What is Hashimoto`s thyroiditis?
The thyroid is a small, butterfly-shaped gland in the front of your neck. Hashimoto thyroiditis (HT), also known as chronic autoimmune thyroiditis or chronic lymphocytic thyroiditis, is an autoimmune disease that leads to the destruction of thyroid follicular cells through immune-mediated processes. As a result, large numbers of white blood cells which are part of the immune system, build up in the thyroid eventually causing fibrosis and dysfunction of the gland.
This condition was initially described by a Japanese physician, Haruto Hashimoto, in 1912 as "struma lymphomatosa" after he found enlarged thyroids having lymphocytic infiltration.
Who gets HT?
Women are more commonly affected. The female-to-male ratio is at least 7 to 10:1. The incidence of HT increases with age, with most cases found between ages 45 and 55 years. The incidence tends to be higher in countries with a lower prevalence of iodine deficiency. HT can occur alone, or it can occur as a part of autoimmune polyglandular syndrome (APS). Some individuals with Graves disease might transform into HT and vice versa. This could indicate a common pathogenesis for these disorders but different clinical presentations.
Almost 10% of the population in the United States has been shown to have positivity for thyroid antibodies. HT is the most common cause of hypothyroidism in the United States and in those areas of the world where dietary iodine intake is adequate. A systematic review and meta-analysis, including studies from multiple countries, found the overall global prevalence of HT to be 7.5%, higher in low-middle-income areas at 11.4%. Additionally, the prevalence in women was 4 times that in men. (https://www.ncbi.nlm.nih.gov/books/NBK459262/)
What are the causes of HT?
What causes the immune system to attack thyroid cells is not clear, however disease onset may be related to:
People with following conditions are at an increased risk of getting Hashimoto's thyroiditis:
What are the symptoms of HT?
Goitre is a first common sign which appears in HT, with enlargement of the thyroid gland. It can create a feeling of fullness in your lower neck with appearance of swelling. With further disease progression, hypothyroidism can cause following symptoms over time:
Tiredness, fatigue, lethargy and excessive sleeping
How is HT diagnosed?
How is HT treated?
Not everyone with Hashimoto’s disease develops hypothyroidism. The mainstay of treatment for hypothyroidism that develops due to Hashimoto thyroiditis is thyroid hormone replacement.
Titrated levothyroxine sodium has a half life of 7 days and is typically prescribed to be taken once per day orally. It is best taken early in the morning on an empty stomach for optimum absorption, should not be taken with iron or calcium supplements, aluminium hydroxide, and proton pump inhibitors to avoid suboptimal absorption.
There is little evidence supporting the role of alternative therapies to regulate immune function. Strong evidence supports the role of balanced diet, adequate sleep, regular exercise and managing stress for helping alleviate symptoms and coping with hypothyroidism.