Hashimoto’s Thyroiditis

Hashimoto’s Thyroiditis

Like many other thyroid diseases, it is quite easy to miss out Hashimoto’s thyroiditis until the condition is quite severe. Being an autoimmune thyroid disease, Hashimoto’s thyroiditis is something that seeps in slowly. It gradually causes the thyroid glands to fail functioning without you noticing.

Feeling tired all the time, lack of focus and concentration, improper digestion, and inability to sleep – these are symptoms of modern day life and no one would suspect that there is something wrong with their thyroid function. However, Hashimoto’s thyroiditis is a condition that gradually starts to demand your attention.

What is Hashimoto’s thyroiditis?

It is a condition where there are enlarged thyroid glands due to autoimmune thyroid disease. It is known as chronic lymphocytic thyroiditis and a condition that manifests with subtle symptoms. It is a condition wherein the immune system of the body attacks cells of the thyroid glands leading to gradual destruction and possibly hypothyroidism. It is prevalent in people with thyroid autoimmunity and a genetic predisposition to autoimmune diseases exacerbated by environmental factors.

How is Hashimoto’s thyroiditis different from other thyroid diseases?

Though Hashimoto’s thyroiditis is one of the major causes of hypothyroidism in places that have no iodine deficiency, its genesis and classification is different due to many causes. Hashimoto’s thyroiditis is a thyroid disease where one might not have hypothyroidism or goiters that are responsible for various thyroid diseases. In fact, one might not even have any destruction of the cells of the thyroid glands. The very presence of thyroid autoantibodies is itself a decisive evidence of the possibility of having Hashimoto’s thyroiditis.

This might sound confusing, but people with Hashimoto’s thyroiditis may have hypothyroidism, goiters, or have atrophy of the thyroid glands (destruction of thyroid cells). The disease can occur in different forms. However, the most common feature among people with Hashimoto’s thyroiditis is the presence of thyroid autoantibodies. This is because of the fact that people having thyroid autoantibodies in most cases have lymphocytic infiltration of the thyroid glands.

What is lymphocytic infiltration of the thyroid gland?

Any form of thyroiditis is due to the inflammation of thyroid glands causing an enlarged thyroid. As in the case of any inflammatory disease, cells like eosinophils, neutrophils, lymphocytes, and macrophages infiltrate target cells.  In the case of autoimmune thyroid disease, lymphocytes and macrophages infiltrate (attack) the thyroid gland due to impaired immune response. This causes inflammation, enlarged thyroid, thyroid cell destruction, and subsequently other manifestations of Hashimoto’s thyroiditis.

Apart from the infiltration of lymphocytes, certain cells of the immune system (T cells & B cells) lead to autoimmune thyroid diseases. While T cells are known to destroy thyroid cells directly, B cells cause autoantibodies to thyroid peroxidase, thyroglobulin, and TSH. This leads to reduced thyroid function.

What causes Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis occurs much more in women when compared to men. It is known to be caused due to genetic factors that are exacerbated by environmental factors. Mutations in the HLA gene complex, immune regulator genes, and genes specific to the thyroid glands are responsible for autoimmune thyroid disease.  When these mutated genes are subject to certain environmental factors, it leads to Hashimoto’s thyroiditis. Apart from these genetic groups, people with the skin condition called vitiligo also share the possibility of getting autoimmune thyroid disease.

Along with genetic factors, environmental factors like poor diet, deficiencies in vitamin D and selenium, excess iodine intake, smoking and alcohol, and exposure to pollution and low-dose radiation are known to increase the risk of Hashimoto’s thyroiditis.

Risk factors for Hashimoto’s thyroiditis

  • Women are eight times more likely to have Hashimoto’s thyroiditis than men
  • The likelihood of this thyroid disease increases with age
  • People who have genetic mutations HLA gene complex, genes specific to the thyroid glands and immune regulator genes
  • People with other autoimmune diseases
  • Radiation exposure
  • Family history of Hashimoto’s thyroiditis

Complications of Hashimoto’s thyroiditis

  • Enlarged thyroid
  • Formation of goiters
  • Hypothyroidism
  • Increase in cholesterol levels increasing risk of heart disease
  • Psychological issues like depression
  • Decreased sexual drive
  • Myxedema coma
  • Birth defects for babies born to women with Hashimoto’s thyroiditis

Symptoms, diagnosis, & treatment of Hashimoto’s thyroiditis

Symptoms of Hashimoto’s thyroiditis

To a large extent, Hashimoto’s thyroiditis does not show any symptoms. Even though there are increased amounts of thyroid autoantibodies in the blood, there might not be symptoms as the damage is gradual.

Once there is significant amount of thyroid cell damage leading to enlarged thyroid and impaired thyroid function, it does show up symptoms. Since impaired thyroid function leads to underactive thyroid or hypothyroidism, symptoms are that of hypothyroidism. When Hashimoto’s thyroiditis manifests in the form of goiters, there is swelling in the neck with possible difficulty in breathing and swallowing.

Hashimoto’s Thyroiditis – Diagnosis

  • Physical examination
  • Thyroid function test
  • TPO antibody test
  • Anti-Thyroglobulin test
  • Prolactin level
  • Creatine kinase level
  • Thyroid ultrasound
  • Fine-needle aspiration

Hashimoto’s Thyroiditis Treatment

A person with Hashimoto’s thyroiditis needs to consult an endocrinologist. In most cases, treatment with medications are prescribed; however, in some cases, surgery might be needed.

As part of medication, thyroid hormone replacement therapy is prescribed with synthetic levothyroxine. One has to take this medication lifelong.

Surgery is done when there is presence of a large goiter that causes difficulty swallowing or breathing.

Apart from medication, people with Hashimoto’s thyroiditis are advised to avoid consuming gluten substances and follow a healthy Hashimoto’s thyroiditis diet.