Hashimoto's Disease: The Silent Enemy of the Thyroid Gland

Hashimoto's disease is the most common form of autoimmune disorder affecting the function of the thyroid gland, an organ that plays a key role in regulating metabolism. Although many people are unaware that they suffer from this disease, symptoms such as fatigue, unexplained weight gain, or feeling cold may indicate its onset. Hashimoto's disease gradually reduces the ability of the thyroid gland to produce hormones necessary for the proper functioning of the body, which can lead to serious consequences if not recognized and treated in time. In this text, we will explore the causes, symptoms, diagnosis, and treatment of Hashimoto's disease, so that you can better understand this condition and how to manage it.

What is Hashimoto's disease?

Hashimoto's disease, also known as Hashimoto thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis, is an autoimmune disease that can cause reduced thyroid function (hypothyroidism) and, in rare cases, increased function (hyperthyroidism) (NIDDK, n.d.). It is named after Hakaru Hashimoto, a Japanese doctor who first described this condition in 1912 (Dunkin, 2023).

In people with Hashimoto's disease, the immune system attacks the thyroid gland, which is located at the front of the neck and produces hormones that regulate metabolism, i.e., how the body uses energy. These hormones affect many processes in the body, including heart rate and how the body burns calories from food. When the thyroid gland does not produce enough hormones, it can lead to hypothyroidism, a condition in which the body does not receive the necessary amount of hormones for proper functioning (Dunkin, 2023).

The exact cause of the disease is not fully understood, but it is believed that many factors can contribute to its onset, including:

• Genes – People with Hashimoto's disease often have family members who suffer from thyroid diseases or other autoimmune disorders, suggesting that genes may play a significant role in the development of the disease.
• Infectious diseases – A virus or bacteria may trigger an immune system reaction, causing it to attack its own body.
• Environmental factors – Factors such as stress or excessive exposure to radiation may also contribute to the development of this disease (Dunkin, 2023).

Risk factors

Gender – Hashimoto's disease affects women about seven times more often than men, suggesting that sex hormones may play a role in the development of the disease. Also, many women experience thyroid issues in the first year after childbirth. Although these problems usually disappear, as many as 20% of those women develop Hashimoto's disease several years later.

Age – Although Hashimoto's disease can occur at any age, it most commonly affects women between the ages of 30 and 50.

Other autoimmune diseases – If you already have another autoimmune disease, such as rheumatoid arthritis, lupus, or type 1 diabetes, the risk of developing Hashimoto's disease is increased. This is linked to genetic factors and immune system dysfunction.

Excessive iodine intake – Although iodine is essential for thyroid hormone production, excessive intake can act as a trigger for disease development in individuals already prone to thyroid problems. Also, certain medications can increase the risk of developing the disease.

Exposure to radiation – An increased number of thyroid disease cases has been reported in people exposed to radiation, including those who survived atomic bombings in Japan, the Chernobyl disaster, and those who received radiation as treatment for Hodgkin's disease. This exposure can have long-term effects on the thyroid gland (Mayo Clinic Staff, 2022; Dunkin, 2023).

All these factors suggest that Hashimoto's disease does not occur due to one single reason but is the result of a complex relationship between genetics, lifestyle, and the external environment.

Symptoms

The symptoms of Hashimoto's disease are usually mild and develop gradually. The first sign is often an enlargement of the thyroid gland – goiter, which causes swelling in the neck and, in severe cases, difficulty swallowing (Mayo Clinic Staff, 2022). Although it is usually painless, goiter can cause a sensation of fullness in the throat. After many years, damage to the gland may lead to its shrinkage and disappearance of the goiter (NIDDK, n.d.).

Although Hashimoto's disease initially often does not show any symptoms, as the disease progresses, one or more symptoms of hypothyroidism may appear (NIDDK, n.d.). The lack of thyroid hormones (hypothyroidism) slows many body functions, and symptoms develop gradually and are often mistaken for depression, especially in older individuals:

• Facial expressions become lifeless, the voice becomes hoarse, and speech becomes slow;
• Eyelids droop, and the face and eyes may appear swollen;
• Hair becomes thin, coarse, and dry;
• Skin becomes dry, scaly, and thickened;
• People with hypothyroidism often feel fatigued, gain weight, suffer from constipation, and are unable to tolerate the cold;
• Muscle cramps, tingling in the hands (due to carpal tunnel syndrome), and a slowed pulse may occur;
• Carotenemia (slight orange tint to the skin);
• Loss of the outer parts of the eyebrows;
• Older individuals may show symptoms such as confusion and forgetfulness, which can be confused with dementia;
• Women with hypothyroidism may notice changes in menstrual cycles;
• Elevated cholesterol levels in the blood (Boucai, 2024).

A small number of people with an overactive thyroid (hyperthyroidism) may show symptoms that reflect the speeding up of body functions, such as:

• Increased heart rate and blood pressure;
• Palpitations due to abnormal heart rhythms (arrhythmias);
• Excessive sweating and feeling too warm;
• Hand tremors (shakiness);
• Nervousness and anxiety;
• Difficulty sleeping (insomnia);
• Weight loss despite increased appetite;
• Increased activity level despite fatigue and weakness;
• Frequent bowel movements, occasionally with diarrhea;
• Change in menstrual periods in women (Boucai, 2024).

Possible complications

Thyroid hormones are crucial for many body functions, so untreated Hashimoto's disease and hypothyroidism can lead to serious complications, such as:

• Goiter – Enlargement of the thyroid gland due to reduced hormone secretion, which can make swallowing and breathing difficult.
• Heart problems – Hypothyroidism can lead to poor heart function, enlarged heart, irregular heartbeats, and elevated LDL cholesterol, increasing the risk of cardiovascular disease.
• Mental problems – Depression and other mental disorders may occur and worsen over time. Sexual and reproductive dysfunction – In women, decreased libido, irregular menstruation, and ovulation problems; in men, decreased libido and erectile dysfunction.
• Poor pregnancy outcomes – Hypothyroidism can increase the risk of miscarriage, premature birth, and developmental problems in babies, such as reduced intelligence or autism.
• Myxedema – Severe, untreated hypothyroidism can lead to myxedema coma, a condition requiring emergency medical attention (Mayo Clinic Staff, 2022).

Diagnosis and treatment

Doctors diagnose Hashimoto's disease based on:

• Medical history and physical examination – The doctor will first collect your medical history and perform a physical exam. In addition to checking symptoms, the doctor will examine if you have a goiter.
• Blood tests – The doctor will perform one or more blood tests to check for hypothyroidism and its causes. Examples of tests include: thyroid hormones T4 (thyroxine) and T3 (triiodothyronine), TSH (thyroid-stimulating hormone), and antibodies to thyroperoxidase (TPO), which are present in most people with Hashimoto's disease.
• If the doctor suspects Hashimoto's disease but does not find antibodies in the blood, they may recommend a thyroid ultrasound. Ultrasound can show the size of the thyroid gland and other characteristics of the disease, and it can also exclude other causes of an enlarged gland, such as nodules (NIDDK, n.d.)

Treatment for Hashimoto's disease depends on the degree of thyroid damage, i.e., the presence of hypothyroidism. In the case of mild hormone disorder, the doctor may not prescribe medication but will monitor symptoms and thyroid hormone levels. If you have hypothyroidism, treatment consists of thyroid hormone replacement therapy, which the doctor adjusts according to your age, weight, degree of hypothyroidism, and other health factors. The doctor then monitors the therapy and adjusts it as needed. Treatment is lifelong, as there is no cure for Hashimoto's disease. Due to the slow action of hormones, it may take several months for symptoms to disappear and the goiter to shrink. If the goiter remains large, surgery may be required (Dunkin, 2023).

It is possible that symptoms may worsen with therapy, especially while the doctor is trying to find the correct dose. Causes may be physical (such as infections) or emotional (such as stress, insomnia, or life changes). Worsening symptoms include fatigue, insomnia, irritability, and rapid heart rate. Some recommendations if symptoms worsen include:

• Take medications regularly.
• Follow an anti-inflammatory diet rich in fruits, vegetables, lean meats, and fatty fish. Avoid processed meats and sodas.
• Monitor iodine levels in your diet, as excessive intake may worsen symptoms.
• Reduce stress and ensure enough rest.
• Consult your doctor about possible supplementation with vitamin D and selenium (Ibid).

Hashimoto's disease is a subtle yet serious autoimmune disorder that gradually impairs thyroid function. Early detection and proper treatment are crucial to preventing complications and maintaining quality of life. With the right therapy, people with Hashimoto's disease can live a healthy and balanced life. Regular monitoring and a healthy lifestyle play a key role in effectively managing this condition.

*This text is intended for informational purposes only. In case of any symptoms, it is recommended to seek advice from your doctor or a qualified healthcare professional.

References:

• National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]. (n.d.). Hashimoto’s disease. National Institutes of Health. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease
• National Cancer Institute. (2020, March 18). Couple clasping hands. Unsplash. https://unsplash.com/photos/person-wearing-gold-wedding-band-BxXgTQEw1M4
• Mayo Clinic Staff. (2022, January 15). Hashimoto's disease symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
• Dunkin, M. A. (2023, October 26). Hashimoto's thyroiditis: Symptoms, causes, treatments. WebMD. https://www.webmd.com/women/hashimotos-thyroiditis-symptoms-causes-treatments
• Boucai, L. (2024, February). Hyperthyroidism (Thyrotoxicosis, including Graves Disease). In MSD Manual. Retrieved April 2024, from https://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/thyroid-gland-disorders/hyperthyroidism