough syrups that might contain iodine.
Most patients who have Hashimoto’s disease are treated by thyroid hormone replacement therapy as long as they stick to their medication regimen. Some may even be required to take the medication for a certain period of time, although others may have to undergo therapy for the rest of their lives.
The prognosis
With proper treatment and adherence to medication, you will get to enjoy a long, healthy and normal life even with Hashimoto’s disease. This is why it’s very important to seek consultation the moment you experience any signs and symptoms of the disease so you could get the best prognosis. If left untreated, Hashimoto’s disease could get worse and would result in the following complications:
- Heart problems. Hashimoto’s thyroiditis has been linked to a higher risk for heart disease primarily due to elevated cholesterol levels that’s common in patients with hypothyroidism. If left untreated, this could lead to cardiomegaly or heart enlargement and eventually, heart failure.
- The most common complication of Hashimoto’s disease is goiter, which is an enlargement of the thyroid gland that could interfere with breathing or swallowing.
- Mental health problems. Depression is a common sign of Hashimoto’s disease and it could get worse if the disease is not treated promptly. Patients may also experience a lack of sexual desire and even some delays in mental functioning.
- Although this condition is very rare, it could be life threatening if Hashimoto’s disease is not treated right away. Symptoms include drowsiness, lethargy and eventually, unconsciousness or myxedema coma that is triggered by stress, sedatives or infection.
The rate of patients suffering from Hashimoto’s disease continues to increase around the world. But the condition is highly treatable if you seek medical consultation right away. So if you experience any symptoms or if you think that you may have an enlarged thyroid, it’s best to consult your doctor at once.
Read About Integrative Medicine Vs Functional Medicine.
