Hashimoto Thyroiditis: Causes, Treatment and History

Neysha L. Gonzalez

Hashimoto Thyroiditis

Hashimoto’s Thyroiditis is a common form of Thyroiditis and disorder in the United States. Not many people know about its existence until they have acquired the disorder. It is considered a condition where your immune system attacks your thyroid. An individual’s thyroid is located on the side of the neck right below the Adam’s apple. It can easily be located and felt on those who have this condition. Thyroid is a gland located in your endocrine system along with other glands, which are said to create hormones and control your metabolic system. The ability of not creating thyroid hormones can result in hypothyroidism. Hashimoto Thyroiditis can be diagnosed and can bring about some common signs that can be picked up easily. Complications, along with risk factors can occur, so knowing the basic about the disorder can help any individual live through it as it is a life time disease. There are several causes, effects, and symptoms of Hashimoto Thyroiditis.

History

The name “Hashimoto” comes from the founder who was known to be a Japanese surgeon. Hashimoto can lead to dyspnea and even dysphagia due to the pressure felt on the neck area. The founder had diagnosed four patients with a thyroid disease called Struma Lymphomatosa (DeGroot & Amino, 2013). Struma Lymphomatosa was uncommon, but as the years have gone by many cases have appeared. Diagnosis was made by the surgeon and it was not until the patient came in, that they would be diagnosed with Hashimoto. Studies were done on animals, in particular rabbits and they studied the immunization of the extracts of the rabbit thyroid. Researchers concluded that rabbit thyroid had some sort of similarity to that of Hashimoto thyroiditis (DeGoot & Amino, 2013).

Signs and Symptoms

There are various characteristics used to distinguish Hashimoto Thyroiditis. It is beneficial to recognize these signs and symptoms as soon as possible in order to start treatment that an individual might need. Goiter may develop when your immune cells attacks your thyroid tissues, inflammation and an enlarged thyroid may occur (Milas, 2014). Swelling around the neck is considered the primary sign of a goiter. When it first starts to occur, the pain may be non-existence. However, if no treatment is administered, an individual might feel some pressure in the lower part of the neck. The neck area may feel a bit sensitive to the touch and discomfort may start to develop, which may extend to other parts of the body that is close to the area.

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Additionally, if still un-treated, the swelling may then cause a difficulty in swallowing and breathing and depending on the individual, other symptoms such as hoarseness or other voice changes that do not go away, may come about due to the effect of the previous symptoms (Milas, 2014). Symptoms can be different for every individual. If you develop hypothyroidism some symptoms that may be associated with this disorder includes weight loss or weight gain, fatigue, muscle soreness, or even dry skin, nail, and hair. An individual’s hair may lose its shine and even cause a bit of hair loss in parts of their scalp. These symptoms may not be easy to detect, and one may see this as a normal occurrence.  For that reason, it is always good to have a basic knowledge about Hashimoto in order to detect the disease and look for help (Milas, 2014).

Risk Factors

Women are at higher risk of getting Hashimoto due to sex hormones. Studies show that it is 5 to 10 times more likely in woman than in men (Chen, Lin, Cheng, Sung, & Kao, 2013).  Having regular check-ups with your doctor is the best way to prevent the disease from getting worse. Middle aged individuals have a high likelihood of getting Hashimoto disease (Chen et al., 2013).  No studies have shown the reason why this occurs, but middle aged individuals are advised to keep alert on the signs and symptoms that are faced within this condition.  If an individual’s family has a history of thyroid or even some type of autoimmune diseases such as, type 1 diabetes or even lupus, then they might be at a high risk (Chen et al., 2013).

Additionally, individuals who are exposed to excessive environmental radiation can develop this condition as well.  Studies has shown that the development of Hashimoto can have negative effects on some types of cancers. The autoimmunity of the thyroid hormone is the cause of this association. Types of cancers that can develop due to this condition include lung, breast, and thyroid cancer (Chen et al., 2013). Chen et al. (2013) stated that studies are still being conducted in order to examine the different conditions individuals living with this disease may face with their lives. Researchers are focusing more on women because they are at a higher risk.

There is no major cause on what may trigger Hashimoto’s disease. According to Chen et al. (2013) your immune system is said to create antibodies which harms their thyroid gland. Various research has been conducted in order to find answers, but nothing has been proven to be true (Chen et al., 2013). Some scientists consider the possibility of a virus or even a bacteria being the reason behind this condition. Others conclude that it is a genetic defect that might have been the cause and so nothing can be done in order to prevent the condition (Chen et al., 2013).

Diagnosis

Hashimoto Thyroiditis can be diagnosed through various blood work. When blood tests are done, they tend to measure the thyroid gland function. The main objective upon these blood test is to search for antibodies against the proteins which are found in the thyroid gland (Lee, 2013). The blood work can either be done at the provider’s office or even at a commercial facility. One or two tubes of blood is all that is needed in order to diagnose whether or not there is a chance of having Hashimoto.

Some diagnostic blood tests that may be performed would be he TSH (Thyroid-stimulating hormone, T4, or the Anti-thyroid antibody test. The TSH test is said to be the first one performed because it is considered the most accurate measure of thyroid activity. T4 can measure the amount of thyroid hormone within your blood and the Anti-thyroid antibody tests looks for the autoantibodies within the body’s tissue (Lee, 2013). Hashimoto can also be diagnosed through a physical examination or even a medical history. This disorder can be diagnosed by asking of questions and the regular checkups to the doctor’s office can bring about the probability of diagnosing this disorder. During a physical examination, nodules could be found by your care provider who may palpate your thyroid gland and do further investigation to rule out this particular disorder (Lee, 2013). Blood work may then be requested in order to confirm if the patient has Hashimoto Thyroiditis.

Ultrasound for detecting Hashimoto Thyroiditis has been a useful tool. It helps doctors evaluate the disorder itself with high resolution. This type of testing is low in cost, widely available, is not painful, and it does not utilize ionizing radiation. (Chaudhary & Bano, 2013). Patients are put in a supine position and a high frequency instrument is utilized to detect any mass. The instrument is moved around the neck in a slow circular motion. The imaging of the thyroid gland is done in both color and gray-scale in order to get a better visualization of the gland and possible masses that might be present (Chaudhary & Bano, 2013).

Treatment

Hashimoto can be controlled by a medication called levothyroxine sodium. The individual would have to take this pill every day for the rest of their life. This pill replaces the hormones that the thyroid can no longer supplement.  Each individual’s dose intake is different because it depends on various factors. Some factors that are taken into consideration are the patient’s age, weight, and even the severity of the condition has on the patient (Schori-Ahmed, 2003). According to Schori-Ahmed (2003), the doctor may start off the patient with a low dose for about two to four weeks. By doing this they are keeping a close watch on the TSH levels to see if they have settled back to normal. If it has not, then a higher dose may be given to the patient (Schori-Ahmed, 2003). For the elderly and those who may have cardiovascular disease, it is important to take into consideration what pills they take as some side effects may occur due to overtreatment (Schori-Ahmed, 2003). A thyroidectomy can also be done if the condition worsens with time. It is commonly performed on individuals who developed Graves’ disease or thyroid cancer. This may result in taking thyroid medications for life (Schori-Ahmed, 2003).

Complications

If the condition is not treated on a timely manner, various complications may occur. Hashimoto is the cause of hypothyroidism and is one of the main cause for goiter, which is when your thyroid gland is enlarged. This happens when your thyroid gland is regularly aroused to release hormones. Goiter can be palpated or a times even seen by the human eye if big enough. It may give an individual difficulty breathing and even swallowing (Wint & Boskey, 2012). People who have hypothyroidism may be linked to developing heart problems. This is due to the high levels of low-density lipoprotein cholesterol. If untreated an enlarged heart may occur which may cause heart failure eventually (Wint & Boskey, 2012). Depression and loss of sexual desire can occur due to this disease for both men and woman.  If untreated, Hashimoto can cause Myxedema, which is not seen much, but can be life-threatening to those who do get it. Myxedema is the swelling of the skin and can be triggered by exposure to cold, stress and even infections (Wint & Boskey, 2012). Women may have birth defects such as heart, kidney, and even brain problems in the infant (Wint & Boskey, 2012).

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Hashimoto Thyroiditis can be a serious disease if left untreated. Having regular check-ups can be beneficial when taking into consideration the complications it may have if not treated right away. If an individual experiences any sort of sign such as inflammation, difficulty swallowing, or feels some type of symptom such as fatigue and weight loss, immediate action should be taken. Various complications can develop if an individual does not seek for help right away, which can affect both your loved ones and yourself in both the short and even long run. There are various tests that can be completed in order to see if an individual has Hashimoto Thyroiditis. Blood work, ultrasounds, and even palpation around the neck area can help diagnose this disease. Hashimoto Thyroiditis cant be cured but it can be treated if diagnosed on time.

References

Chen, Y., Lin, C., Cheng, F. T., Sung, F., & Kao, C. (2013). Cancer risk in patients with Hashimoto’s thyroiditis: a nationwide cohort study. British Journal Of Cancer, 109(9), 2496-2501. doi:10.1038/bjc.2013.597

Chaudhary, V., & Bano, S. (2013). Thyroid ultrasound. Indian Journal of Endocrinology and Metabolism, 17(2), 219-227. http://doi.org/10.4103/2230-8210.109667

DeGroot, L., & Amino, N. (2013). Hashimoto’s Thyroiditis. Kuma Hospital, Center for Excellence in Thyroid Care. Retrieved February 28, 2017, from http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis

Lee, S. (2013). Hashimoto’s Disease | NIDDK. Retrieved February 20, 2017, from https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

Milas, K. (2014). Symptoms of Hashimoto’s Thyroiditis. Endocrineweb. Retrieved February 20, 2017, from https://www.endocrineweb.com/conditions/hashimotos-thyroiditis/symptoms-hashimotos-thyroiditis

Schori-Ahmed, D. (2003). Thyroid disease. Rn, 66(6), 38-44.

Wint, C., & Boskey, E. (2012). Hashimoto’s Disease. Healthline. Retrieved February 25, 2017, from http://www.healthline.com/health/chronic-thyroiditis-hashimotos-disease