What is Hashimoto's Thyroiditis

The term "Thyroiditis" refers to "inflammation of the thyroid gland". There are many potential causes of thyroiditis. Hashimoto's thyroiditis, also referred to as 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 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 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 located 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 working as they should.

Symptoms

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

Because the disorder typically progresses really 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 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 aches and reduced exercise tolerance, and irregular or heavy menses. Sometimes, 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 patients 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 disease might be diagnosed early, especially in individuals with a strong family history of thyroid disease. TPO antibodies may be positive, but thyroid hormone levels may be normal or there might just be isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism might be missing.

Treatment

Individuals with elevated TPO antibodies but normal thyroid function tests (TSH and Free T4) do not need treatment. Patients with only 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 individuals with overt hypothyroidism (elevated TSH as well as low thyroid hormone levels) treatment consists of thyroid hormone replacement. Synthetic levothyroxine taken orally at a suitable dose, is affordable, very effective in restoring normal thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. Most patients with Hashimoto's thyroiditis will require lifelong treatment with levothyroxine. Identifying the proper dose, particularly at the beginning, may require testing with TSH every 6-8 weeks after any dose change, until the correct dose is identified. Afterwards, monitoring of TSH once a year is generally enough.

When levothyroxine is taken in the right dose, it has no side effects. However, when an inadequate dose is taken, serum TSH stays raised and patients may 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 San Marcos, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377