Hashimoto's Disease
The Leading Cause Of Hypothyroidism In Women

Hashimoto's Disease

Contents

• What Is Hashimoto's Disease?
• What Are The Symptoms?
• What Causes It?
• What Are The Risk Factors?
• How Is It Diagnosed?
• How Is It Treated?
• What Complications Can It Cause?
• How Is Hashimoto's Treated In Pregnant Women?

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Thyroid Disease Guide

What Is Hashimoto's Disease?

Hashimoto's disease is an autoimmune disorder. It results in antibodies being produced by the body which can attack the thyroid and interfere with its ability to produce thyroid hormones. Hashimoto's is the most common cause of an underactive thyroid (hypothyroidism) in the United States. When a thyroid is underactive, the whole body slows down. Your heart rate slows down, as well as your brain function and the rate at which you burn calories (so you gain weight). Doctors can tell the difference between hypothyroid patients with Hashimoto's disease from other forms of hypothyroidism because their blood tests reveal the presence of specific antibodies. It is closely related to Graves disease, another autoimmune disease which has the opposite effect causing an overactive thyroid, or hyperthyroidism. Hashimoto's is also called autoimmune thyroid disease and Hashimoto's thyroiditis.

What Are The Symptoms?

To begin with, many patients with Hashimoto's display no symptoms and may be undiagnosed. The first sign of the disease, which sends people to the doctor, is usually a swollen thyroid gland called a goiter (picture). Goiters come in different shapes and sizes but they all tend to make the neck area look swollen. Although a goiter rarely causes pain, it can make swallowing or breathing difficult if it becomes large enough. Eventually, most people with Hashimoto's go on to develop hypothyroidism. To begin with the symptoms of thyroid disease might be nonexistent or mild, but they tend to worsen over time. Signs include:
• Moderate weight gain (10-15 pounds).
• Prone to feeling the cold.
• Get tired easily. See also, why am I so tired all the time?
• Heavy periods.
• Younger women may have difficulties becoming pregnant.
• Dry skin and puffy face.
• Hair loss (image) and if untreated thinning of eyebrows.
• Hoarseness.
• Depression.
• Constipation.
• Slower heartbeat.
It should be noted that Hashimoto's and hypothyroidism are not the same thing. It is possible to test positive for Hashimoto but not be hypothyroid (although most will go on to become so). Hashimoto's disease gradually destroys the thyroid gland - there can be times when the thyroid rapidly goes downhill causing symptoms of hypothyroidism, but then it can splutter back to life, even causing temporary hyperthyroidism. One minute you might have constipation, the next diarrhea. You main gain weight, then lose it. This backing and forthing is characteristic of Hashimoto's.

What Causes It?

Hashimoto's disease is an autoimmune disorder. This means the body's own immune system creates antibodies which end up attacking and destroying the thyroid cells. Scientists are not sure what causes the immune system to attack the body in this way, but possible theories include:
Virus: A virus or bacterium could trigger the body to produce antibodies to fight the infection, and those antibodies end up attacking the body as well.
Genes: It may be that autoimmunity is passed down through the generations, particularly through the female line.
Pregnancy: Some women develop a temporary form of hypothyroidism after childbirth. In most cases it will clear, even without treatment. However about 20 percent go on to develop Hashimoto’s disease in later years. It seems that pregnancy may be a trigger in some women: Thyroid disease and pregnancy.
Iodine: Consuming too much iodine might trigger the disease in people who are prone to it. For more details see causes of thyroid disease.

What Are The Risk Factors?

Gender: Hashimoto's is 7 times more common in women than it is in men.
Age: It tends to start between the ages of 30 and 60, although it can occur in young women and teens.
Genes: It appears to run in families who have thyroid disease or other autoimmune diseases such as:
Type 1 diabetes.
Lupus.
Pernicious anemia.
Rheumatoid arthritis.
Vitiligo.
Addison's disease.

How Is It Diagnosed?

In the past doctors were not able to diagnose Hashimoto's until symptoms were more advanced. Now, due to the advent of more sensitive blood tests, it is possible to diagnose the condition earlier. Initially your doctor will perform a physical examination, looking for signs of neck swelling, dry skin and hair loss. He will ask you about your energy levels, if there have been any changes in your bowel movement and if you have been experiencing a hoarse voice. Laboratory blood tests will be necessary to make a clinical diagnosis (these are discussed in more detail in our article thyroid tests):
Hormone Tests: A sample of blood will be taken and sent to the lab to test for TSH and T4 hormone levels. If this is positive, an antibody test is usually ordered.
Antibody Test: A blood sample will be tested for the presence of certain antibodies associated with Hashimoto's disease. Some people can have the antibodies but still have normal thyroid function. Unless the antibodies are present in high amounts, your doctor cannot make a diagnosis of Hashimoto's. A higher concentration of the antibodies does not necessarily mean you are 'sicker' than someone else, it just means the condition is less likely to clear up naturally.

How Is It Treated?

If you test positive for Hashimoto antibodies, but your thyroid is still functioning normally, doctors may recommend a wait-and-see approach. If your thyroid is affected, you will need to start taking thyroid hormone replacement drugs, probably for the rest of your life. This is not as bad as it seems, it usually only involves taking one oral pill daily - usually levothyroxine (brand names Levoxyl, Levothroid and Synthroid). When you start treatment you should feel less exhausted quite quickly. The medication also helps to lower cholesterol levels and may help reverse weight gain. As your dosage requirements can change over time, you will need to have a blood test every 6 to 12 months check your TSH hormone levels. The dose may also need to be changed if you become pregnant, develop heart disease or start taking estrogen replacement therapy for treating menopause symptoms.

What Complications Can It Cause?

If you do not treat Hashimoto’s it can lead to problems such as:
Pregnancy: Infertility, miscarriages and babies being born with birth defects.
Heart: High cholesterol levels, increasing your heart attack risk factors.
Myxedema: An extreme case of hypothyroidism which goes untreated is called myxedema. It can lead to seizures, coma and even death.

How Is Hashimoto's Treated In Pregnant Women?

You should plan your pregnancy carefully if you have been pre-diagnosed with the condition. You will need to consult with both your OB/Gyn and endocrinologist. Levothyroxine is safe to continue taking during pregnancy but you may need to take a higher dose. You will have to be carefully monitored during your pregnancy trimesters and your thyroid function should be checked every 6 to 8 weeks. You can normally return to your pre-pregnancy dosage after delivery. Levothyroxine is not likely to pose problems to your baby if you breastfeed (although it does pass into breast milk).

Related Articles on Hashimoto's Thyroiditis

For more related issues, see the following:

• Thyroid Nodules : Lumps which appear on the front of the neck.
• Thyroid Cancer : Symptoms, Treatment and Prevention

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