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 condition has a tendency to run in families. Over time, the ability of the thyroid gland to produce thyroid hormones often becomes damaged and results in a gradual decline in function and ultimately an underactive thyroid (Hypothyroidism). Hashimoto's thyroiditis occurs most often in middle-aged women, but can be seen at any age, and can also affect men and kids.
The thyroid gland is a butterfly-shaped endocrine gland that is usually 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 various other organs functioning as they should.
Symptoms
There are no signs or symptoms that are unique to Hashimoto's thyroiditis.
Because the condition usually progresses very slowly over many years, people with Hashimoto's thyroiditis might not have any symptoms early on, even when the characteristic thyroid peroxidase (TPO) antibodies are detected 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 include 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 seldom may 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.
Occasionally, the disease may 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 normal or there may just be an isolated mild elevation of serum TSH seen. Symptoms of hypothyroidism may be missing.
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) may not need 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 normal thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. Most people 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 change until the right dose is determined. 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 insufficient dose is taken, serum TSH stays elevated and individuals might 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.
