Hashimoto’s thyroiditis is the most common autoimmune-related, chronic inflammation of the thyroid gland, the cause of which has not yet been clarified. Women are about nine times more likely to be affected by Hashimoto’s thyroiditis than men, and the disease is usually easy to treat.

What is Hashimoto’s thyroiditis

According to ABBREVIATIONFINDER, Hashimoto’s thyroiditis is a chronic inflammation of the thyroid gland that is caused by a dysregulation of the body’s defenses (autoimmune thyroid disease). Characteristic symptoms of Hashimoto’s thyroiditis are frequent tiredness, weight gain and increased sensitivity to cold and edema (water retention).

While Hashimoto’s thyroiditis manifests itself over the long term in an underactive thyroid gland (hypothyroiditis), there can also be an overactive thyroid gland (hashitotoxicosis) at the beginning of the disease, which can be associated with irritability, sleep disorders, tachycardia, cravings, weight loss and a disrupted menstrual cycle.

There are two subtypes of Hashimoto’s thyroiditis. While the more common atrophic form is associated with a loss of thyroid cells, in the less common hypertrophic form of Hashimoto’s thyroiditis, the thyroid gland enlarges and a goiter (goiter) forms.

Causes

Hashimoto’s thyroiditis is caused by a misregulated immune system that attacks the body’s own structures in the thyroid gland, triggering inflammatory processes there and causing lasting damage to the organ and its hormone production. What triggers this autoimmune dysregulation has not yet been clarified.

In addition to a genetic predisposition (predisposition), bacterial and viral infections with severe courses ( shingles, glandular fever ), malfunctions of the adrenal cortex as well as environmental factors and stress are suspected as possible triggers for Hashimoto’s thyroiditis.

Furthermore, 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 iodine intolerance, which can cause Hashimoto’s thyroiditis to manifest in a predisposition, are discussed. In addition, Hashimoto’s thyroiditis is also associated with type I diabetes mellitus and vitiligo (white spot disease).

Symptoms, Ailments & Signs

Hashimoto’s thyroiditis usually begins insidiously with mild symptoms that are not associated with the thyroid gland. These include unwanted weight gain despite unchanged eating habits, constipation and a decrease in concentration and performance. Those affected freeze easily, are constantly tired, listless and tend towards depressive moods.

A reduced 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 tissue (oedema) is noticeable through a doughy consistency of the skin.

Menstrual disorders can develop in women as part of Hashimoto’s thyroiditis: the lack of ovulation can be the reason for an unfulfilled desire to have children. During pregnancy, the disease affects the development of the baby and often causes a miscarriage. Men often complain about erectile dysfunction, and the [[sexual reluctance|sexual desire[] can decrease in both sexes.

The symptoms of Hashimoto’s thyroiditis are diverse, often only some of the aforementioned symptoms occur. Initially, the condition can cause a short-term overactive thyroid, characterized by severe nervousness, insomnia, increased sweating, tremors, food cravings, palpitations, weight loss, and diarrhea. Occasionally, during the course of the disease, hormone values ​​fluctuate between overfunctioning and underfunctioning, with the corresponding symptoms.

Diagnosis & History

The first suspicion of Hashimoto’s thyroiditis is always based on the characteristic symptoms. The diagnosis is confirmed by blood tests. In Hashimoto’s thyroiditis, for example, the concentration of antibodies against certain thyroid enzymes such as thyroid peroxidase antibodies (TPO-AK) or thyroglobulin antibodies (TgAK) is usually increased.

Furthermore, an increased TSH value (thyroid stimulating hormone) indicates an underactive thyroid, since the body reacts to the underactive or reduced thyroid hormone levels with an increased TSH release (marker for underactive). In the context of a thyroid sonography, statements about the size and structural changes of the thyroid can be made.

In the case of Hashimoto’s thyroiditis, the damage to the thyroid gland is reflected in a hypoechoic and inhomogeneous sonogram. A scintigraphy and a histological (histological) analysis of the thyroid tissue are required to differentiate between Hashimoto’s thyroiditis and Graves ‘ disease. Although Hashimoto’s thyroiditis cannot be cured, in most cases it has a mild course, while the hypothyroidism and the accompanying symptoms can be treated well with medication.

Complications

Hashimoto’s thyroiditis is predominantly found in women. The primary cause of this disease is a severe enlargement of the thyroid gland. This enlargement can lead to swallowing difficulties, so that the patient is usually no longer able to take in liquids and food as usual. Other symptoms and complications depend on whether the thyroid gland is underactive or overactive.

In general, Hashimoto’s thyroiditis has a very negative effect on everyday life and leads to symptoms such as diarrhea, tiredness or hair loss. It is also not uncommon for swelling or sweating to occur, which lead to a greatly reduced quality of life. The diagnosis of Hashimoto’s thyroiditis usually proceeds without complications and thus enables this disease to be treated very quickly and, above all, at an early stage.

Medications are mainly taken to relieve the symptoms and normalize the function of the thyroid gland. There are no particular complications or side effects. In some cases, the patient is dependent on a special diet. Life expectancy is not affected by Hashimoto’s thyroiditis.

When should you go to the doctor?

Hyperthyroidism or hypofunction of the thyroid should always be checked out by a doctor. If you lose or gain a lot of weight without an obvious and understandable reason, you should see a doctor. Bouts of cravings are considered a concern and need to be investigated.

A doctor should be consulted in the event of mood swings, a conspicuous appearance or mental disorders. If interpersonal conflicts repeatedly arise due to one’s own behavior, libido problems or sexual disorders, it is advisable to consult a doctor.

In the case of sleep disorders, abnormalities in the cardiovascular system or high blood pressure, a doctor’s visit is necessary. Irregularities in the menstrual cycle or fertility problems should be examined and treated by a doctor. Swelling in the region of the thyroid is a red flag that should be addressed immediately. People who experience difficulty swallowing, sweating, or hot flashes should consult a doctor.

A doctor should be consulted in the event of hair loss, repeated diarrhea, constipation or persistent exhaustion. Fatigue, hoarseness, dry skin and sensitivity to cold should be presented to a doctor. A low pulse, disturbances in attention and concentration are also unusual. Reduced performance should be discussed with a doctor if it persists for several weeks.

Treatment & Therapy

The therapeutic measures in Hashimoto’s thyroiditis are aimed at treating the symptoms. As a result of the organ damage, there is a hormonal imbalance that needs to 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 life as part of a substitution therapy, whereby side effects or a reduced life expectancy are usually not to be expected with the correct dosage and adjustment.

The TSH value should be checked regularly, since the chronic course of Hashimoto’s thyroiditis can change the amount of hormone to be replaced, so that those affected may have to be readjusted with medication. A sonographic check of the thyroid gland should also be carried out every 6 to 12 months.

While the amount of iodine taken in with food is classified as harmless, an additional intake of iodine (including iodine tablets) should be avoided in Hashimoto’s thyroiditis, as this can accelerate the inflammatory processes in the thyroid gland. Some studies also indicate that the additional intake of the trace element selenium can have a positive effect on the body’s immune processes and thyroid function.

Outlook & Forecast

Hashimoto’s thyroiditis is incurable. Early diagnosis significantly improves the prognosis.

Lifelong intake of thyroid hormones can enable those affected to lead a symptom-free life. Despite T4 substitution, symptoms of hypothyroidism can occur in patients. This is due to the constant decrease in thyroid performance, which requires the hormone dose to be adjusted at regular intervals.

In the classic form, the thyroid grows, but loses its function. The thyroid tissue is gradually replaced by connective tissue. In extreme cases, a goiter (goiter) can develop, which must be surgically removed. The atrophic form of the autoimmune disease is more common in Germany: it atrophies the thyroid gland.

About 25% of those affected develop other autoimmune diseases. 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 (hyperfunction of the adrenal cortex) and endocrine orbitopathy. In rare cases, Hashimoto’s disease can progress to Basedow’s disease. Cervical lymphoma is an extreme complication.

If Hashimoto’s thyroiditis is not treated, it becomes severely hypothyroid. The serious symptoms manifest themselves, among other things, in reduced mental and physical performance, massive hair loss and uncontrolled weight gain.

Prevention

Since the exact triggers of autoimmune Hashimoto’s thyroiditis are not yet known, the disease cannot be specifically prevented. However, triggering factors (high iodine doses) should be avoided if there is a genetic predisposition (family accumulation).

Likewise, the thyroid gland should be checked at the first symptoms after infectious diseases with severe courses, in order to ensure an early diagnosis and start of therapy in the event of a possible manifestation of Hashimoto’s thyroiditis.

Aftercare

Patients with diagnosed Hashimoto’s thyroiditis should continue to be endocrinologically cared for even after their metabolic status has returned to normal. This includes, among other things, regular monitoring of the thyroid levels TSH and fT4/fT3. In addition, the thyroid tissue itself should be assessed. A doctor’s palpation of the thyroid gland and an ultrasound of the neck can help here.

Especially in old age, when there are changes in the hormone status or in stressful situations, there can be another flare-up with changes in the thyroid values. In consultation with the doctor treating you, the dose of L-Thyrox should be adjusted again and again, depending on the metabolic situation. Also, the patient should be alert to the symptoms that Hashimoto can produce.

In the case of new depressive moods, inexplicable weight gain, hair loss or other unclear symptoms, a medical check-up should be carried out. It is also always advisable to consult your doctor about special situations, such as a planned pregnancy.

In order to keep hormonal fluctuations and changing metabolic conditions as low as possible, patients should ensure a balanced lifestyle. Above all, a restful and sufficient night’s sleep, healthy nutrition and a reduction in stress can have a positive effect and prevent flare-ups. Taking additional iodine or consuming large amounts of iodine from food should be avoided.

You can do that yourself

Hashimoto’s thyroiditis sufferers can make their lifestyle more comfortable on their own by reducing grain consumption to a minimum. It is also important to integrate unroasted nuts and lots of vegetables and fruit into the diet. Sufficient fluid intake is also important, but sugar-sweetened drinks such as iced tea or lemonade should be avoided.

Light exercise such as stretching exercises, yoga or Pilates can improve mood. Adequate intake of vitamin D is also important. Sick people who eat little meat and no offal can get vitamin D3 as gel capsules or as vegan drops with orange oil in pharmacies.

In this way, the symptoms known for the slow Hashimoto metabolism such as sluggishness, dry skin and rashes, hair loss and brittle fingernails, cold hands and feet, difficulty falling asleep or irregularities in the female menstrual cycle can be improved or disappear.

The thyroid hormone must be continued 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 grain should have their thyroid status checked again by their doctor after the first measurable success in losing weight and feeling good. In this way, the success of the treatment can be fully medically documented.