Hashimoto's Disease (Hashimoto's Thyroiditis)
What is Hashimoto's Disease (Hashimoto's Thyroiditis)?
Hashimoto's disease (Hashimoto's Thyroiditis) is the most common type of thyroid gland inflammation, i.e. thyroiditis, and is also called Autoimmune Thyroiditis or Chronic Lymphocytic Thyroiditis. Hashimoto's disease is currently a common thyroid disease. It is an endocrine system disease caused by a disorder of the immune system.
Hashimoto's disease was described by the Japanese scientist Akira Hashimoto in 1912 and is also known as Japanese Thyroid among the people.
The disease, which especially affects women in the middle age group, can be currently seen in everyone, regardless of age group and gender.
What is the Thyroid Gland? How Does a Thyroid Gland Function?
Thyroid gland is a butterfly-like endocrine gland located just below the neck, and it secretes thyroid hormone. Thyroid hormone plays an important role in maintaining the body's energy balance, regulating body temperature, and healthy functioning of organs such as muscles, brain and heart.
Thyroid is originally a Latin word and means shield. The thyroid gland continues to work under the control of the hypothalamus and pituitary gland, which are the upper centers in the brain. The hormones it synthesizes have a stimulating effect on the metabolism of all body cells.
How Does the Thyroid Gland Function?
Commands transmitted from the pituitary gland in the brain are conveyed to the thyroid gland via the TSH hormone secreted by the pituitary gland. The thyroid gland uses iodine from the food we eat to make two main hormones. After TSH hormone is transmitted to the thyroid gland by blood, Triiodothyronine (T3) and Thyroxine (T4) hormones begin to be secreted.
Thyroid hormones play an important role in the correct functioning of metabolism, as well as in strengthening the immune system. The hormones secreted by the thyroid gland also play a major role in the heart rate, the body's heat balance, and the conversion of food into the energy the body needs.
The thyroid gland balances the baby's brain and intelligence development before and immediately after birth. It also plays an important role in the progression of the normal growth process of children. In absolute deficiency of thyroid hormone, growth stops completely. The organ that regulates the fat, glucose and protein mechanism of adults is the thyroid gland.
The biggest obstacle to the general functioning of the thyroid gland is not getting enough iodine. Despite the absence of iodine deficiency, the most common cause of the thyroid gland not functioning fully is Hashimoto's disease.
Various disorders can occur when the thyroid gland produces too much hormone (hyperthyroidism) or when there is not enough hormone production (hypothyroidism). Hashimoto's disease is one of the 4 common thyroid gland diseases (Hashimoto's disease, Graves disease, Goiter and thyroid nodules).
What Are the Symptoms of Hashimoto's Disease?
Hashimoto's thyroiditis is a disease that progresses slowly and causes chronic thyroid damage. Since the symptoms of the disease appear over time, patients with Hashimoto's Thyroiditis may not have any complaints in the early period.
During the course of the disease, there are periods when the thyroid gland functions normally, excessively or insufficiently. During these periods, different symptoms occur due to the nature of the disease, and even the first stages of the disease can be passed without any obvious findings. By the time the disease is noticed, in most cases, the thyroid gland is damaged to some extent.
For these reasons, there is no clinical finding of Hashimoto's disease and the symptoms seen are not specific to the disease. In cases where there is an imbalance in hormone levels and a decrease in the quality of life, patients should consult a physician.
The most common symptoms of the disease can be listed as follows:
Generally,
- Weight gain,
- Constipation,
- Voice change,
- Fatigue,
- Easily chill,
- Skin dehydration
are common symptoms. However, since these symptoms are seen in many diseases, the diagnosis of the disease is difficult. In addition to these symptoms;
- Menstrual irregularities
- Enlargement of tongue
- Nervosity
- Absence of sexual appetite,
- Lactation,
- Dry skin and swelling of face,
- Hair loss and eyebrow loss,
- Sleep apnea (somnolence during the day),
- Constipation,
- Depression,
- Lack of appetite,
- Pale skin,
- Swelling under eye and in face,
- Brittle nails,
- High blood pressure,
- Speaking slowly,
- Concentration disorder,
- Unremembrance and moving slowly,
- Slow heartbeat,
- High cholesterol level
can be seen, though.
What Causes Hashimoto's Disease? Who Are at Risk of Hashimoto's Disease?
How Does the Hashimoto's Thyroiditis Develop?
With various triggering factors, the patient's immune defense system "accidentally" produces molecules that we call antibodies against the patient's thyroid cells. Two of these antibodies are very important: anti-thyroglobulin antibody (anti-tg antibody) and anti-thyroid peroxidase antibody (anti-tpo antibody). These antibodies attach to the patient's hormone-producing thyroid cells, they also have harmful, devastating, and sometimes overworking effects.
Hashimoto's disease is about 8 times higher in women than in men. Although it can be seen at any age, it is more common especially in the young and middle age group. Women with history of recurrent abortion and stillbirths as well as those with high prolactin levels, high cholesterol and unexplained anemia are advised to regularly have check-up examinations for the possibility of Hashimoto's thyroiditis.
It is not possible to prevent the occurrence of Hashimoto's disease. Some disorders in the body's defense system play a role in its emergence and are usually congenital.
It is not currently known why the body's immune system attacks thyroid cells by producing antibodies. However, family history or familial factors are presumed to play an important role.
Hashimoto's disease is more common in certain risk groups:
- Smokers,
- Pregnants,
- Those who exposed to high levels of environmental radiation,
- Those who have a family history of Hashimoto's thyroiditis or other immune system disease (increases risk)
- Those with autoimmune disorders such as Type 1 diabetes, Vitiligo, Rheumatoid Arthritis, Pernicious Anemia, Lupus, Celiac Disease, Addison's Disease and Hepatitis are risky groups for Hashimoto's disease. This disease is more common in people with hepatitis C.
Causes such as excessive iodine intake and selenium deficiency also increase the risk of Hashimoto's thyroiditis.
Diagnosis of Hashimoto's Disease
The diagnosis process of Hashimoto's thyroiditis usually starts with the analysis of TSH and thyroid hormone levels in routine follow-ups or when patients see the physician for reasons such as malaise and hair loss. After asking for medical history and performing physical examination, if Hashimoto's disease is suspected, some tests will be requested by your physician.
First of all, TSH, T3 and T4 hormones in the blood are checked. An ultrasound test is performed for the structure and size of the thyroid. The differential diagnosis is made with high levels of anti-tpo and anti-thyroglobulin antibodies in the blood.
With these examinations, both the diagnosis is made, and the stage of the disease is determined. Ultrasound results give information about the size of the gland and nodule formation.
As a result of the inhibition of the functioning of the thyroid gland, thyroid gland enlargement, called goiter, may occur when the gland forces itself to produce hormones. In Hashimoto's disease, the goiter is of rigid and irregular structure. If nodule formation has occurred in the gland, these structures can be detected during physical examination.
How Is the Hashimoto's Disease Treated?
Hashimoto's Disease requires long-term follow-up examinations.
Currently, there is no application to prevent the destruction of the thyroid tissue in the treatment. The purpose is to eliminate the symptoms related to its deficiency by giving thyroid hormone. It is a process that requires regular follow-up and adjustment according to the patient's age, activity, weight, hormone levels and, if any, other diseases. Uncontrolled use of hormones can cause inadequate treatment as well as excessive intake can lead to a serious disease called hyperthyroidism. In elderly patients or those with coronary heart disease, treatment is started at very low doses and increased at intervals of 4-6 weeks.
Most women require a 25-50% increase in dose during pregnancy. The absorption of the medication taken on an empty stomach is better. Especially calcium, iron and gastric medications impair the absorption of thyroid medication. Women who consider conceiving should consult their physician about the dosage of the medication. Thyroid medications are also taken during pregnancy, it is not harmful to the fetus. If the TSH hormone is not kept below certain levels during pregnancy, learning difficulties may occur when the baby grows up. If thyroid medication is not taken, the risk of abortion increases. Postpartum check-ups should also be done.
Harms of Hashimoto's Disease
Which Diseases Can Hashimoto's Thyroiditis Cause?
Hashimoto's disease can lead to serious health problems if not treated. The most common of these health problems in our country is goiter disease. Goiter is an overgrowth of the thyroid gland. Goiter disease, which mostly occurs due to iodine deficiency, can lead to hypothyroidism in most cases.
If Hashimoto's disease is not controlled due to thyroid hormone deficiency, it can also lead to heart problems. Especially high LDL (in other words bad cholesterol) is a common condition in patients with hypothyroidism. Therefore, if hypothyroidism and Hashimoto's disease are not treated, enlargement of the heart and heart failure may occur.
Another problem caused by the Hashimoto's disease is psychological disorders. The first of these is depression. Depending on the slowing of mental activity, depression and sexual reluctance may occur in people. Often, with the treatment of the disease, the symptoms of depression decrease, and people regain their old energy.
Patients with Hashimoto’s disease attempting to conceive a baby should not forget that this disease can be inherited. Babies of people with this disease are more likely to develop cognitive and mental developmental disorders than babies of people without Hashimoto's disease. In addition, some studies indicate that hypothyroidism plays a role in heart, brain and renal disorders in infants. For this reason, it is very important for people who are pregnant or consider conceiving to have their thyroid glands checked in order to prevent complications that may occur in the baby.
Obesity
Thyroid hormone decreasing due to Hashimoto's disease (hypothyroidism) slows down the functioning of the body's organs and causes weight gain (obesity). In these patients, diets, heavy sports programs and medications will not be effective and beneficial unless thyroid hormone starts to function completely again.
The Harms of Obesity
In addition to aesthetic deterioration with obesity, an increase in low back pain, herniated disc, shoulder and back pain, cervical disc hernia, digestive system cancers can be seen.
Harms of Constipation
Hashimoto’s disease causes constipation. As a result of constipation, an increase in hemorrhoids and colon cancers can be seen. In these patients, diets and medications for constipation, even for a long time, are not effective and beneficial unless thyroid hormone starts to function completely again.
Depression, Sexual Disorders and Irritability
Hashimoto's disease causes depression, sexual disorders and irritability. As a result, the patients' work life, marriage and social relations are affected negatively. In these patients, unless the thyroid hormone is completely replaced, it is not possible to get results with psychiatric medication treatment, even for a long time.
Menstrual Irregularity and Infertility
The Hashimoto’s disease causes menstrual irregularity in women. In addition, due to high antibodies and low thyroid hormone, ovulation function and egg quality in women as well as quality and number of sperm in men are impaired. As a result, infertility may occur. After female patients become pregnant, there may be a temporary decrease in antibodies to thyroid cells, but thyroid auto-antibodies rise again after pregnancy.
Hair and Skin Disorders
In Hashimoto's disease, dulling of the hair, hair loss, dry and peeling skin and cellulite occur. Most patients with cellulite have thyroid hormone deficiency, especially occult thyroid insufficiency. Since this subject is not yet known in Turkey, thyroid is not examined when skin treatments are performed in the treatment of cellulite.
Brittle and Peeling Nail
Patients with Hashimoto's disease may experience thickening, dullness and layered separation in nails. Since this subject is not yet known in Turkey, patients’ thyroid glands are not examined while medical or non-medical "nail strengthening treatments" are performed after making diagnoses such as iron deficiency, zinc deficiency, selenium deficiency.
Thyroid Cancer
Papillary type thyroid cancer is more common in patients with Hashimoto's disease than in other patients with thyroid disorders. In the first examination of the glands of patients with Hashimoto’s disease and in routine follow-up examinations, ultrasonography should also be performed. If nodules are detected, fine-needle biopsy should be performed for the possibility of cancer.
Heart and Brain Diseases
Thyroid hormone decreasing in patients with Hashimoto's disease (hypothyroidism) deteriorates the patients’ cholesterol and fat absorption and use (metabolism). High cholesterol also narrows and clogs the heart and brain vessels of patients. The patient may have a stroke and paralysis due to stenosis and occlusion in the brain vessels. A stenosis or occlusion in the heart vessels can cause infarction. In addition, high cholesterol can cause serious erection problems by causing stenosis and occlusion in the penile arteries in male patients.