An overview of Hashimoto’s disease

To understand Hashimoto’s disease, you need to understand the thyroid.  The thyroid is a 2-inch long butterfly-shaped gland located in front of the neck below the larynx or voice box.  It is one of the glands making up the endocrine system which produces and stores hormones releasing them into the bloodstream when needed.  Hashimoto’s disease, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis, is a disorder affecting the thyroid gland and is the most common cause of hypothyroidism in the United States.  It was named after a pathologist who in 1912 described the microscopic features of the disease and it can result in a gradual loss of thyroid functioning. 

Symptoms

At first, there are no symptoms of Hashimoto’s disease.  Then as the disease slowly progresses, the thyroid enlarges and may cause the front of the neck to look swollen.  This enlargement is most likely the sign of a bulge called a goiter.  In the beginning, a goiter is painless but as they grow they can put pressure on the lower neck possibly interfering with breathing and swallowing.

Hashimoto’s disease may or may not develop hypothyroidism.  In people who do develop hypothyroidism, the symptoms may be mild at first while eventually presenting with the following symptoms:

·Fatigue

·Weight gain

·Cold intolerance

·Joint and muscle pain

·Constipation or fewer than three bowel movements a week

·Dry, thinning hair

·Heavy or irregular menstrual periods and problems getting pregnant

·Depression

·Memory problems

·A slowed heart rate

Who develops Hashimoto’s disease?

This disease is much more common in women than men usually appearing between 30 and 50 years of age and does tend to run in families. 

People with an autoimmune disease are more likely to develop Hashimoto’s disease at and the same time, a person with Hashimoto’s disease is more likely to develop other autoimmune diseases.  These include:

·Vitiligo – areas of the skin that lose color

·Rheumatoid arthritis – disease causing pain, swelling, stiffness and loss of function in the joints.

·Addison’s disease – damage to the adrenal glands

·Type 1 diabetes – the pancreas is damaged and no longer produces insulin

·Pernicious anemia – caused by low levels of vitamin B12.

·Celiac disease – where a person cannot tolerate gluten.

Complications of Hashimoto’s disease

The complications of this disorder are the same as those of an underactive thyroid gland:

·Goiter

·Cardiac complications – Increased risk of heart disease

·Psychiatric complications – depression or complaints of mental fogginess or slowing of reaction times and a reduction in sexual desire

·Myxedema coma – In the severest form of it, untreated hypothyroidism may result in a rare life-threatening condition called myxedema coma. This results in mental slowing, profound lethargy, and ultimately coma. 

Treatment

Usually Hashimoto’s disease, with or without hypothyroidism, will be treated with a thyroid hormone replacement therapy using synthetic thyroxine, which is man-made T4, such as Synthroid.  

Routine blood tests are done checking on synthetic thyroid hormone and adjusting the dose as necessary.  As long as a person takes their recommended dosage daily as instructed, the hypothyroidism can be controlled.

Women with Hashimoto’s disease should discuss their condition with their physician before becoming pregnant as uncontrolled hypothyroidism can increase the chance of miscarriage, premature birth, stillbirth, and preeclampsia which is a dangerous rise in blood pressure during pregnancy. 

If a pregnant woman’s hypothyroidism is untreated during pregnancy, this can affect the baby’s growth and development.   But as long as a woman is taking thyroid medications which are safe during pregnancy, this can be avoided.