Explore Hashimoto's Disease, an autoimmune disorder affecting the thyroid gland, its symptoms, causes, and available treatment options, on Meri Sehat.

Hashimoto’s Disease

Overview

Hashimoto&rsquo;s disease is an autoimmune disorder characterized by chronic inflammation of the thyroid, resulting in a decline in thyroid function. 
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The thyroid gland produces hormones that govern almost all of the body&#39;s metabolic processes, which convert food into energy and keep the body functioning normally. In Hashimoto&rsquo;s disease, the immune system produces antibodies against the thyroid, damaging healthy tissues. Thus, hormone production declines, resulting in an underactive thyroid (<a href="https://merisehat.pk/disease/hypothyroidism">hypothyroidism</a>).&nbsp;&nbsp;

While iodine deficiency is the most common cause of hypothyroidism worldwide, Hashimoto&rsquo;s is most frequently responsible for causing hypothyroidism in developed countries<a href="#accordion">[3]</a>. It is also known as autoimmune thyroiditis, chronic lymphocytic thyroiditis, and Hashimoto&#39;s thyroiditis.

The incidence of Hashimoto&rsquo;s disease varies by gender. Women are more frequently affected than males(350 vs. 80 per 100,000 people a year)<a href="#accordion">[1]</a>. 
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Hashimoto&#39;s disease has no specific subtypes. 
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Signs and Symptoms

The condition is not characterized by any unique symptoms. Moreover, since the disease advances gradually, many individuals appear asymptomatic, despite positive laboratory results. Eventually, a decline in thyroid hormone production results in the following signs and symptoms.&nbsp; 
&nbsp;

<ul>
	<li>Fatigue</li>
	<li>Sluggishness</li>
	<li>Increased cold sensitivity</li>
	<li>Increased somnolence</li>
	<li>Dry skin</li>
	<li><a href="https://merisehat.pk/disease/constipation">Constipation</a></li>
	<li>Muscle tremor</li>
	<li>Aches, soreness, and stiffness of the muscles</li>
	<li>Joint stiffness</li>
	<li>Heavy or irregular menstrual bleeding</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a></li>
	<li>Memory or concentration issues</li>
	<li>Slow heart rate</li>
	<li>Goiter (enlarged thyroid)</li>
	<li>Swelling of the face</li>
	<li>Brittle nails and hair</li>
	<li>Enlarged tongue (<a href="https://merisehat.pk/disease/macroglossia">macroglossia</a>) 
	&nbsp;</li>
</ul>

The enlarged thyroid (goiter) is not usually painful but may cause discomfort or difficulty swallowing. Moreover, it causes the neck to appear swollen. Eventually, tissue damage shrinks the gland, causing the goiter to disappear. 
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Causes

Hashimoto&#39;s disease is an autoimmune condition that results in the body&rsquo;s white blood cells and antibodies attacking the thyroid cells. It is unclear as to what causes the development of antibodies against various thyroid antigens. Genetic factors seem to account for 70 to 80 % of the risk for thyroid autoimmunity<a href="#accordion">[1]</a>. 
&nbsp;

Other possibles causes of Hashimoto&rsquo;s disease are:

<ul>
	<li>Environmental triggers such as stress, viruses, or radiation exposure</li>
	<li>Medications used for treating bipolar disorder</li>
	<li>Medications containing iodine</li>
	<li>Pregnancy 
	&nbsp;</li>
</ul>

There are no specific screening guidelines for Hashimoto&rsquo;s disease. However, asymptomatic individuals with abnormal thyroid stimulating hormone (TSH) levels may be recommended for further tests to confirm the diagnosis. 
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Diagnosis

The signs and symptoms of Hashimoto&rsquo;s disease resemble those of a variety of illnesses. Therefore, doctors will look through the patient&rsquo;s medical history, conduct a physical examination, and conduct various diagnostic tests to reach a diagnosis. 
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During a physical exam, the doctor will assess the patient for goiter and other symptoms of hypothyroidism.

<h5>Testing Thyroid Function</h5>

The doctor may prescribe blood tests such as the ones listed below to evaluate whether hypothyroidism is the root of the patient&rsquo;s symptoms.

<ul>
	<li>TSH Test</li>
</ul>

The pituitary gland creates TSH, or thyroid stimulating hormone. TSH is sent to the thyroid to cause an increase in thyroid hormone production when the pituitary detects low levels of thyroid hormones in the blood. A high blood TSH level is a sign of hypothyroidism.

<ul>
	<li>T4 Tests</li>
</ul>

Thyroxine is the primary hormone for the thyroid (T4). The results of a TSH test are confirmed by a low blood level of T4, which shows the thyroid is the source of the issue. 
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<h5>Antibody Tests</h5>

Hypothyroidism can be brought on by numerous medical conditions. The doctor will request an antibody test to identify whether Hashimoto&#39;s disease is to blame for the patient&rsquo;s hypothyroidism.

In Hashimoto&rsquo;s disease, the immune system typically creates antibodies against thyroid peroxidase (TPO), a protein crucial to the generation of thyroid hormones. Elevated levels of these antibodies signify Hashimoto&rsquo;s disease. Other than levels of anti-TPO, levels of anti-thyroglobulin antibodies may also be measured. However, antithyroid antibodies are not present in all individuals. 
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<h5>Ultrasound</h5>

An ultrasound of the thyroid may be conducted to rule out other causes of hypothyroidism, such as thyroid nodules. 
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Treatment

To treat hypothyroidism, most Hashimoto&#39;s disease patients take medication. 
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<h5>T-4 Hormone Replacement Therapy</h5>

Levothyroxine, a synthetic hormone, is used to treat hypothyroidism brought on by Hashimoto&#39;s disease (Levoxyl, Synthroid). The synthetic hormone functions similarly to the thyroid&#39;s own naturally occurring T-4 hormone.

The purpose of treatment is to improve hypothyroidism symptoms and restore and maintain appropriate T-4 hormone levels. Patients may need to take levothyroxine for the rest of their lives. 
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<h5>Monitoring The Dosage</h5>

The doctor will choose a levothyroxine dosage based on the patient&rsquo;s age, weight, level of thyroid production, underlying medical conditions, and other considerations. About 6 to 10 weeks later, the healthcare professional will retest TSH levels and modify the dosage as appropriate.

The patient will continue taking the drug once daily once the ideal dosage has been established. Yearly follow-up exams are required to adjust the patient&rsquo;s dosage based on their TSH levels.

The levothyroxine pill is typically taken In the morning, just before breakfast.

Note: If you have any concerns about taking the medication correctly, consult your doctor. Moreover, find out what to do if you accidentally miss a dose. 
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<h5>Precautions For This Therapy</h5>

Levothyroxine mimics natural T-4 in the body. Thus, as long as the medication is causing your body to produce T-4 at &quot;natural&quot; levels, there shouldn&#39;t be any negative side effects. Osteoporosis, which results in weak, brittle bones, can be made worse by too much thyroid hormone, and it can also lead to irregular heartbeats (arrhythmias). 
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<h5>Effects Of Other Substances</h5>

Certain drugs, dietary supplements, or foods can interfere with the body&rsquo;s ability to absorb levothyroxine. Levothyroxine should be taken at least four hours before these medications, if possible. Any of the following should be discussed with the doctor:

<ul>
	<li>Soy-based goods</li>
	<li>Fiber-rich foods</li>
	<li>Iron supplements, such as iron-containing multivitamins</li>
	<li>A drug called cholestyramine (Prevalite) is used to reduce blood cholesterol levels.</li>
	<li>Aluminium hydroxide, which is found in several antacids</li>
	<li>Sucralfate, a drug for ulcers</li>
	<li>Supplements with calcium 
	&nbsp;</li>
</ul>

<h5>T-3 Hormone Replacement Therapy</h5>

T-4 generated naturally is transformed into the thyroid hormone triiodothyronine (T-3). The body receives an adequate amount of T-3 from the T-4 replacement hormone, which is also transformed into T-3 in the majority of patients receiving T-4 replacement treatment.

A physician might also suggest a synthetic T-3 hormone (Cytomel) or a synthetic T-4 and T-3 combo for those who require improved symptom control. Side effects include a fast heartbeat, sleeplessness, and anxiety. Three to six months of testing could be used to evaluate these medicines.

Note: If your hypothyroidism is mild, you might not need treatment, but you should still undergo frequent TSH testing to check your thyroid hormone levels. 
&nbsp;

Thyroid hormones are necessary for the optimal function of numerous physiological systems. As a result, several issues may arise if hypothyroidism and Hashimoto&#39;s disease are not treated. They consist of: 
&nbsp;

<ul>
	<li>
	<h5>Goiter</h5>
	</li>
</ul>

The pituitary gland directs the thyroid to produce more thyroid hormones as the amount produced decreases due to Hashimoto&#39;s disease. As a result of this cycle, the thyroid enlarges, causing goiter. A huge goiter can change one&rsquo;s appearance and make breathing and swallowing difficult. However, it&#39;s not usually painful. 
&nbsp;

<ul>
	<li>
	<h5>Heart Problems</h5>
	</li>
</ul>

Poor cardiac performance, an enlarged heart, and irregular heartbeats are all side effects of hypothyroidism. Moreover, it can lead to high levels of low-density lipoprotein (LDL) cholesterol, also known as &quot;bad&quot; cholesterol, which increases the risk of heart failure and cardiovascular disease. 
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<ul>
	<li>
	<h5>Mental Health Issues</h5>
	</li>
</ul>

Early signs of Hashimoto&#39;s disease can include depression or other mental health concerns, which can progress to more severe forms over time. 
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<ul>
	<li>
	<h5>Sexual And Reproductive Dysfunction</h5>
	</li>
</ul>

In women, hypothyroidism can lead to decreased libido (sex desire), infertility, and irregular and heavy menstrual flow. Males with hypothyroidism may experience erectile dysfunction, decreased sperm count, and decreased libido. 
&nbsp;

<ul>
	<li>
	<h5>Poor Pregnancy Outcomes</h5>
	</li>
</ul>

An increased risk of miscarriage or preterm birth can result from hypothyroidism during pregnancy. Reduced intellectual ability, autism, speech difficulties, and other developmental abnormalities are risks for children born to women who have untreated hypothyroidism. 
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<ul>
	<li>
	<h5>Myxedema </h5>
	</li>
</ul>

Long-term, severe, untreated hypothyroidism can lead to the development of this uncommon, potentially fatal illness. It is characterized by drowsiness, which is followed by extreme sluggishness and unconsciousness. The use of sedatives, exposure to the cold, an infection, or other stresses on the body might cause a myxedema coma. Myxedema necessitates urgent medical attention. 
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The following elements raise the likelihood of developing Hashimoto&#39;s disease: 
&nbsp;

<ul>
	<li>Sex 
	Hashimoto&#39;s disease affects women more than men.</li>
	<li>Age 
	Although Hashimoto&#39;s disease can strike at any age, it tends to occur more commonly in middle age.</li>
	<li>Other Autoimmune Diseases 
	The risk of acquiring Hashimoto&#39;s disease increases if one already has an autoimmune condition, such as <a href="https://merisehat.pk/disease/systemic-lupus-erythematosus">lupus</a>, <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">type 1 diabetes</a>, or <a href="https://merisehat.pk/disease/rheumatoid-arthritis">rheumatoid arthritis</a>.</li>
	<li>Genetics And Family History 
	If someone in the family has a thyroid condition or another autoimmune disease, the risk of developing Hashimoto&#39;s disease increases.</li>
	<li>Pregnancy 
	Hashimoto&#39;s disease that develops after pregnancy may be influenced by typical changes in immunological function during pregnancy.</li>
	<li>Excessive Iodine Intake 
	In those who are already at risk for Hashimoto&#39;s disease, consuming too much iodine in the diet may act as a trigger.</li>
	<li>Radiation Exposure 
	Individuals with Hashimoto&#39;s disease are more likely to be exposed to high doses of environmental radiation. 
	&nbsp;</li>
</ul>

Regrettably, there is no known way to stop Hashimoto&#39;s thyroiditis or thyroid gland inflammation. On the plus side, this condition is incredibly curable. People can begin receiving treatment as soon as they receive a diagnosis.

Hashimoto&rsquo;s disease is an autoimmune condition. In other words, a compromised immune system is the root of the problem. Because the reason why the immune system assaults healthy tissues instead of defending them is still poorly understood, it is not currently possible to prevent it. 
&nbsp;
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Key Points

<ul>
	<li>Hashimoto&rsquo;s disease is a chronic autoimmune condition that damages the thyroid gland, causing an underactive thyroid.</li>
	<li>The thyroid gland is attacked by the immune system, which causes inflammation and thyroid tissue destruction.</li>
	<li>Women are more likely than males to have Hashimoto&#39;s disease, and as people get older, their risk rises.</li>
	<li>The signs and symptoms of Hashimoto&#39;s disease can vary. However, they may include depression, weight gain, sensitivity to cold, constipation, exhaustion, and weight gain.</li>
	<li>Blood tests that check for thyroid antibodies and thyroid hormone levels are frequently used to diagnose thyroid disorders.</li>
	<li>Thyroid hormone replacement therapy, which aids in reintroducing the thyroid hormone that has been lost and restoring normal thyroid function, may be used as part of the treatment.</li>
	<li>Hashimoto&#39;s disease has no known cure. However, the majority of sufferers can have healthy, active lives with the right care and management.</li>
	<li>Healthy eating habits, regular exercise, stress management, and quitting smoking are lifestyle choices that may help lower the likelihood of getting Hashimoto&#39;s disease or manage its symptoms. 
	&nbsp;</li>
</ul>
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[1] Attard CDC, Vella S, others. Aetiology of thyroid autoimmunity. Malta Med J. 2018;30(1):26–31.

[2] Garber JR, Cobin RH, Gharib H, Hennessey J V, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200–35.

[3] Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.