Hashimoto Thyroiditis

Hashimoto Thyroiditis

I did not know too much about Hashimoto thyroiditis and I wanted to learn about something that I didn’t know a whole lot about. I knew basic things like patients have to take their medication, see their doctor, and if a female patient gets pregnant to see their doctor immediately.
Hashimoto’s disease is a disease known by many names. They are chronic lymphocytic thyroiditis, Hashimoto thyroiditis, and autoimmune thyroiditis. It was first discovered by a scientist named Hakaru Hashimoto. He was working at the Kyushu University when he first published his article in a German publication. Years later this paper was evaluated by American and English researchers as an independent disease. The American and English researchers then named it after him. (Wikipedia, 2012)
So to learn about this disorder one must first know what the thyroid actually does. The thyroid is one of the largest endocrine glands in the body. It’s found in the neck and is shaped like a butterfly. As a baby and as a child it is important for brain development. The hormones that the thyroid makes are triiodothyronine (T3) and thyroxine. They go to all of the body’s cells and see if they need more or less oxygen or nutrients. This directly effects metabolism by either stepping it up or slowing it down. These hormones also take a role in stimulating the hearts muscle contractions and nerve function, increasing the use of cholesterol and nutrients, normal growth and brain development. (Toothman, 2008)
Hashimoto disease is an autoimmune disease. That means that the body’s immune system sees the thyroid gland as an invader and it attacks it. This causes the thyroid gland to start to fail. So with Hashimoto thyroiditis it is different antibodies from the body that are attacking the thyroid peroxidase, thyroglobulin, and the TSH receptors. Although some patients may have none of these antibodies at all. While some people can have these antibodies without developing the disease. A big factor of Hashimoto thyroiditis is the antibody- dependent cell- mediated cytotoxicity. It is behind the apoptotic fall out of Hashimoto thyroiditis. The activation of the cytotoxic T- lymphocytes is the main reason that they destroy the epithelial cells of the thyroid. Macrophages are recruited with Th1. They then make the inflammatory cytokines in the thyroid. And over and over the process repeats it’s self-till the thyroid gland is ravaged and its function ability is decreased. (Wikipedia, 2013)
Before a patient is diagnosed with Hashimoto’s disease the patient may begin to notice symptoms or a patient may even be asymptomatic (meaning no symptoms). The symptoms for Hashimoto’s disease are fatigue, increased sensitivity to hot and cold, pale, dry skin, a puffy face, unexplained weight gain (only a few pounds), muscle stiffness in the joints, swelling in the knees, heavy or longer than normal periods, depression, memory loss, high cholesterol, bradycardia (slow heart rate), tachycardia (fast heart rate), vision problems, hair loss, and unable to or have difficulty having children. (Akamizu, 2013) The symptoms are vague and nonspecific. These symptoms can lead doctors to misdiagnose people. People can be misdiagnosed as having depression, cyclothymia (a type of depression that is similar to bipolar disorder), premenstrual syndrome, chronic fatigue syndrome, fibromyalgia, and rarely even an eating disorder and anxiety disorder. Being misdiagnosed can lead to serious consequences and even death. (Wikipedia)
How doctors find or diagnosis Hashimoto thyroiditis is by a patient going to their office. The doctor will give the patient a physical exam and take a history along with a list of their symptoms. The doctor will also take the patients’ blood to test. The test that the doctor will want run are a THS (this measures the thyroid stimulating hormone in the blood), T3 (used to diagnosed hypothyroidism and how bad it is), and T4 (which measures either the T4 bonded to a protein or the free T4 that is free in your blood). The normal value for the TSH test is .4 – 4.0 mlu/L. The higher the levels means hypothyroidism. The lower the level means Graves’ disease and toxic nodules, and a goiter. The normal values for the T3 test is 100 – 200 ng/dL. The lower the level could mean an illness, thyroiditis, or even starvation. The higher the level could mean pregnancy or overactive thyroid. The normal values for the T4 test are 4.5 – 11.2 mcg/dL. The higher the level could mean Graves’ disease, pregnancy, or sub-acute thyroiditis. The lower the level could mean hypothyroid, malnutrition, or illness. With the combination of the exam, the blood tests, and the history of symptoms, your doctor can come to the diagnosis of Hashimoto thyroiditis. (Labtestesonline, 2014)
In the past people went without medical intervention for a long time. The longer the patient went without medical treatment the more severe the patients’ symptoms are. But doctors now use the sensitive TSH test. This test can let the doctor know earlier and let the doctor figure out how much medication you need. If you do end up needing medication. The patient will have to have blood tests periodically to ensure that their level of medication is at its optimum levels in the blood. The medications that the patient may be put on are levothyroxine, triiodothyronine, or desiccated thyroid extract. The patient will just have to take a pill for the rest of their life. The patient will have to make sure that none of their other medication doesn’t interfere with their thyroid medication. Some of the medications that affect a person’s thyroid medication are iron supplements (even multivitamins), cholestyramine (a cholesterol lowering drug), Aluminum hydroxide (an ingredient found in antacids), Kayexalate, Sucralfate, and calcium supplements. Some thyroid medications have to be taken at certain time of day. And some of the medications have to be taken at least 4 hours before other medications. Or 1 hour before eating or 2 hours after eating.( Mayoclinic)
With all autoimmune disorders scientists are not really sure what causes the body to attack its self. They have noticed that it is largely seen in middle age women have noticed that Hashimoto Thyroiditis is seen in people who have a family history of the disease. Hashimoto Thyroiditis affects 1% to 5% of all adults in western countries. People with rheumatoid arthritis or lupus can have a higher risk of Hashimoto disease .Hashimoto thyroiditis can be but is rarely associated with other endocrine disorders like adrenal insufficiency and type 1 diabetes. When this happens it is called type 2 polygladular or PGA 2. (MedlinePlus, June 4, 2012)
If a patient does not take care of themselves when they are diagnosed with Hashimoto thyroiditis. There are many things that can happen. The patient can develop a goiter. This is when the thyroid gland gets so large to compensate. The goiter can cause problems with swallowing and breathing. A goiter is not life threatening but can affect how a person looks. Another thing that can happen is heart problems. This disease can cause an increase in the patient’s low-density lipoprotein (LDL) cholesterol or bad cholesterol if you will. If Hashimoto thyroiditis is left untreated is could cause an enlarged heart and rarely heart failure. Hashimoto thyroiditis can cause a decrease in sexual desire. It can also cause depression early in the disease progression that may become worse as the disease gets worse over time. Another effect is a slowed mental function. It can even affect your ability to have children if left unchecked long enough. A rare condition is myxedema. This can happen if you do not take care of you thyroid for a very long time. This condition is life threatening. A sign of this is the inability to withstand the colder temperatures, and tiredness. Then that is followed by extreme tiredness and unconsciousness. This is called a myxedema coma. It needs immediate emergency medical attention. A myxedema coma can be triggered by different things. Like stress on the body, sedatives, or infection. Hashimoto thyroiditis can cause an increased risk of birth defects. They may be born with mental or development problems. There is a connection between hypothyroid pregnancies and infants born with cleft palates, heart problems, brain, and even kidney problems. (Mayoclinic) (Women’s Health)
Your body does it’s best to maintain homeostasis. Hashimoto thyroiditis can wreak havoc with it. But overall the prognosis for any one diagnosed with this disease is that life can go on. All that person has to do is remember to get routine medical care though their family doctor and take their medication.

Sources:
Wikipedia (2014), Hashimoto Thyroiditis, retrieved June 5, 2014 from, http://en.wikipedia.org/wiki/Hashimoto%27s_thyroiditis
Mayo clinic, Hashimoto’s disease, retrieved June 5, 2014 from http://www.mayoclinic.org/diseases-conditions/hashimotos-disease/basics/definition/con-200
Medline (June 4, 2012) Chronic thyroiditis, retrieved June 5, 2014 from http://www.nlm.nih.gov/medlineplus/ency/article/000371.htm
Hashimoto disease fact sheet, retrieved June 5, 2014 from https://www.womenshealth.gov/publications/our-publications/fact-sheet/hashimoto-disease.html
Hashimoto lab test, retrieved June 5, 2014 from http://labtestsonline.org/understanding/conditions/hashimoto/
Akamizu,Takashi MD, PhD, Amino Nobuyuki MD, DeGroot, Leslie MD, December 20, 2013, Hashimoto thyroiditis, retrieved July 1, 2014 from http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
Toothman, Jessika. "Exactly why is your thyroid so important?" 05 November 2008. HowStuffWorks.com. 10 July 2014.