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 disorder tends to run in families. With time, the ability of the thyroid gland to make thyroid hormones often becomes damaged and leads to a gradual decline in function and eventually an underactive thyroid (Hypothyroidism). Hashimoto's thyroiditis occurs most commonly 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 functioning as they should.

Symptoms

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

Because the condition typically progresses very slowly over several years, individuals with Hashimoto's thyroiditis may 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 resulting in low thyroid hormone levels, patients will eventually develop symptoms of hypothyroidism. Hypothyroid symptoms might consist of fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle aches and reduced exercise tolerance, and irregular or heavy menses. In some cases, the inflammation causes the thyroid to become enlarged (goiter), which seldom might cause neck discomfort 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.

Sometimes, the condition may be diagnosed early, particularly in people with a strong family history of thyroid disease. TPO antibodies may be positive, but thyroid hormone levels may be normal or there might only be isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism may be absent.

Treatment

Individuals with elevated TPO antibodies but regular thyroid function tests (TSH and Free T4) do not require treatment. Individuals with only a slightly elevated TSH (mild hypothyroidism) might not need medication and should have repeat testing after 3-6 months if this has not already been done. For individuals with overt hypothyroidism (elevated TSH and low thyroid hormone levels) treatment consists of thyroid hormone replacement. Synthetic levothyroxine taken orally at a suitable dose, is inexpensive, very effective in restoring normal thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. The majority of individuals with Hashimoto's thyroiditis will need lifelong treatment with levothyroxine. Identifying the proper dose, especially at the beginning, may require testing with TSH every 6-8 weeks after any dose change until the correct dose is identified. Afterward, monitoring of TSH once a year is usually enough.

When levothyroxine is taken in the appropriate dose, it has no side effects. However, when an inadequate dose is taken, serum TSH remains raised and individuals might have persistent symptoms of hypothyroidism. If the dose is excessive, serum TSH will become suppressed and individuals may develop symptoms of hyperthyroidism or have other side effects.

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