Hashimoto Disease – Diagnosis & Treatment

Hashimoto disease, or commonly known as Hashimoto’s thyroiditis, is the most common autoimmune thyroid disorder and leading cause of hypothyroidism. In this condition, the immune system attacks an individual’s thyroid tissue resulting in a depletion of thyroid hormones. The thyroid hormone is responsible for many physiological systems within the body and how the body utilizes energy. The thyroid plays a role in nearly every organ system in the body. This makes it extremely problematic if the thyroid is not functioning properly, which is the circumstance in Hashimoto disease. When a patient suffers from hypothyroidism, many organ systems within the body slow down which can have a significant effect on a patient’s quality of life.1

The incidence of Hashimoto disease is estimated to be 0.8 cases per 1,000 population per year in men and 3.5 cases per 1,000 population per year in women. The female-to-male ratio is roughly 10:1.2 It usually affects people aged 40 to 60 years old but has the possibility of occurring at any age. Besides gender, a person is at increased risk if other family members have the disease as well. Other factors that put an individual at increased risk of developing Hashimoto disease are if other autoimmune disorders coexist within an individual, such as Sjogren’s syndrome, type 1 diabetes mellitus, celiac disease, autoimmune hepatitis, pernicious anemia, lupus, rheumatoid arthritis, Addison’s disease, or vitiligo. One of the most common complications due to the disorder is hypercholesterolemia that can lead to heart disease. In severe cases, this disease can lead to myxedema coma, which is when the function of organ systems within the body become severely decreased. This condition is considered life-threatening and requires immediate medical treatment.1

Clinical Presentation

 Most patients with Hashimoto disease are asymptomatic initially. The disease usually has a slow onset and the first sign hinting of Hashimoto’s disease is a diffuse, symmetric enlargement of the thyroid. Patients may also present with hyperthyroidism initially due to destruction of thyroid tissue causing an increase in the release of thyroid hormone into the bloodstream. Evidence of hypothyroidism occurs when enough damage has been caused by the antibody response and starts to alter normal physiology of the body. Possible symptoms include fatigue, brittle nails, constipation, bradycardia, hypersensitivity to the cold, hair loss, weight gain, depression, memory alterations, tongue enlargement, muscle aches and weakness, and a puffy face. These symptoms usually do not occur abruptly or at the same time. As mentioned before, this disease slowly progresses, sometimes over years, and as more thyroid cells are destroyed more symptoms start to surface. If left untreated, the most common complications from the disease are goiter, heart issues, mental health issues, myxedema, and birth defects in pregnant females.1

Hashimoto’s disease has an autoimmune etiology that results from complex interactions between environment and genetic factors. Abnormalities in certain genes can influence the development of the disease, such as IL2RA, human leukocyte antigen (HLA), PTPN22, CTLA4, FCRL3, TSH receptor (TSH-R), HLA class I, FOXE1, GDCG4p14 and RNASET2 expressed on CD4+ and CD8+ cells, as well as BACH2 that is expressed during the maturation of B-cells. Many of these known susceptibility genes play a role in T cells; underlining the importance of T cells in the development of Hashimoto’s disease. Although much progress has been made over the years, how and why this disease ultimately develops in an individual is still not completely certain.3

Diagnosis

 Symptoms of hypothyroidism are not simple enough to have confirmatory diagnosis due to an overlap with common manifestations of aging and other disease states. The diagnosis of Hashimoto’s disease first starts with a medical history and physical exam of the patient. Blood tests are also common in the diagnosis of disease in order to confirm the presence of hypothyroidism. Patients with Hashimoto’s disease-associated hypothyroidism have antithyroid antibodies, particularly thyroperoxidase (TPO), which is nearly present in all individuals with Hashimoto’s disease. In the minimal amount of cases where antithyroid antibodies are not present in a patient’s blood, imaging tests are utilized to confirm the diagnosis. A thyroid ultrasound evaluates the size of the thyroid, as well as certain features associated with Hashimoto’s disease. This allows providers to further differentiate and rule out other causes of an enlarged thyroid gland.1,3

Treatment

 The mainstay for the treatment of Hashimoto’s disease is consistent replacement of the thyroid hormone. In some individuals, however, treatment may not be indicated. This decision is based on the extent of damage to the thyroid gland. If evidence of hypothyroidism is not present, providers may only monitor the progression of the disease and wait until symptoms start to surface. If treatment is warranted, the preferred treatment is levothyroxine. This is a thyroid hormone medication that is extremely similar to the hormone the thyroid usually makes. This medication is usually taken every day, specifically in the morning on an empty stomach, and is very effective in controlling a patient’s hypothyroidism. Concomitant use of iron or calcium supplements, aluminum hydroxide, and proton pump inhibitors is not advised due to these medications altering the absorption of levothyroxine. Blood tests are taken often (every 6-8 weeks) at the beginning of treatment in order to determine the most effective dose of the medication and to ensure hormone levels in the bloodstream are within range. When the most optimal dose is figured, blood tests may be pushed back to every 6 months or once a year.If you are looking for treatment for hashimoto’s disease, then you can ask doctor online by visiting our website: https://justhealthexperts.com/  .

You can also prefer thyroid support supplement to treat hashimoto’s disease. To learn more about thyroid support supplement, kindly visit this link: Thyroid system overview 

Non-Pharmacological Approach

 Currently, there is no proven non-pharmacological approach that can directly alter the disease itself. Rather, there are tips that could potentially help with the management of the symptoms of hypothyroidism. First, an individual’s diet should focus on vegetables, fruits, whole grains, lean protein, and healthy fats. A diet rich in these components may aid in the lowering of high cholesterol and weight gain caused by the disease. Second, is to have a sufficient exercise plan. Regular exercise can help boost energy, help maintain a healthy weight, and decrease unwanted stress. Thirdly, get an appropriate amount of sleep. Hypothyroidism is known to cause fatigue and make individuals feel sluggish. Lastly, take your medication in the morning and on an empty stomach. This will help boost the thyroid function whenever it is most needed, and will help the medication be more readily absorbed. Although levothyroxine is the mainstay of treatment, following these additional tips may help further alleviate symptoms related to Hashimoto’s disease. 

References 

  1. Hashimoto’s Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease#:~:text=Hashimoto’s disease is an autoimmune,the front of your neck. Published September 1, 2017. Accessed June 8, 2020.
  2. Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2020 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
  3. Ragusa F, Fallahi P, Elia G, et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019;33(6):101367. doi:10.1016/j.beem.2019.101367

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