Definition and Overview
Hashimoto’s disease, which is also called Hashimoto’s thyroiditis, is an autoimmune disorder that affects the thyroid glands.
The thyroid glands are a significant part of the body’s endocrine system. Located within the trachea (windpipe) and just below the voice box (larynx), the glands are divided into two sections: right and left. Together, they look like a butterfly with spread wings and weigh no more than an ounce. Both of these lobes are connected through the isthmus.
The glands secrete thyroid hormones, namely, triiodothyronine (T3) and thyroxine (T4). The latter is a prohormone, which is inactive and does not have a significant effect on the body. T3, on the other hand, has a huge role in the body’s metabolism, a term to describe a variety of processes that are essential to human life, including the consumption of oxygen and its use to generate cellular energy.
These hormones are introduced into the bloodstream, but governing both is the pituitary gland, which produces thyroid-stimulating hormone (TSH).
On the other hand, the body has an immune system, which is meant to prevent pathogens and other forms of threat from damaging the body. The white blood cells develop antibodies and actively attack the infection, eventually killing it.
For some reason, however, the body develops autoimmunity of the thyroid. When this happens, the immune system attacks and damages the thyroid glands until they produce significantly less hormones, a condition known as hypothyroidism. When the thyroid glands become underactive, different complications may arise.
For one, the person can develop a goiter or the enlargement of the gland as the thyroid is forced to produce more hormones to compensate for the small production. Pregnant women who have been diagnosed with the disease may suffer from stillbirths, miscarriages, and birth defects. In some cases, the condition can cause a fatal problem known as myxedema, a form of severe hypothyroidism. One of its distinct symptoms is low tolerance to cold, coupled with confusion and breathing difficulty.
Causes of Condition
Although it is already known that Hashimoto’s disease is an autoimmune disorder, it remains unclear how it develops. Experts are yet to establish the exact cause of the problem other than the theory that it may be triggered by an infection caused by any of the pathogens such as bacteria and viruses.
Nevertheless, there are risk factors. While men can develop the disease, it is at least four times more common among women. Further, age is a risk factor. It is often seen in middle-aged people, perhaps because it takes months or even years for the disease to be diagnosed. In some cases, the disease is familial, which means the patient has a direct family member or a close relative that also suffers the same condition.
Those with Hashimoto’s disease are also predisposed to other types of autoimmune illnesses, including but not limited to lupus and type 1 diabetes (also called juvenile diabetes). They also often develop fungal infections in their nails.
One of the common characteristics of the disease is the increased presence of certain proteins in the thyroid glands. These are called thyroglobulin and thyroperoxidase. Both of these can be determined through an antibody test.
A person who has been diagnosed with vitiligo, celiac disease, and pernicious anemia (where there is a very low level of vitamin B12) are also at a higher risk of developing the disease.
Some of the most common signs and symptoms of Hashimoto’s disease are:
- Slow heart rate
- Memory loss
- Brain fog
- Muscle pain
- Painful joints
- Intolerance to cold
- Weight gain
- Poor bowel movement
- Irregular periods
- Mood disorders such as depression
- Elevated levels of blood cholesterol
The damage to the thyroid glands can be very subtle that it may take a long time before the problem is discovered. In fact, more often than not, by the time it is diagnosed, the thyroid glands are already producing substantially less hormones, which make the symptoms more prominent.
Meanwhile, hypothyroidism is one of the outcomes of Hashimoto’s disease, but being diagnosed with the former doesn’t have to mean you’ll also develop an underactive thyroid.
Who to See & Types of Treatment Available
Usually, the immunologist handles autoimmune issues. However, since Hashimoto’s disease also affects the production of hormones, an endocrinologist can also diagnose it. The best possible scenario is when these two experts collaborate to diagnose and treat the condition.
Different kinds of tests are performed to assess and diagnose the condition. It begins with physical exam, checking for weight gain or signs of obesity, heart rate, and dry skin. The doctor would also obtain the patient’s medical and family history records.
If the doctor suspects a possible thyroid disorder, tests such as hormone and antibody will be requested. The hormone test aims to measure the level of particular hormones in the bloodstream, the range of which can differ depending on the lab. The antibody test, meanwhile, will reveal abnormal antibodies present in the thyroid glands.
If necessary, imaging examinations are carried out. A CT scan can be used to assess the extent of the goiter. An ultrasound, meanwhile, may detect the presence and coverage of the inflammation, which is a common trait of an autoimmune disease. With Hashimoto’s disease, the glands can be inflamed without causing any redness or tenderness in the area.
Once the patient has been diagnosed with Hashimoto’s disease, the most appropriate treatment program is carefully planned. First, the doctor assesses the severity of the condition. Usually, early-onset detection means a wait-and-see approach, with the doctor closely monitoring the progression of the disease.
If the production of the hormones is already significantly low, synthetic hormones can be given as part of hormone replacement therapy. The more preferred is synthetic T4 since it stays in the bloodstream for a much longer period. However, since the body needs to continuously maintain the right balance of hormones, the dosage should be regularly adjusted.
If the patient has a goiter, it is remedied only when it is already affecting the body’s normal functions and aggravating the symptoms. Often, the common treatment is hormone replacement. But sometimes thyroidectomy (removal of the thyroid gland) is performed.
- FamilyDoctor.org: "Hashimoto's Disease."
- Cedars-Sinai Medical Center: "Hashimoto's Thyroiditis."
- WomensHealth.gov: "Hashimoto's Disease: Frequently Asked Questions."
- Oregon State University Linus Pauling Institute: "Iodine."
- University of Maryland Medical Center: "Endocrinology Health Guide: Hashimoto's Thyroiditis."