The term "Thyroiditis" refers to "inflammation of the thyroid gland". There are many potential causes of thyroiditis. Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is the most prevalent cause of hypothyroidism in the United States. It is an autoimmune disorder involving chronic inflammation of the thyroid. This disorder has a tendency to run in families. Over time, the ability of the thyroid gland to make thyroid hormones often becomes impaired and leads to a gradual decline in function and ultimately an underactive thyroid (Hypothyroidism). Hashimoto's thyroiditis occurs most frequently in middle-aged women, but can be seen at any age, and can also affect men and kids.
The thyroid gland is a butterfly-shaped endocrine gland that is usually located in the lower front of the neck. The thyroid's job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and various other organs working as they should.
Symptoms
There are no signs or symptoms that are unique to Hashimoto's thyroiditis.
Because the disorder usually progresses very slowly over many years, individuals with Hashimoto's thyroiditis might not have any symptoms early on, even when the characteristic thyroid peroxidase (TPO) antibodies are found in blood tests. TPO is an enzyme that plays a role in the production of thyroid hormones. If Hashimoto's thyroiditis causes cell damage resulting in low thyroid hormone levels, individuals will eventually develop symptoms of hypothyroidism. Hypothyroid symptoms might consist of fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle pains and lower exercise tolerance, and irregular or heavy menses. Sometimes, the inflammation causes the thyroid to become enlarged (goiter), which rarely may result in neck discomfort or difficulty swallowing.
Diagnosis
The diagnosis of Hashimoto's thyroiditis might be made when patients present with symptoms of hypothyroidism, often accompanied by a goiter (an enlarged thyroid gland) on physical examination, and laboratory testing of hypothyroidism, which is an elevated thyroid stimulating hormone (TSH) with or without a low thyroid hormone (Free thyroxine [Free T4] levels. TPO antibodies, when measured, are usually elevated.
Occasionally, the disease may be diagnosed early, particularly in individuals with a strong family history of thyroid disease. TPO antibodies may be positive, yet thyroid hormone levels might be regular or there might only be an isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism might be absent.
Treatment
Patients with elevated TPO antibodies but normal thyroid function tests (TSH and Free T4) do not need treatment. Individuals with just a slightly elevated TSH (mild hypothyroidism) may not require medication and should have repeat testing after 3-6 months if this has not already been done. For patients with overt hypothyroidism (elevated TSH as well as low thyroid hormone levels) treatment includes thyroid hormone replacement. Synthetic levothyroxine taken orally at an appropriate dose is inexpensive, very effective in restoring regular thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. Most individuals with Hashimoto's thyroiditis will require lifelong treatment with levothyroxine. Identifying the proper dose, particularly at the beginning, may require testing with TSH every 6-8 weeks after any dose adjustment until the proper dose is determined. After that, monitoring of TSH once a year is generally sufficient.
When levothyroxine is taken in the right dose, it has no side effects. However, when an inadequate dose is taken, serum TSH remains raised and individuals may have persistent symptoms of hypothyroidism. If the dose is too much, serum TSH will become suppressed and individuals might develop symptoms of hyperthyroidism or have other side effects.
