What is Hashimoto's Thyroiditis?

The term "Thyroiditis" refers to "inflammation of the thyroid gland". There are many possible causes of thyroiditis. Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is the most prevalent cause of hypothyroidism in the United States. It is an autoimmune disorder consisting of chronic inflammation of the thyroid. This condition tends to run in families. Over time, the ability of the thyroid gland to make thyroid hormones often becomes impaired and leads to a gradual decline in function and ultimately an underactive thyroid (Hypothyroidism). Hashimoto's thyroiditis occurs most frequently in middle-aged women, but can be seen at any age, and can also affect men and children.

The thyroid gland is a butterfly-shaped endocrine gland that is normally found in the lower front of the neck. The thyroid's job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm, and keep the brain, heart, muscles, and other organs working as they should.

Symptoms

There are no signs or symptoms that are unique to Hashimoto's thyroiditis.

Since the condition usually progresses really slowly over several years, people with Hashimoto's thyroiditis might not have any symptoms early on, even when the characteristic thyroid peroxidase (TPO) antibodies are found in blood tests. TPO is an enzyme that plays a role in the production of thyroid hormones. If Hashimoto's thyroiditis causes cell damage leading to low thyroid hormone levels, individuals will eventually develop symptoms of hypothyroidism. Hypothyroid symptoms might include fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle pains and reduced exercise tolerance, and irregular or heavy menses. In some cases, the inflammation causes the thyroid to become enlarged (goiter), which rarely might cause neck pain or difficulty swallowing.

Diagnosis

The diagnosis of Hashimoto's thyroiditis might be made when individuals present with symptoms of hypothyroidism, often accompanied by a goiter (an enlarged thyroid gland) on physical examination, and laboratory testing of hypothyroidism, which is an elevated thyroid stimulating hormone (TSH) with or without a low thyroid hormone (Free thyroxine [Free T4] levels. TPO antibodies, when measured, are usually elevated.

Occasionally, the disease might be diagnosed early, particularly in people with a strong family history of thyroid disease. TPO antibodies might be positive, yet thyroid hormone levels may be regular or there may just be an isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism might be missing.

Treatment

Patients with elevated TPO antibodies but regular thyroid function tests (TSH and Free T4) do not require treatment. Patients with just a slightly elevated TSH (mild hypothyroidism) may not require medication and should have repeat testing after 3-6 months if this has not already been done. For patients with overt hypothyroidism (elevated TSH as well as low thyroid hormone levels) treatment consists of thyroid hormone replacement. Synthetic levothyroxine taken by mouth at a suitable dose is affordable, very effective in restoring regular thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. The majority of patients with Hashimoto's thyroiditis will need lifelong treatment with levothyroxine. Finding the appropriate dose, especially at the beginning, might require testing with TSH every 6-8 weeks after any dose adjustment until the proper dose is identified. Afterward, monitoring of TSH once a year is generally sufficient.

When levothyroxine is taken in the proper dose, it has no side effects. However, when an inadequate dose is taken, serum TSH stays elevated and individuals may have persistent symptoms of hypothyroidism. If the dose is too much, serum TSH will become suppressed and patients may develop symptoms of hyperthyroidism or have other side effects.

For further information about Dr. Stengler’s practice and his clinic in Carlsbad, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377