Hashimoto's thyroid disease

Hashimoto's disease is a chronic inflammation of the thyroid gland caused by autoimmune diseases. As a result of the dysfunction of the immune system, antibodies against the thyroid gland are produced. The thyroid gland secretes less and less thyroxine and triiodothyronine - hormones responsible for e.g. for regulating metabolism. Hashimoto's disease is one of the most common causes of hypothyroidism.
You can also come across the term "lymphocytic thyroiditis" - it is associated with the presence of diffuse lymphocytic inflammatory infiltrates within the thyroid parenchyma. As the disease progresses, more and more extensive foci of fibrosis appear with the simultaneous atrophy of the thyroid parenchyma. This process is chronically progressive and takes years. It is worth noting that the thyroid gland in the course of Hashimoto's inflammation does not hurt. Hashimoto's disease, on the other hand, can cause symptoms related to a disturbed thyroid function. In the event of their occurrence, an endocrinologist should be consulted, who will carry out diagnostics, diagnose and propose appropriate treatment.

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Hashimoto's disease - symptoms

In the initial stage, Hashimoto's disease may not present the symptoms typical of hypothyroidism. Many patients first develop mild, transient hyperthyroidism, such as symptoms such as hyperactivity, excessive sweating, hot flushes, and palpitations. Short-term hyperthyroidism may result from the initial destruction of the parenchyma and an increased release of hormones from the damaged tissue.
This is followed by an asymptomatic period during which thyroid hormone levels remain normal.
In the following months, Hashimoto's syndrome progresses to typical hypothyroidism. The thyroid gland is gradually degraded - the follicular cells of the thyroid gland are atrophied. Deficiency of thyroxine and triiodothyronine results in the appearance of symptoms: constant fatigue, drowsiness, frequent depressive states, dry skin, feeling cold and weight gain. Due to slower bowel movements, a person with Hashimoto's syndrome may suffer from chronic constipation. Some patients develop the so-called mucoid swelling, most evident around the face. Women with Hashimoto's disease are more likely to report menstrual disorders.
The severity of the symptoms listed above depends on the degree of thyroid hormone deficiency and the duration of Hashimoto's disease. Long-term untreated hypothyroidism may result in infertility, the development of cardiovascular diseases, and in extreme cases may even lead to a life-threatening hypometabolic crisis.
In addition to global symptoms resulting from disturbances in thyroid hormone release, local symptoms related to changes in the volume of the thyroid gland may also be noticeable. The classic Hashimoto syndrome leads to an enlargement of the thyroid gland and the formation of the so-called will. The circumference of the neck increases. If a large goiter is pressed against adjacent structures, difficulty swallowing and a feeling of distension around the neck may appear. Hashimoto's thyroiditis can also take the form of atrophy - then no typical thyroid goiter is observed.

Hashimoto's thyroiditis - causes

Hashimoto's autoimmune disease can develop at any age, even in children. The highest percentage of cases is observed at the age of 45-65. Women get sick even 10-20 times more often than men, which may be related to the participation of estrogens in the pathogenesis of immune system disorders.
Hashimoto's thyroiditis may be genetic. If Hashimoto's disease is present in your family, anti-thyroid antibodies are found in the blood of family members.
The risk of developing Hashimoto's syndrome is higher in people with other autoimmune diseases (type I diabetes, Addison's disease adrenal cortex, systemic lupus erythematosus, Sjörgen's syndrome, rheumatoid arthritis).
Environmental factors also play a role. The risk of developing Hashimoto's thyroid disease is greater in people who have frequent viral infections and are treated with highly active antiviral drugs. The thyroid gland is also adversely affected by exposure to X-rays and therapy with radioactive iodine. Toxic compounds in cigarette smoke weaken the body's overall immune processes, increasing the risk of autoimmunity.

Hashimoto's disease in women after childbirth

Postpartum thyroiditis occurs in about 5-10% of women. The disease can take two forms:
1. Monophasic - when there is only temporary hyperthyroidism,
2. Classic - covering two phases:
◦ I - hyperthyroidism and euthyroidism (lasting about 1-2 months)
◦ II - hypothyroidism (lasting about 6 months).
Hypothyroidism associated with postpartum Hashimoto's disease lasts longer in one third of women and requires further treatment.
Postpartum Hashimoto's disease is caused by specific changes in the way the immune system works during pregnancy and after birth. In a pregnant woman, the immune system is controlled to protect the fetus from rejection (the baby is a source of "foreign" antigens from the father to the mother's body). The phenomenon of microchimerism, i.e. the penetration of fetal cells into the maternal circulation, may play a significant role in the development of postpartum Hashimoto's disease. Childbirth is a turning point in which the protective profile of the immune system is withdrawn. Then, the immune reaction against the cells of the fetus remaining in the mother's body is disinhibited, resulting in the initiation of autogression against thyroid antigens.
Having Hashimoto's disease after the first birth significantly increases the risk of developing Hashimoto's disease after having another baby. Women with diagnosed disturbances in the level of thyroid hormones should be under close supervision of an endocrinologist.
Hashimoto's syndrome diagnosis - necessary tests

Laboratory tests

1) The level of anti-thyroid antibodies:
• anti-TPO - antibodies directed against thyroid peroxidase (TPO). TPO is an enzyme that is involved in the synthesis of thyroid hormones.
• anti-TG - antibodies directed against thyroglobulin (TG). TG is a protein produced by thyroid follicular cells. On the way of further changes, thyroid hormones (triiodothyronine T3 and thyroxine T4) are formed from TG.
In the course of Hashimoto's disease, the level of anti-thyroid antibodies (anti-TPO and anti-TG) is increased.
2) Hormone levels:
◦ Thyroid stimulating hormone (TSH), produced by the pituitary gland and stimulating the secretion of thyroid hormones,
◦ Thyroxine T4,
◦ Triiodothyronine T3.
Typical for Hashimoto's syndrome is an increase in TSH levels and a decrease in the level of free thyroxine. In the advanced stage of the disease, the concentration of free triiodothyronine in the blood also decreases.

Ultrasound examination of the thyroid gland

The ultrasound image of the thyroid gland may vary depending on the severity of Hashimoto's inflammation. In the early stages of the disease, only the size of the gland is enlarged. In the next stages, the heterogeneity of the structure of the thyroid parenchyma with a decrease in its echogenicity can be noticed. There is also a fibrosis, the extent of which increases with the progression of the disease.

Thyroid scintigraphy

Scintigraphy is a complementary examination to the ultrasound of the thyroid gland. Iodine tracer uptake is heterogeneous in Hashimoto's disease. This fact is used in the differential diagnosis in the early stage of the disease, when hyperthyroidism is present - it allows to distinguish Hashimoto's syndrome from Graves-Basedow's disease.
Thyroid biopsy
If the ultrasound also shows the presence of nodules on the thyroid gland, your doctor may order a thyroid biopsy. The biopsy is performed under ultrasound guidance and involves taking a material for histopathological examination with a thin needle. In the course of Hashimoto's disease, there is a visible image of damaged epithelium, inflammatory lymphocytic infiltrates and fibroblast clusters. Hashimoto's disease increases the risk of thyroid cancer, so the appearance of a palpable lump in a person with Hashimoto's thyroiditis is an indication for extended diagnosis.

Hashimoto's disease - treatment

Pharmacotherapy is indicated in the case of symptomatic hypothyroidism and in the presence of elevated TSH levels with a reduced level of thyroxine. Compression symptoms resulting from excessive thyroid enlargement (goiter formation) may also be an indication for taking medications.
Drug treatment is based on the oral intake of levothyroxine tablets. Levothyroxine works in a similar way to thyroxine naturally synthesized in the body. Taking the drug prevents the secondary effects of thyroxine deficiency in the body. In young people, it is possible to reduce goiter after several months of treatment with levothyroxine. In the elderly, especially when the thyroid gland has numerous fibrosis, it is no longer possible to reduce the volume of the goiter.
Levothyroxine tablets should be taken on an empty stomach, at least half an hour before breakfast. The dose is always determined individually. In most cases, drug treatment must be carried out for life.
The use of immunosuppressants, e.g. glucocorticosteroids, is not recommended, mainly due to the low benefit-to-side-effects ratio. An exceptional situation is a hypometabolic crisis, which is life-threatening, when it is necessary to quickly stabilize the patient's clinical condition.

Hashimoto's disease - diet

People with autoimmune thyroid disease should pay close attention to their diet. The goal of the diet is to provide the necessary nutrients and compounds needed for the efficient synthesis of thyroid hormones. Due to the overweight often accompanying Hashimoto's disease, the caloric content of food should be monitored.
Hashimoto - substances desirable in the diet
People with Hashimoto's disease should ensure an adequate supply of:
1) Wholesome protein, because it is a building block of hormones (eggs, meat, sea fish),
2) Omega 3 fatty acids - stimulate the conversion of triiodothyronine into thyroxine (T3-> T4), omega 3 fatty acids also have anti-inflammatory effects (linseed oil, olives),
3) Vitamin D with anti-inflammatory properties (fish, oils, dietary supplements with vitamin D),
4) Iodine - iodine is a component of thyroid hormones (seafood, fish, iodized salt), it should also be emphasized that an excess of iodine can be as harmful to the thyroid as its deficiency,
5) Selenium - selenium is part of the enzymes influencing the thyroid hormone balance (shrimps, sardines, eggs, mushrooms).

Find out more - Hashimoto's diet.

Hashimoto's - what products should be limited?

Avoid excessive consumption of products containing goitrogenic substances. These substances bind to iodine and prevent it from attaching to particles of thyroid hormones. The products containing the goitreating substances include: green and black tea, soybeans, peanuts, red pepper, mustard.
Vegetables such as Brussels sprouts, cabbage, broccoli or spinach should be eaten cooked - this allows you to reduce the content of goitrogenic substances. You should not completely give up eating these vegetables as they are a valuable source of vitamins and minerals.
In the case of diagnosed intolerance to gluten or lactose, it is advisable to avoid products containing these substances.

FAQs:
1. How is Hashimoto's disease diagnosed?
Hashimoto's disease diagnosis includes:
• analysis of clinical symptoms (fatigue, dry skin, depression, slow heart rate, tendency to be overweight),
• imaging tests (ultrasound of the thyroid gland, possibly scintigraphy),
• laboratory tests (levels of TSH, thyroid hormones and anti-thyroid antibodies).
• in some cases, the doctor may decide to perform a thyroid biopsy followed by a histopathological analysis of the sample.
2. What is the treatment of Hashimoto's disease?
Treatment is undertaken in people with a deficiency of thyroid hormones shown in laboratory tests and in people with goiter causing oppressive symptoms. Treatment is symptomatic by taking drugs containing levothyroxine orally, which replaces the function of natural thyroxine.
3. What are the dietary recommendations for Hashimoto's disease?
The basis is a properly balanced diet, i.e. rich in substances that are the building blocks of hormones and compounds involved in the metabolism of thyroid hormones. Desirable ingredients in the diet of a person with Hashimoto's disease are: complete protein, omega-3 fatty acids, vitamin D, iodine, selenium. Avoid consuming highly processed products (cookies, sweets), which are high in calories and at the same time of poor nutritional value. It is also advisable to limit products rich in iodine-binding compounds, i.e. soybeans, tea (black and green), peanuts, mustard.