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Hashimoto’s Thyroiditis: Symptoms, Causes, and Treatments

Hashimoto’s - Autoimmune Thyroid Disease

Autoimmune disorders are among the most challenging conditions to correctly diagnose and treat. Most autoimmune conditions bring with them an array of symptoms that have a lasting impact on wellness. Hashimoto’s thyroiditis is one such condition that can have a life altering effect if not properly identified and treated. Understanding the basics of Hashimoto’s, being familiar with its symptoms, and knowing the elements of effective treatment may help you protect your long-term wellness. 

What is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis is an autoimmune condition that causes the body’s own defenses to attack healthy thyroid tissue. It is also the leading cause of hypothyroidism, a common thyroid condition that has the capacity to drastically impede overall bodily function. 

When working properly, the immune system does an excellent job at protecting the body from disease. It does this by quickly recognizing invasive or threatening substances and releasing antibodies to eliminate them. With Hashimoto’s, the immune system misidentifies proteins in the thyroid gland as dangerous. This triggers an outright assault on the thyroid destroying tissue, cells, and blood vessels contained. 

As Hashimoto’s progresses and it does greater damage to the thyroid, its function declines, and the body enters a continuously worsening state of hypothyroidism. The decrease in thyroid function adversely affects many areas of wellness including cognitive function, mood, energy level, blood pressure, metabolic activity, and much more. This often manifests as symptoms of hypothyroidism, including but not limited to fatigue, weight gain, constipation, depression, and brain fog. 

Hashimoto’s patients may also experience temporary symptoms that oppose those relating to hyperthyroidism. When thyroid tissue is destroyed, it introduces a great deal of thyroid hormones into the bloodstream all at once. The surge in hormone values triggers symptoms more often associated with hyperthyroidism. We know this phenomenon as Hashitoxicosis and it typically causes symptoms including anxiety, diarrhea, accelerated heart rate, and sudden weight loss. 

What Contributes to Autoimmune Thyroid Disease?

There is no single definitive cause of Hashimoto’s. Rather, there are several contributing factors that increase the likelihood of autoimmune malfunction and subsequent development of Hashimoto’s. Below are some factors that may increase an individual’s risk for Hashimoto’s.

Age and Sex

Approximately one in every thousand people will develop Hashimoto’s, with most them being between the ages of 45 and 65. Thyroid disease, including Hashimoto’s, is more likely to develop in women.

Family History

Those with a family history of thyroid disease, specifically Hashimoto’s, are more likely to develop an autoimmune thyroid disorder. 

Pregnancy

Pregnancy may also be a major contributor to Hashimoto’s as childbirth puts additional stress on the immune system. 

Nutrient Deficiencies

Hashimoto’s is associated with a deficiency of specific nutrients, including but not limited to selenium, zinc and iron. A lack of these nutrients encourages thyroidal inflammation and malfunction.

Chronic Conditions

Chronic disease and infection can also contribute to the development of autoimmune disorders because they tax the immune system. Conditions such as Epstein Barr, Lyme disease and mycoplasma further increase the likelihood of immune dysfunction. 

Chronic Stress

Prolonged emotional or physical stress can disrupt the immune system and trigger significant inflammation. Additional stress placed on an already exhausted immune system causes further dysfunction and increases the risk of developing an autoimmune disorder.

Difficulties of Diagnosis

Hashimoto’s can be difficult to identify in its early stages. This is because damage done to the thyroid typically accrues slowly. The symptoms of Hashimoto’s present themselves gradually over a long period. Sometimes patients and doctors may not recognize symptoms of multiple years. Often, Hashimoto’s is only identified after symptoms have reached a severe and easily recognizable level. 

Another reason many Hashimoto’s patients go undiagnosed is because most doctors rely solely on thyroid stimulating hormone (TSH) values to diagnose their patients. This is a flawed approach, as TSH and thyroid levels change only after irreparable damage has already been done to the gland. This means that by the time most physicians can identify Hashimoto’s, it is already too late to prevent thyroid degradation. 

Signs and Symptoms of Hashimoto’s

Depending on its progression, Hashimoto’s can present an array of symptoms. Some of the most common symptoms of Hashimoto’s are listed below. Keep in mind that Hashimoto’s patients may experience some or all of the following symptoms with varying frequency and intensity.

Early stage Hashimoto’s is often accompanied by the following symptoms:

  • Acid reflux
  • Bloating
  • Constipation
  • Diarrhea
  • Irritable bowel syndrome

More established cases of Hashimoto’s are associated with a broader range of symptoms, including:

  • Brain fog
  • Changes in weight
  • Difficulty swallowing
  • Fatigue
  • Hair loss
  • Hoarseness
  • Inability to regulate temperature
  • Irregular periods
  • Joint and muscle pain
  • Low libido
  • Memory loss
  • Swelling in the hands, feet, or face
  • Tightness in the throat
  • Weakness

Hashitoxicosis triggered by the destruction of thyroid tissue can lead to temporary symptoms, including:

  • Anxiety
  • Diarrhea
  • Hastened heartbeat
  • Panic attacks
  • Rapid weight loss
  • Shaking hands
  • Sweating

Sometimes, patients may also develop a goiter or enlargement of the thyroid gland. Goiters can cause tenderness and soreness around the neck and may obstruct airways. Depending on the size, a goiter may be barely perceptible or appear as a large growth or protuberance. 

Identifying Autoimmune Malfunction

Diagnosing any autoimmune thyroid condition begins with testing for thyroid peroxidase antibodies and antithyroglobulin antibodies. Up to 95 percent of those with Hashimoto’s have elevated levels of thyroid peroxidase antibody and about 80 percent have increased antithyroglobulin antibody. An increase in these substances strongly shows that an autoimmune thyroid disorder has developed. It is important to note, however, that even if thyroid antibodies are not elevated, a patient may still have Hashimoto’s

To properly test for Hashimoto’s, besides testing thyroid antibodies, a full thyroid panel must be administered. At minimum, this should include testing the patient’s values of Free T4, Free T3, Reverse T3, sex hormone binding globulin (SHGB), and basal metabolic rate. Without these tests, it is impossible to accurately assess thyroid function. 

Treating Autoimmune Thyroid Disease

The treatment of Hashimoto’s almost always involves thyroid hormone replacement therapy. Every Hashimoto’s patient will require lifelong medication with one or more types of thyroid hormone. Depending on the specific needs of the patient, an individual may be prescribed T4 only, T3 only, combined T4/T3, time released T3, bioidentical hormones, or some combination of formulations.

 

Frequently, those with Hashimoto’s have reduced levels of various hormones used to regulate immune function and antibody activity. Restoring these hormones to their appropriate value may be required. Most times, supplementing with DHEA, testosterone, or other regulatory hormones can help normalize immune response and limit future thyroid damage.

Resolving deficiencies of important nutrients such as selenium and iodine may also prove highly beneficial. Keep in mind, it is always best to speak with a physician prior to taking supplements.

Stopping Hashimoto’s in Its Tracks

Even though Hashimoto’s is a common cause of thyroid disease, it frequently goes undiagnosed until serious damage has already been done. One of the best ways to prevent this from happening is by getting educated about Hashimoto’s, the symptoms it manifests, and how it may be identified and treated. If you think you may have Hashimoto’s seek a physician who is well-trained in autoimmune thyroid disease and willing to conduct a thorough assessment of thyroid function.

Resources

1. Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).” National Academy of Hypothyroidism and Integrative Sciences.

2. Kent Holtorf, MD. “Thyroid Hormone Transport.” National Academy of Hypothyroidism and Integrative Sciences.

3. Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?” National Academy of Hypothyroidism and Integrative Sciences.

3. Dana L. Mincer; Ishwarlal Jialal. “Hashimoto Thyroiditis.” https://www.ncbi.nlm.nih.gov/books/NBK459262/

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