What is Hashimoto’s Thyroiditis?
- Hashimoto’s Thyroiditis or Hashimotos Disease is the most common form of thyroiditis (inflammation of the thyroid gland) and also the most common thyroid disorder
- Is named after the first doctor who described this condition, Dr. Hakaru Hashimoto, in 1912
- It is an autoimmune disorder, which means it occurs when immune cells attack healthy tissue instead of protecting it
- In the case of Hashimoto’s thyroiditis, immune cells mistakenly attack healthy thyroid tissue, causing inflammation of the thyroid
- Autoimmune diseases affect women more than men, and women are 7 times more likely to have Hashimoto’s thyroiditis
- Hashimoto’s thyroiditis is the most common cause of hypothyroidism
Symptoms of Hashimoto’s Disease
- Many people with Hashimoto’s disease have no symptoms for years
- An enlarged thyroid, is often the first sign of disease
- The goitre may cause the front of the neck to look swollen
- If large, it may cause a feeling of fullness in the throat or make it hard to swallow
- Many people with Hashimoto’s disease develop an underactive thyroid
- They may have mild or no symptoms at first – but the symptoms tend to worsen over time
Hashimoto’s Disease – Hyperthyroid Phase
- There are a few patients with Hashimoto’s thyroiditis who may undergo a hyperthyroid phase (too much thyroid hormone), called hashitoxicosis, before eventually becoming hypothyroid
- Hashitoxicosis, is a transient hyperthyroidism caused by inflammation associated with Hashimoto’s thyroiditis disturbing the thyroid follicles, resulting in excess release of thyroid hormone
Other symptoms and signs include:
- Swelling of the thyroid gland (due to the inflammation), leading to a feeling of tightness or fullness in the throat
- A lump in the front of the neck, (the enlarged thyroid gland) called a goitre
- Difficultly swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the oesophagus
Symptoms of an underactive thyroid
- Fatigue
- Weight gain
- Pale, puffy face
- Feeling cold
- Joint and muscle pain
- Constipation
- Dry, thinning hair
- Heavy menstrual flow or irregular periods
- Depression
- A slowed heart rate
- Problems getting pregnant
Hashimoto’s Disease diagnosis
- If you have symptoms of Hashimoto’s disease, your doctor will do an exam and order one or more tests
- Sometimes, routine screening of thyroid function reveals a mildly underactive thyroid in a person with no symptoms
- Tests used to find out if you have Hashimoto’s disease include a blood test to see if your body has the right amount of TSH and thyroid hormone (T4)
Thyroid function tests
- An above normal level of TSH is a sign of an underactive thyroid
- When the thyroid begins to fail, the pituitary gland makes more TSH so as to trigger the thyroid to make more thyroid hormone
- For a while, the thyroid can keep up, and the blood test will show slightly higher TSH levels with normal T4 levels – this is called subclinical hypothyroidism
- Over time, the damaged thyroid cannot keep up, and T4 levels will drop below normal while TSH levels are highA blood sample to look for antibodies that suggest Hashimoto’s disease
Antibody test
- Most people with Hashimoto’s disease will have specific antibodies that people with other causes of an underactive thyroid do not have
- Some people have the antibodies seen with Hashimoto’s disease, but have normal thyroid function – so having only the antibodies does not cause any symptoms
- Hashimoto’s disease can be harder to diagnose during pregnancy
- Hashimoto’s disease has many of the same symptoms as normal pregnancy, such as fatigue and weight gain
- Yet an untreated underactive thyroid during pregnancy may affect the baby’s growth and brain development – so make sure to tell your doctor if you have symptoms of thyroid problems
Treatment
- Hashimoto’s disease responds well to treatment
- It is treated with a single daily tablet of levothyroxine – a manmade form of T4 thyroid hormone
- It also is called thyroid replacement therapy because it restores back to normal the T4 that the damaged thyroid can no longer make
- It almost always needs to be taken for the rest of a person’s life and in the same manner each day
- Thyroid replacement medication comes in different amounts – the exact dose depends on:
When you start treatment, you will need a follow-up TSH test so your doctor can fine-tune your dose.
Factors that can affect the dose of your thyroid hormone replacement include.
- Age
- Weight
- Severity of the underactive thyroid
- Other health problems
- Use of other medicines that can interact with levothyroxine
Remember
Thyroid hormone acts very slowly in the body, so it can take several months after the start of treatment for symptoms to go away and goitre to shrink. Once the TSH level is normal, your doctor will need to see you less often – with a thyroid check-up and TSH test once a year
If you have any questions about Hashimoto’s disease, thyroiditis or thyroid symptoms, contact your local doctor, who will arrange to contact your thyroid surgeon.