What is Hashimoto’s disease?
Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that affects the thyroid gland. It is the most common cause of hypothyroidism in the United States. In Hashimoto’s disease, the immune system mistakenly attacks the thyroid gland, leading to inflammation and damage that can reduce the amount of thyroid hormone the gland produces. This results in a variety of symptoms related to having too little thyroid hormone.
What causes Hashimoto’s disease?
The exact cause of Hashimoto’s disease is unknown, but it is believed to be due to a combination of genetic and environmental factors. Risk factors include:
– Family history – Hashimoto’s disease often runs in families. Having a close family member with Hashimoto’s increases your risk.
– Sex – Women are much more likely to develop Hashimoto’s than men.
– Age – Hashimoto’s typically starts between the ages of 30 and 50.
– Other autoimmune diseases – People with other autoimmune disorders like type 1 diabetes and celiac disease are at increased risk.
– Pregnancy – Hashimoto’s disease often starts during or shortly after pregnancy.
– Radiation exposure – Exposure to high levels of radiation may trigger Hashimoto’s in some cases.
– Viral infections – Some viruses may prompt the immune system to attack thyroid tissue.
– Excess iodine intake – Consuming too much iodine can damage the thyroid and initiate Hashimoto’s in those prone to it.
What are the symptoms of Hashimoto’s disease?
The symptoms of Hashimoto’s disease stem from having too little thyroid hormone (hypothyroidism). They tend to come on slowly over months or years. Common symptoms include:
– Fatigue and sluggishness
– Muscle aches, tenderness and stiffness
– Joint pain
– Depression
– Weight gain or difficulty losing weight
– Coarse, dry hair and dry, rough pale skin
– Increased sensitivity to cold
– Constipation
– Heavy menstrual bleeding
– Impaired memory and concentration
– Enlarged thyroid gland (goiter)
The severity of symptoms can fluctuate over time. Some people with Hashimoto’s disease have mild symptoms that do not require treatment, while others can eventually develop severe hypothyroidism.
How is Hashimoto’s disease diagnosed?
Hashimoto’s disease is diagnosed through a combination of physical examination, personal and family medical history, and blood tests. Common findings that may point to a diagnosis include:
– Enlarged thyroid gland (goiter)
– Symptoms of hypothyroidism
– Personal or family history of autoimmune disorders
– Presence of thyroid antibodies in the blood
Two blood tests are particularly important in diagnosing Hashimoto’s:
TSH test: This measures levels of thyroid stimulating hormone (TSH). High levels indicate hypothyroidism.
Thyroid antibody test: High levels of antibodies against thyroid proteins like thyroid peroxidase (TPO) and thyroglobulin indicate an autoimmune thyroid condition like Hashimoto’s.
Your doctor may also order additional blood tests related to thyroid hormone levels and function to help confirm the diagnosis and determine the severity.
What is the treatment for Hashimoto’s disease?
The primary treatment for Hashimoto’s disease is thyroid hormone replacement medication to correct the hormone deficit. Levothyroxine is a synthetic version of thyroxine (T4), one of the key hormones secreted by the thyroid gland. It is usually taken once per day as an oral tablet.
The levothyroxine dose must be adjusted based on regular monitoring of TSH and thyroid hormone levels via blood tests. It may take several months to determine the optimal dose that relieves symptoms for each individual patient. The dose often needs to be increased over time as Hashimoto’s progresses.
In addition to medication, your doctor may recommend:
– Periodic thyroid ultrasounds to monitor thyroid size and look for nodules
– A thyroid-friendly diet limiting goitrogenic foods like soy, cruciferous vegetables, certain nuts and excess iodine
– Stress management techniques
– Moderate aerobic exercise to counteract weight gain
– Treatment of any vitamin and mineral deficiencies
– Management of other autoimmune conditions if present
In some cases, synthetic liothyronine (T3) is added to levothyroxine therapy. Surgery may be necessary in rare cases of extremely large goiters or thyroid nodules.
What happens if Hashimoto’s disease goes untreated?
Leaving Hashimoto’s disease untreated allows hypothyroidism to progress, leading to increasingly severe symptoms and health complications:
– Worsening fatigue and sluggishness
– Greater risk of depression and mental impairment
– More weight gain and muscle wasting
– Worsening cholesterol and heart problems
– Increased risk of heart failure
– Higher risk of dementia and cognitive decline
– Menstrual irregularities and impaired fertility
– Increased risk of birth defects and pregnancy complications
– Fluid accumulation and swelling (myxedema)
– Coma and life-threatening myxedema coma
That’s why it’s critical to treat Hashimoto’s with thyroid medication as soon as a diagnosis is made. This helps resolve symptoms and prevent long-term consequences of progressive hypothyroidism.
What is the prognosis for someone with Hashimoto’s disease?
With early diagnosis and proper treatment, most people with Hashimoto’s disease can manage symptoms and lead a normal life. However, there is currently no cure for the condition itself.
Hashimoto’s is a progressive disease – over time, more of the thyroid gland becomes damaged until it can no longer produce sufficient hormones. Doses of thyroid medication usually have to be steadily increased. Some eventually require the maximum dose to maintain hormone levels.
Rarely, the thyroid is damaged to the point that thyroid medication can no longer adequately treat hypothyroidism. At that point, surgical removal of the thyroid followed by thyroid hormone replacement may be required.
It’s also important to be aware of and monitor for other autoimmune conditions that tend to occur more often with Hashimoto’s:
– Type 1 diabetes
– Celiac disease
– Rheumatoid arthritis
– Vitiligo
Ongoing medical monitoring and management are crucial for the best quality of life. With proper treatment, most people with Hashimoto’s can expect a normal lifespan.
How does Hashimoto’s disease affect pregnancy and fertility?
Hashimoto’s disease can affect pregnancy and fertility in several ways:
– Thyroid antibodies – High levels of thyroid antibodies are associated with increased risk of miscarriage and preterm birth.
– Hypothyroidism – Untreated hypothyroidism increases the chance of infertility, menstrual irregularities, and pregnancy complications.
– Thyroid enlargement – A large goiter can cause problems swallowing, breathing, and labor complications.
– Fluctuations – The high hormone levels of pregnancy can cause thyroid levels to vary greatly. Frequent monitoring and medication adjustments are needed.
– Postpartum thyroiditis – Hashimoto’s increases the risk of inflamed or overactive thyroid after giving birth.
To improve fertility and reduce pregnancy risks, thyroid hormone levels should be optimized before conception. Thyroid function requires very close monitoring throughout pregnancy to maintain normal hormone ranges.
Despite potential challenges, the majority of women with Hashimoto’s disease can have healthy pregnancies and babies with proper medical care.
What foods should you avoid with Hashimoto’s disease?
Certain foods may trigger or worsen inflammation and symptoms in people with Hashimoto’s disease. Foods to limit or avoid include:
– Gluten – Found in wheat, barley and rye. May promote autoimmunity.
– Dairy – Can trigger immune reactions in some people.
– Soy – Contains compounds that suppress thyroid function.
– Cruciferous vegetables – Broccoli, cabbage, Brussels sprouts. Goitrogens may interfere with thyroid hormone synthesis when consumed raw and in large amounts.
– Certain fruits – Peaches, pears, strawberries, spinach. Also contain goitrogens.
– Fatty foods – Can exacerbate hypothyroidism and weight gain.
– Simple sugars – Can provoke inflammation and contribute to fatigue.
– Caffeine – Over-consumption stresses the thyroid.
– Alcohol – Excess intake stresses the thyroid and triggers autoimmunity.
– Kelp/seaweed – Extremely high in iodine, which can worsen Hashimoto’s when consumed in large amounts.
Following an elimination diet under a doctor’s supervision can help identify personal food triggers. Those with Hashimoto’s generally feel best following a balanced, anti-inflammatory diet rich in vegetables, lean proteins, healthy fats and complex carbs.
What vitamins and supplements help Hashimoto’s disease?
Certain vitamins, minerals and supplements may help relieve symptoms and address nutrient deficiencies common in hypothyroidism:
– Vitamin D – Regulates immune function and thyroid cell growth. Low levels linked to Hashimoto’s risk.
– Omega-3 fatty acids – Helps fight inflammation and autoimmunity. Found in fish oil.
– Selenium – Important for thyroid hormone production. Deficiency linked to Hashimoto’s.
– Zinc – Essential for thyroid function. Supplements may boost levels.
– Iron – Anemia from low iron aggravates hypothyroid fatigue.
– Tyrosine – Amino acid aids thyroid hormone production.
– Ashwagandha – Ayurvedic herb may help thyroid and adrenal function.
– Probiotics – Can improve gut health and immune regulation.
– Vitamin B complex – Important for energy levels. B12 deficiency common with autoimmune conditions.
Work with your doctor to identify any specific nutritional deficiencies. Avoid high-dose iodine supplements, which can make Hashimoto’s worse. Have vitamin D, B12 and iron levels tested regularly.
Can Hashimoto’s disease be cured naturally?
There is currently no known “cure” for the underlying autoimmune disorder of Hashimoto’s disease. Thyroid medication is necessary to replace missing hormones once the damage is done. However, complementary approaches can help manage symptoms and progression.
Potential natural therapies to discuss with your healthcare provider include:
– Elimination diet – Removing trigger foods may reduce inflammation.
– Stress management – Techniques like meditation help regulate the immune system.
– Supplements – As described above, some supplements may support the thyroid.
– Moderate exercise – Movement helps fight fatigue and weight gain.
– Acupuncture – May help reduce thyroid antibodies and hypothyroid symptoms.
– Thyroid gland massage – Gentle massage may improve blood flow and hormone release.
– Infrared sauna – Helps detoxification which could reduce autoimmune flares.
The key is partnering these complementary methods with your standard thyroid hormone therapy. While they cannot cure Hashimoto’s, natural approaches may provide symptom relief and help stabilize the progression of the disease.
What is a normal TSH level for someone with Hashimoto’s disease?
The “normal” TSH reference range is typically 0.4 to 4.0 mIU/L. However, in Hashimoto’s disease, a lower TSH level within the normal range is often the optimal target:
– 0.4 to 2.0 mIU/L – For most with Hashimoto’s, keeping TSH between 0.4 to 2.0 mIU/L relieves symptoms best without risking overtreatment.
– <1.0 mIU/L - Some patients feel better with TSH suppressed below 1.0 mIU/L. However, this slightly increases risks of cardiac side effects and bone loss. - >3.0 mIU/L – Letting TSH drift higher tends to result in return of hypothyroid symptoms, weight gain, and high cholesterol.
– 2.5 to 3.5 mIU/L – Levels in this range may be acceptable for Hashimoto’s patients who are elderly, have heart conditions, or are at risk of bone loss.
Doctors should use both clinical symptoms and TSH testing to determine the optimal thyroid hormone dose and TSH level for each individual Hashimoto’s patient. This may require some trial and error. Frequent monitoring is important, as changing antibody levels can affect TSH over time.
What other tests help manage Hashimoto’s disease?
In addition to TSH testing, other laboratory tests provide helpful information for optimally managing Hashimoto’s disease:
– Free T4 and Free T3 – Measures the circulating levels of active thyroid hormone available to body tissues. Helps confirm dose of medication is appropriate.
– Thyroid antibodies – Tracks levels of TPOAb and TgAb over time to gauge autoimmune activity and progression.
– Thyroid ultrasound – Checks for nodules and goiter size. Can aid early detection of thyroid cancer risk.
– Complete blood count – Anemia and low white blood cells may indicate deficiency or thyroid under-treatment.
– Comprehensive metabolic panel – Assesses liver function, electrolytes, and markers of metabolic health impacted by hypothyroidism.
– Lipid panel – Monitors cholesterol levels commonly elevated with Hashimoto’s.
– C-reactive protein – Elevated levels indicate increased inflammation from autoimmunity.
– Vitamin D, iron studies – Low levels of these nutrients are frequently associated with Hashimoto’s.
Doctors also closely monitor factors like heart rate, body weight, body temperature, and menstrual cycle regularity in Hashimoto’s patients. Tracking symptoms and quality of life are important to guide treatment decisions.
Is Hashimoto’s a disability?
While Hashimoto’s disease often responds well to treatment, the condition can potentially meet the criteria for several types of disability programs when symptoms are severe:
– Social Security Disability Insurance (SSDI) – For those whose Hashimoto’s restricts ability to work and earn income. Approved after required work credits are earned.
– Supplemental Security Income (SSI) – For disabled adults and children with limited income and resources. Does not require work credits.
– Americans with Disabilities Act (ADA) – Provides protections and accommodations for disabilities that affect major life activities.
– Disability parking permits – May be eligible with conditions like severe fatigue, joint pain, weakness affecting mobility.
– State or local disability programs – Some provide services, vocational rehabilitation, caregiver benefits.
– Disability insurance through employer or private insurer – Hashimoto’s may qualify as a covered condition rendering one unable to work.
The key criteria are having well documented symptoms and functional limitations that prevent ability to work, attend school, or complete normal daily tasks. Supporting medical records, test results, treatment history and physician statements are required.
What is the connection between Hashimoto’s and anxiety/depression?
There are several reasons why anxiety and depression commonly occur in people with Hashimoto’s disease:
– Hormone effects – Thyroid hormones regulate serotonin, norepinephrine and dopamine which influence mood. Hypothyroidism reduces levels of these brain chemicals.
– Inflammation – The autoimmune attack of Hashimoto’s provokes widespread inflammation which can directly impact brain function and mental health.
– Fatigue – Physical and mental exhaustion from hypothyroidism can worsen mood and emotional health.
– Emotional stress – Struggling with a chronic illness often compounds fears, grief, strain on relationships and sense of loss.
– Nutrient deficiencies – Low vitamin D, B vitamins, iron and zinc impair mood regulation.
– Genetic factors – Shared genes may predispose to both Hashimoto’s and mental health disorders.
Mental health support, counseling, stress management and carefully optimized thyroid treatment are extremely helpful for managing the anxiety and depression frequently tied to Hashimoto’s. In some cases, antidepressant or anti-anxiety medications may be warranted as well.
Conclusion
Hashimoto’s disease is an autoimmune disorder causing progressive thyroid gland failure and symptoms of hypothyroidism. Also known as chronic lymphocytic thyroiditis, it is the leading cause of hypothyroidism. Hashimoto’s results from the immune system mistakenly attacking the thyroid, leading to inflammation and damage that impairs the gland’s ability to produce hormones. This condition tends to run in families and mainly affects middle-aged women. Fatigue, weight gain, sensitivity to cold, joint pain and depression are among the common symptoms. Diagnosis is made through a combination of physical exam, personal and family medical history, and blood tests for TSH levels and thyroid antibodies. Hashimoto’s requires daily thyroid hormone replacement medication but there is no cure for the autoimmune disorder itself. With treatment, most patients can manage symptoms and avoid complications. But Hashimoto’s is a progressive condition requiring ongoing monitoring and medication adjustments. Regular thyroid function testing along with checkups, thyroid ultrasounds and management of other autoimmune issues are key to maintaining health and quality of life. When optimized, most people with Hashimoto’s can expect a normal lifespan. With support and diligent treatment, it is possible to thrive with this condition.
