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Thyroid Guide


Hashimoto's thyroiditis

  Hashimoto's thyroiditis

General Overview
The thyroid is a small butterfly-shaped gland, which rests in the lower neck. Its main function is to control your body's growth and metabolism. To control metabolism, your thyroid gland produces hormones (thyroxine [T4] and triiodothyronine [T3]). A properly functioning thyroid will produce the right amount of hormones required to keep your body functioning normally. The levels of thyroid hormones in the blood are controlled by your pituitary gland. Hashimoto's thyroiditis is the commonest form of thyroiditis. Hashimoto's thyroiditis is an inherited condition, which is more common in women than in men, where the body's own T-cells attack the cells of the thyroid.
Inflammation of the thyroid gland usually occurs in this condition resulting in hypothyroidism (underactive thyroid). It is also called autoimmune or chronic lymphocytic thyroiditis. It can occur in people with a family history of thyroid diseases or with other types of autoimmune disorders like type 1 diabetes. Countrywide studies in India have shown that the prevalence of autoimmune thyroiditis is 7.5% in female students with goiter.
Introduction
What is Hashimoto's thyroiditis?
Hashimoto's thyroiditis is a type of autoimmune disease in which antibodies are produced by your immune system (body's defense system) against your own thyroid gland reducing its ability to make thyroid hormone. Hypothyroidism develops, if the thyroid hormone produced is insufficient to meet your body's needs. In some persons, there is an increase in the size of the thyroid gland forming a goiter. The thyroid helps to set the rate of metabolism, which is the rate at which the body uses energy. Hashimoto's thyroiditis stops the gland from making enough thyroid hormones for the body to work the way it should. Hashimoto's thyroiditis often occurs in adulthood and is 5 to 10 times more frequently seen in women than in men. Hashimoto's thyroiditis often occurs with other autoimmune disorders and can sometimes develop into thyroid cancer.
Signs and Symptoms
What are the symptoms of Hashimoto's thyroiditis?
Symptoms of Hashimoto's thyroiditis are usually subtle and similar to those who have hypothyroidism. As your condition worsens, the symptoms will generally become more obvious. Common symptoms include:
  • Fatigue.
  • Weight gain.
  • Cold intolerance.
  • Depression.
  • Excessive sleepiness.
  • Constipation.
  • Dry, coarse hair.
  • Dry skin.
  • Increased levels of cholesterol.
  • Decreased concentration.
  • Muscle cramps.
  • Swelling of the legs.
Other symptoms and signs include:
  • Swelling of the thyroid gland.
  • Feeling of tightness or fullness in the throat.
  • A lump in the front of the neck.
  • Difficultly in swallowing solids and/or liquids.
Causes
What causes Hashimoto's thyroiditis?
Hashimoto's thyroiditis occurs due to inflammation of the thyroid gland due to an autoimmune process. The exact cause of this process is unknown. Your immune system attacks the thyroid gland treating it as a foreign tissue. Antibodies are produced against an enzyme called thyroid peroxidase, which is found in the thyroid gland. Thyroid tissue gets destroyed due to the interaction between the enzyme and antibodies by reducing the production of thyroid hormone causing hypothyroidism.
Risk Factors
Find out if you are at risk of developing Hashimoto's thyroiditis
Your risk of developing Hashimoto's thyroiditis depends on many factors that are mentioned below.
Smoking:
Smoking increases the risk of developing thyroid disease significantly, especially autoimmune Hashimoto's thyroiditis.
Genetics:
Certain genetic features appear to play a role in Hashimoto's thyroiditis.
Autoimmune diseases:
History of other autoimmune diseases, such as pernicious anemia, type 1 diabetes, underactive adrenal or parathyroid glands, rheumatoid arthritis, and lupus increases your risk of developing Hashimoto's thyroiditis.
Diagnosis and Screening
Your doctor will diagnose Hashimoto's disease based on the symptoms, history, and physical examination. He may also advise you to undertake certain tests to confirm the diagnosis.
To evaluate, whether you have autoimmune thyroiditis, your doctor will ask you for a detailed medical and family history, along with a physical examination.
Medical and family history:
Your doctor will question you about:
  • Family history of thyroid disease.
  • The presence of any symptoms that you are having or have experienced earlier.
  • Any thyroid surgery or any radiation treatment on your neck.
  • Medicines that you are currently taking or have taken earlier that could trigger the condition.
Physical examination:
Your doctor will conduct a thorough physical examination, during which he will:
  • Check your weight.
  • Check your blood pressure.
  • Check your thyroid gland to determine size, nodularity, and vascularity.
  • Look for changes in your skin and hair.
  • Check your pulse to calculate the rate at which your heart is beating.
  • Check your reflexes for any signs of change.
  • Check your eyes.
How will my doctor diagnose Hashimoto's thyroiditis?
Your doctor will recommend certain diagnostic tests. Thyroid disorders can be confidently diagnosed with the availability of ultrasensitive, third-generation thyroid-stimulating hormone (TSH) assays.
Blood tests:
For diagnosing Hashimoto's thyroiditis, your doctor will advise certain blood tests to measure the hormone levels.
Thyroid-stimulating hormone (TSH) test: Thyroid-stimulating hormone is a hormone produced by the pituitary gland, which regulates the production and release of the hormones T4 and T3 from the thyroid gland. During this test, the blood is collected from a vein, usually from the inside of your elbow or the back of your hand. As some drugs can alter the results, your doctor may advise you to stop them before the test. Your normal TSH levels will range between 0.4 mIU/L to 4.0 mIU/L. If you are undergoing treatment for any thyroid disorder, your TSH level should lie in the range of 0.5 mIU/L to 3.0 mIU/L. A normal TSH level indicates normal pituitary function. Increased TSH level is usually diagnostic of hypothyroidism.
Free thyroxine (T4) test: This test is done to determine, if your thyroid gland is functioning properly. It is the active thyroid hormone circulating in your blood. Thyroxine is a hormone produced by the thyroid gland, which is markedly decreased in hypothyroidism. During this test, your blood is collected from a vein, usually from the inside of your elbow or the back of your hand. As some drugs can alter the results, your doctor may advise you to stop them before the test. Your normal T4 levels will range between 4.5 mcg/dL to 11.2 mcg/dL.
Triiodothyronine (T3) test: Triiodothyronine is a hormone produced by the thyroid gland. During this test, your blood is collected from a vein, usually from the inside of your elbow or the back of your hand. As some drugs can alter the results, your doctor may advise you to stop them before the test. Your normal T3 levels will range between 100 ng/dL to 200 ng/dL. The level of T3 is usually low or normal in hypothyroidism.
Antithyroid antibodies: Your doctor may recommend this test to follow-up the other thyroid test results (T4, T3, and/or TSH) that show signs of thyroid dysfunction and/or for investigating the cause of goiter (enlarged thyroid gland). During this test, the blood is collected from a vein, usually from the inside of your elbow or the back of your hand. There is no standard reference range for this test. Presence of thyroid antibodies indicates that you have an autoimmune thyroid disease. Increasing antibody level rather than stable level is more significant. This is the most specific test where an increase in antithyroid antibodies provides the evidence of Hashimoto's thyroiditis. However, these antibodies are not always present in all cases of autoimmune thyroiditis. The antithyroid antibodies include antithyroid peroxidase and antithyroglobulin antibody.
Antithyroid peroxidase (anti-TPO) antibody test: This test detects the presence of antibodies against an enzyme found in the thyroid gland called peroxidase. Antithyroglobulin antibody is a test, which measures the antibodies against a protein found in thyroid cells called thyroglobulin.
Imaging studies:
These tests are generally not needed for diagnosing Hashimoto's thyroiditis. An ultrasound examination may show an enlarged gland with normal texture or a suggestion of multiple ill-defined nodules.
Fine needle aspiration biopsy:
Your doctor may sometimes recommend this test, which is a useful procedure but not very often required.
Treatment
Your doctor will decide on the treatment for Hashimoto's thyroiditis depending on your age, medical history, extent of the disease, overall health, and your tolerance for specific medications or therapies. There is no specific treatment available for Hashimoto's thyroiditis. As it usually results in hypothyroidism, thyroid hormone replacement therapy (the administration of thyroid hormone) is recommended. Your doctor will monitor your condition and adjust the dose of your medicines from time to time. You may require treatment throughout your life.
Self Care and Lifestyle Change
If you know that you have Hashimoto's thyroiditis, stay on your medication as directed by your physician and follow up with him or her for regular thyroid blood tests, which will help you to optimize your treatment.
Your doctor might advise certain changes in your diet such as:
  • High fiber diet to help reduce constipation.
  • Low fat low calorie diet, if you are overweight.
He will also recommend regular screening for other autoimmune conditions, such as pernicious anemia, diabetes, vitiligo, and premature ovarian failure that can coexist with Hashimoto's thyroiditis. Monitoring of these conditions is essential.
References