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 called chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States. It is an autoimmune disorder consisting of chronic inflammation of the thyroid. This disorder has a tendency to run in families. Over time, the ability of the thyroid gland to produce thyroid hormones often becomes impaired and results in a gradual decline in function and eventually 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 functioning as they should.

Symptoms

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

Since the condition typically progresses really slowly over many 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 leading to low thyroid hormone levels, individuals 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 lower exercise tolerance, and irregular or heavy menses. Sometimes, 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 may 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 might be diagnosed early, especially in people with a strong family history of thyroid disease. TPO antibodies may be positive, but thyroid hormone levels may be regular or there might only be an isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism may be absent.

Treatment

Individuals with elevated TPO antibodies but normal thyroid function tests (TSH and Free T4) do not require treatment. Patients with only a slightly elevated TSH (mild hypothyroidism) might 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 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 regular thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. Most people with Hashimoto's thyroiditis will require lifelong treatment with levothyroxine. Finding the proper dose, particularly at the beginning, may require testing with TSH every 6-8 weeks after any dose change until the right dose is determined. After that, monitoring of TSH once a year is usually sufficient.

When levothyroxine is taken in the proper dose, it has no side effects. However, when an insufficient 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 individuals may develop symptoms of hyperthyroidism or have other side effects.

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