Introduction

Hashimoto’s disease is a chronic autoimmune condition known to affect the thyroid gland. It is the main cause for hypothyroidism (underactive thyroid). being an auto-immune disorder, it means that an individual’s immune system affects their own healthy or normal cells. Usually, the thyroid gland is attacked.

 

The thyroid gland and its location

The thyroid gland is an endocrine organ, small and shaped as a butterfly found in the neck region anterior to the trachea. It makes and produces thyroid hormones, which are very crucial in metabolic processes.

 Key Facts & Statistics

What are the key facts and statistics about Hashimoto’s disease?

• Hashimoto’s disease was named after a Japanese physician who identified and first described the condition in 1912. His name was Dr. Hakaru Hashimoto.
• It is a common condition that affects almost 5 in 100 persons living in the United States.
• It is thatHashimoto’s disease is most common cause of hypothyroidism.
• The condition has various other names such as:

1.  Lymphocytic thyroiditis.
2.  Chronic auto-immune thyroiditis.
3.  Hashimoto’s disease.
4.  Lymphadenoid goiter- Hashimoto.
5.  Hypothyroidism-Hashimoto.
6.  Type 2 polyglandular autoimmune syndrome-Hashimoto.

• The condition can affect any person but it is known to affect women very much as compared to men.

 

 Risk Factors

What are the risk factors for Hashimoto’s disease?

There are various risk factors associated with Hashomoto’s thyroiditis, and these are:

 

• Sex.Women and persons assigned female at birth (AFAB) are 10 times highly likely to develop Hashimoto’s disease as compared to men and persons assigned male at birth (AMAB).
• Family history. According to studies, having first degree relatives (biological family members) with this condition or other thyroid disorders raises likelihood of its development in individuals.
• Age. Older age increases chances of developing  Hashimoto’s disease. In fact, for women and Individuals assigned female at birth, diagnosis occurs most commonly when they are aged between 3o to 50 years.
• Presence of other autoimmune conditions. Existence of lupus, type 1 diabetes or rheumatoid arthritis can increase the chance of developing Hashimoto’s disease.
• Exposure to radioactive elements. There have been increased cases of thyroid disorders being reported  in persons exposed to radioactive elements. For example;

1.  The Chernobyl nuclear accidents.
2.  The atomic bombing of Hiroshima and Nagasaki in Japan during world war II.
3. Radiotherapy for treatment of Hodgkin’s disease (a type of cancer of the blood).

• Excessive amounts of iodine. According to some studies, higher than normal amounts of iodine can be a trigger for Hashimoto’s disease in some individuals. Iodine is a trace element needed by the body for making thyroid hormones.
• Pregnancy. Typical alterations in functioning of the immune system during pregnancy may be a risk factor for Hashimoto’s disease that occurs post-pregnancy.

 

 Causes

What are the causes of Hashimoto’s disease?

Hashimoto’s thyroiditis is an autoimmune condition where the immune system attacks healthy cells and organs of the body.

The role of the immune system is to protect the body against harmful pathogens such as  some bacteria, viruses, fungi and parasites. However, in Hashimoto’s disease:

Antibodies are made by the immune system but end up attacking the thyroid gland.

White blood cells especially lymphocytes, accumulate in the thyroid gland leading to inflammation (thyroiditis) and the gland is damaged.

Chronically, this damage leads to production of low amounts of thyroid hormones (hypothyroidism) in some individuals.

 

 Signs & Symptoms

What are the manifestations and indicators of Hashimoto’s disease?

Goiter. The thyroid gland becomes swollen.  Usually, this is a common first sign of the condition.

 

The following signs and symptoms can occur if hypothyroidism develops as a result of Hashimoto’s disease:

•  Bradycardia.
•  Dry skin.
• Increased cold sensitivity (cold intolerance).
•  Fatigue.
•  Mild weight gain.
• Infertility.
•  Low libidy.
• Irregular, heavy menses.
•  Puffy eyes and face.
•  Depressed mood.
• Hair loss.
• Muscle ache.
• Joint stiffness.
• Difficulty concentrating.
• Excessive sleeping.
• Constipation.
• Brittle nails.
• Tongue enlargement.

 

 Diagnostic Procedures  & Tests

How is Hashimoto’s disease diagnosed?

• Patient history-taking. This involves a  conversation between the healthcare provider and a patient to obtain relevant medical history, including presenting signs and symptoms.
• Perform a clinical examination. This will include observing and feeling the thyroid gland.
• Blood tests are conducted after assessment for confirming the diagnosis. These are:

1.  Thyroid-stimulating hormone test.
2. Free thyroxine (T4) test.
3.  Anti-thyroid antibody tests.

• Imaging test. In this case, a thyroid ultrasound is done to ensure thyroid nodules are not present. Apart from this, the physician checks the size of the thyroid gland.

 

 Treatment and Management

Does Hashimoto’s disease have a cure?

This is a condition that lacks a cure. Again, it also cannot be reversed.

 

How is Hashimoto’s disease treated?

Medicines are used to manage hypothyrodism and levels of thyroid hormones. However, it should be noted that not every person who has Hashimoto’s disease ends up developing hypothyroidism.

Levithyroxine. This synthetic form of thyroid hormone T4 is used to treat hypothyroidism that develops due to Hashimoto’s disease. It is taken everyday for life and it restores normal levels of thyroid hormones needed by the body.

For those with higher antibody levels without clinical hypothyroidism, thyroid hormones levels are regularly monitored instead of beginning treatment right away.

 

 Complications

What are the complications of Hashimoto’s disease?

Untreated Hashimoto’s thyroiditis may lead to:

• Goiter. The thyroid gland enlarges. In Hashimoto’s disease due to low thyroid hormone levels, the pituitary gland send signals to the thyroid to manufacture more hormones and this cyclic process can lead to goiter.
• Heart problems. This can happen when there is high levels of low density lipoprotein (LDL) cholesterol – the bad cholesterol. This is as a result of low levels of thyroid hormones. LDL cholesterol is a risk element for cardiovascular disease and heart failure.
• Myxedema.
• Emotional problems such as depression.
• Sexual problems and reproductive disorders. This include: low libido, irregular and excessive menstrual bleeding,  erectile dysfunction and low sperm count.
• Pregnancy issues. Untreated Hashimoto’s disease in expectant women can increase the risk of miscarriage, stillbirth or premature birth. Birth defects such as cleft palate and intellectual disabilities may appear in the child. There may also be preeclampsia in late pregnancy.

 

Prevention

How do we prevent Hashimoto’s disease?

Unfortunately, it is impossible to prevent this condition. Even risk factors such as age and genetics are not modifiable.