Hashimoto’s Thyroiditis

What is it?

Hashimoto’s disease is an autoimmune disease that affects the thyroid gland. It can be seen at any age even in childhood and affects more women (mainly around 30 to 50 years old ) than men as many autoimmune diseases. The presence of antithyroid antibodies which are detected in the blood may cause acute or chronic thyroiditis resulting in hypothyroidism (low production of thyroid hormones by the thyroid gland).

Which are the symptoms? 

Symptoms of hypothyroidism usually are fatigue, weight gain, constipation, increased sensitivity to cold, dry skin and even in some cases the thyroid becomes enlarged may cause difficulty swallowing called in a medical term a goitre.

Who can develop?

Patients must investigate if there is someone in your family with Hashimoto’s disease. But the onset can also happen due to elements in the environment. One of these elements is iodine. Mainly found in table salt and some can products as sausage-related, sea foods such as seaweed, fish and Japanese foods, snacks, pre-prepared soups and even bread or some medications, the iodine excess may lead to thyroid dysfunction.

How is the diagnosis made?

Blood tests to measure the thyroid hormones are vastly available. Tests to evaluate thyroid function include the following:

  • TSH test: a high TSH level indicates that the thyroid gland is not making enough thyroid hormone (it is called primary hypothyroidism). The opposite situation, in which the TSH level is low, usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism) and normal TSH value means that the thyroid is functioning properly.
  • T3 and T4 tests:  reflect how the thyroid gland is functioning and must be checked together with TSH.
  • Thyroid antibodies: two common antibodies are thyroid peroxidase antibody (anti – TPO) and thyroglobulin antibody (anti – TG). Detecting antibodies is useful for the initial diagnosis of Hashimoto’s autoimmune thyroiditis.

Some non- blood tests are also useful to analyse thyroid function and its appearance: 

– Radioactive iodine uptake help to determine is the gland is overactive or not. 

– Thyroid ultrasound to determine the appearance of the thyroid regarding the size, texture or nodules presence and categorised them for a necessity of fine needle aspiration. The most common ultrasound finding in Hashimoto’s disease is an enlarged thyroid with heterogeneous echotexture.

There are some medications that can contain estrogens, such as in birth control pills, or in pregnancy, causing high levels of total T4 and T3. In these situations, TSH test and free T4 test are needed. Biotin also can cause misreading in the measurement of several thyroid tests and should not be taken for 2 days before blood is drawn for thyroid function testing to avoid this effect.

Treatment 

Patients with elevated thyroid antibodies but normal thyroid function tests (TSH and free T4) do not require treatment. For patients with overt hypothyroidism: elevated TSH and low thyroid hormone, the treatment consists of thyroid replacement. Synthetic levothyroxine taken orally is effective and inexpensive. Most patients with Hashimoto’s will require lifelong treatment with levothyroxine and must monitor according to the symptoms usually every 4 months to adjust the therapy if needed.

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