Everything you need to know about Hashimoto’s disease

The autoimmune condition of Hashimoto’s disease is the most common cause of hypothyroidism or of having an underactive thyroid.  This disease that primarily affects women (7 times more common in women than men) is also known by the names of Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis or simply chronic thyroiditis.  The disease can develop in girls in their teens or as young women but is more likely to show up in middle age.

Causes of Hashimoto’s disease

There is no known cause of this disease but what has happened is that antibodies in a person’s body have attacked the cells of the thyroid.  The thyroid is a small gland in the front of the neck and makes hormones called T3 and T4 helping regulate how the body uses energy.  The pituitary, a pea-size gland in the brain, controls the levels of thyroid hormones by making thyroid stimulating hormone (TSH) that tells the thyroid gland to make thyroid hormones.

In a person with Hashimoto’s disease, the antibodies made by the immune system damage the cells of the thyroid interfering with their ability to make thyroid hormones.  Eventually, the damage done to the thyroid can lead to low levels of thyroid hormone resulting in an underactive thyroid or what is known as hypothyroidism.  When this happens, every function of the body slows down from a person’s heart rate, brain function, and the amount of calories burned by the body for energy.

Certain factors that may have a part in the development of Hashimoto’s disease include:

·      Genes

·      Gender

·      Pregnancy

·      Too much of the mineral iodine

·      Radiation exposure

Symptoms

It can be years before a person may be diagnosed with Hashimoto’s disease.  The first sign is usually an enlarged thyroid called a goiter.  A goiter is not painful but may appear at the front of the neck, possibly making the neck look swollen and causing a feeling of fullness in the throat or making it hard to swallow. 

Symptoms of Hashimoto’s disease generally worsen over time with the symptoms being similar to hypothyroidism which can include:

·      Weight gain

·      Fatigue

·      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

People with Hashimoto’s disease are also at risk of having other autoimmune disorders such as:

·      Vitiligo – long-term skin condition characterized by patches of skin losing their color

·      Rheumatoid arthritis – an autoimmune disease causing chronic inflammation of the lining of the joints in the body

·      Addison’s disease – endocrine disorder where the adrenal glands do not produce enough steroid hormones

·      Type 1 diabetes – a form of diabetes in which there is a lack of insulin produced causing blood sugar levels to remain high

·      Grave’s disease – an autoimmune disease that is the most common cause of hyperthyroidism

·      Pernicious anemia – This is a vitamin B12 anemia in which the body cannot make enough healthy red blood cells due to lack of vitamin B12

·      Lupus – an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body

Diagnosing Hashimoto’s disease

To diagnose Hashimoto’s disease, a doctor such as an endocrinologist, will do a clinical exam looking for an enlargement of the thyroid or the presence of a goiter along with tests.  The tests include:

·      Thyroid function tests - These tests are used to check on TSH and T4 hormone levels.  If the level of TSH is high, this is a sign of an underactive thyroid.  As the thyroid becomes more damaged, the T4 levels will drop below normal.

·      Antibody test - A blood sample will be taken to look for antibodies suggesting Hashimoto’s disease. 

Treating Hashimoto’s disease

The good news with this disease is it does respond well to treatment.  The treatment is for the person to take one pill every day for the rest of their life of levothyroxine, a manmade form of T4 thyroid hormone.  It is also known as thyroid replacement therapy as it will restore back to normal the T4 that the damaged thyroid no longer makes. 

Once a person with Hashimoto’s disease begins taking levothyroxine, it can take several months for symptoms to go away and a goiter to shrink as the thyroid hormones can take a long time to respond.  During this time, a person will need follow-up visits with their doctor checking on their TSH levels and doing any fine tuning of a person’s medication dosage.

The follow-up visits can be reduced to once a year once the TSH level is normal.  Generally, most people will still need a thyroid checkup and TSH test done yearly to check on any adjustments needed for the levothyroxine dosage.

What happens if Hashimoto’s disease is not treated?

There can be complications if Hashimoto’s disease is not treated which can include:

·      Heart problems including heart failure

·      High cholesterol

·      Decreased libido

·      Depression

For women who are pregnant and have Hashimoto’s disease, they are more likely to give birth to babies with heart, brain, and kidney defects.