Symptoms

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You might not notice signs or symptoms of Hashimoto's disease at first, or you may notice a swelling at the front of your throat (goiter). Hashimoto's disease typically progresses slowly over years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels in your blood. The signs and symptoms are mainly those of an underactive thyroid gland (hypothyroidism).

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Signs and symptoms of hypothyroidism include:

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• Fatigue and sluggishness

• Increased sensitivity to cold

• Constipation

• Pale, dry skin

• A puffy face

• Brittle nails

• Hair loss

• Enlargement of the tongue

• Unexplained weight gain

• Muscle aches, tenderness and stiffness

• Joint pain and stiffness

• Muscle weakness

• Excessive or prolonged menstrual bleeding

• Depression

• Memory lapses

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Source: Mayo Clinic

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When to see a doctor

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See your doctor if you develop these signs and symptoms:

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• Tiredness for no apparent reason

• Dry skin

• Pale, puffy face

• Constipation

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You'll also need to see your doctor for periodic testing of your thyroid function if:

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• You've had thyroid surgery

• You've had treatment with radioactive iodine or anti-thyroid medications

• You've had radiation therapy to your head, neck or upper chest

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If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause.

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And if you're receiving hormone therapy for hypothyroidism caused by Hashimoto's disease, schedule follow-up visits as often as your doctor recommends. It's important to make sure you're receiving the correct dose of medicine. Over time, the dose you need to adequately replace your thyroid function may change.

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Source: Mayo Clinic

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What causes Hashimoto's?

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Hashimoto's disease is an autoimmune disorder in which your immune system creates antibodies that damage your thyroid gland. Doctors don't know what causes your immune system to attack your thyroid gland. Some scientists think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved.

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A combination of factors — including heredity, sex and age — may determine your likelihood of developing the disorder.

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Source: Mayo Clinic

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Risk factors

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These factors may contribute to your risk of developing Hashimoto's disease:

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• Sex. Women are much more likely to get Hashimoto's disease.

• Age. Hashimoto's disease can occur at any age but more commonly occurs during middle age.

• Heredity. You're at higher risk for Hashimoto's disease if others in your family have thyroid or other autoimmune diseases.

• Other autoimmune disease. Having another autoimmune disease — such as rheumatoid arthritis, type 1 diabetes or lupus — increases your risk of developing Hashimoto's disease.

• Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto's disease.

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Source: Mayo Clinic

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Complications

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Left untreated, an underactive thyroid gland (hypothyroidism) caused by Hashimoto's disease can lead to a number of health problems:

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• Goiter.  Constant stimulation of your thyroid to release more hormones may cause the gland to become enlarged, a condition known as a goiter. Hypothyroidism is one of the most common causes of goiters. It's generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing.

• Heart problems.  Hashimoto's disease may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid gland (hypothyroidism). If left untreated, hypothyroidism can lead to an enlarged heart and, possibly, heart failure.

• Mental health issues.  Depression may occur early in Hashimoto's disease and may become more severe over time. Hashimoto's disease can also cause sexual desire (libido) to decrease in both men and women and can lead to slowed mental functioning.

• Myxedema.  This rare, life-threatening condition can develop due to long-term severe hypothyroidism as a result of untreated Hashimoto's disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.

• Birth defects.  Babies born to women with untreated hypothyroidism due to Hashimoto's disease may have a higher risk of birth defects than do babies born to healthy mothers. Doctors have long known that these children are more prone to intellectual and developmental problems. There may be a link between hypothyroid pregnancies and birth defects, such as a cleft palate.  A connection also exists between hypothyroid pregnancies and heart, brain and kidney problems in infants. If you're planning to get pregnant or if you're in early pregnancy, be sure to have your thyroid level checked.

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Source: Mayo Clinic

 

 

Diagnosis

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In general, your doctor may test for Hashimoto's disease if you're feeling increasingly tired or sluggish, have dry skin, constipation, and a hoarse voice, or have had previous thyroid problems or a goiter.

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Diagnosis of Hashimoto's disease is based on your signs and symptoms and the results of blood tests that measure levels of thyroid hormone and thyroid-stimulating hormone (TSH) produced in the pituitary gland. These may include:

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• A hormone test.  Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone is low. At the same time, the level of TSH is elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.

• An antibody test.  Because Hashimoto's disease is an autoimmune disorder, the cause involves production of abnormal antibodies. A blood test may confirm the presence of antibodies against thyroid peroxidase (TPO antibodies), an enzyme normally found in the thyroid gland that plays an important role in the production of thyroid hormones. But the TPO antibody test isn't positive in everyone with Hashimoto's thyroiditis. Many people have TPO antibodies present, but don't have a goiter, hypothyroidism or other problems.

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In the past, doctors weren't able to detect an underactive thyroid (hypothyroidism), the main indicator of Hashimoto's disease, until symptoms were fairly advanced. But by using the sensitive TSH test, doctors can diagnose thyroid disorders much earlier, often before you experience symptoms.

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Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism. These tests also help your doctor determine the right dosage of medication, both initially and over time.

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Source: Mayo Clinic

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Treatment

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Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life.

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Source: Mayo Clinic

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Synthetic Hormones

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If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others).

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Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism.

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Source: Mayo Clinic

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Monitoring the dosage

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To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after six to eight weeks of treatment and again after any dose changes. Once the dose that normalizes your thyroid tests is determined, your doctor is likely to check your TSH level about every 12 months as the dosage you need may change. Excessive amounts of thyroid hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine can also cause heart rhythm disorders (arrhythmias).

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If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.

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Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage.

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Also, don't skip doses or stop taking the drug. If you do, signs and symptoms will gradually return.

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Source: Mayo Clinic

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Effects of other substances

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Certain medications, supplements and some foods may affect your ability to absorb levothyroxine. However, taking levothyroxine four hours before or after other medications could remedy the problem. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or if you take any of the following:

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• Iron supplements, including multivitamins that contain iron

• Cholestyramine (Prevalite), a medication used to lower blood cholesterol levels

• Aluminum hydroxide, which is found in some antacids

• Sucralfate, an ulcer medication

• Calcium supplements

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Source: Mayo Clinic

 

Is a combination of hormones needed?

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Levothyroxine is the synthetic form of the natural T-4. T-4 is converted into T-3 in the body. While most people are treated successfully with levothyroxine alone, some people don't feel completely normal on levothyroxine.

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Researchers have investigated whether adjusting standard hypothyroidism treatment to replace some T-4 with small amounts of T-3 may offer benefit. But, the majority of studies have determined that the addition of T-3 does not offer any advantage over treatment with T-4 alone.

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There is some evidence that T-3 may offer benefit to certain subsets of people, such as people who have had their thyroid surgically removed (thyroidectomy). Research is ongoing.

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T-3 can be given alone as liothyronine (Cytomel) or in combination with T-4. Taking a combination T-4 and T-3 ends up producing higher than normal levels of T-3, especially soon after the medication is taken. This can cause a fast heart rate, anxiety and trouble sleeping.

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But, for those who haven't gotten enough relief from T-4 alone, adding liothyronine to standard levothyroxine treatment for a three- to six-month trial is a long enough period to see if the combination helps you.

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Source: Mayo Clinic

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Alternative medicine

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Standard treatment for Hashimoto's disease is levothyroxine, the synthetic form of thyroxine (T-4). However, extracts are available that contain thyroid hormone derived from the thyroid glands of pigs. These products — Armour Thyroid, for example — contain both levothyroxine and triiodothyronine (T-3).

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Doctors have a number of concerns about thyroid hormone extracts such as Armour Thyroid, including:

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• The balance of T-4 and T-3 in animals isn't the same as in humans.

• The exact amount of T-4 and T-3 in each batch of a natural extract product can vary, leading to unpredictable levels of these hormones in your blood.

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Source: Mayo Clinic

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Key points about Hashimoto’s thyroiditis

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• Hashimoto's thyroiditis can cause your thyroid to not make enough thyroid hormone.

• It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid.

• Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness.

• You don’t need treatment if your thyroid hormone levels are normal. If you have an underactive thyroid, medicine can help.

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Source: John Hopkins Medicine

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The Hashimoto's-Gluten Connection

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Hashimoto's is an organ-specific autoimmune disorder. The affected person's immune system directs its attack primarily at the thyroid gland. However, people with Hashimoto's have a similar genetic predisposition to those with celiac disease. This connection was established in a research study published in 2007 in the "World Journal of Gastroentorology" and has been repeatedly supported through further studies.

 

Patients with Hashimoto's should be screened for celiac disease and, early in the disease process, may benefit from following a gluten-free diet. Before adopting a gluten-free diet, you should be evaluated by your physician to establish the need for such a measure.

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Source: Healthfully.com

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