Hashimoto’s Thyroiditis

The term “Thyroiditis” refers to “inflammation of the thyroid gland”. There are many potential causes of thyroiditis. Hashimoto’s thyroiditis, also called chronic lymphocytic thyroiditis, is the most prevalent cause of hypothyroidism in the United States. It is an autoimmune disorder consisting of chronic inflammation of the thyroid. This condition has a tendency to run in families. Over time, the ability of the thyroid gland to make thyroid hormones often becomes damaged and results in 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 found 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.

Since the condition typically progresses really slowly over several years, people with Hashimoto’s thyroiditis may 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 leading to low thyroid hormone levels, patients 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 reduced exercise tolerance, and irregular or heavy menses. In some cases, the inflammation causes the thyroid to become enlarged (goiter), which seldom may cause neck discomfort or difficulty swallowing.

Diagnosis

The diagnosis of Hashimoto’s thyroiditis might be made when individuals 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.

Sometimes, the disease might be diagnosed early, especially in people with a strong family history of thyroid disease. TPO antibodies might be positive, yet thyroid hormone levels might be regular or there may only be isolated mild elevation of serum TSH is seen. Symptoms of hypothyroidism might be missing.

Treatment

Patients with elevated TPO antibodies but regular thyroid function tests (TSH and Free T4) do not need treatment. Individuals with only a slightly elevated TSH (mild hypothyroidism) might not require medication and should have repeat testing after 3-6 months if this has not already been done. For individuals with overt hypothyroidism (elevated TSH and low thyroid hormone levels) treatment includes thyroid hormone replacement. Synthetic levothyroxine taken by mouth at an appropriate dose is affordable, very effective in restoring regular thyroid hormone levels, and results in an improvement of symptoms of hypothyroidism. The majority of people with Hashimoto’s thyroiditis will need lifelong treatment with levothyroxine. Finding the right dose, especially at the beginning, may require testing with TSH every 6-8 weeks after any dose adjustment until the proper dose is determined. Afterward, monitoring of TSH once a year is generally sufficient.

When levothyroxine is taken in the proper dose, it has no side effects. However, when an insufficient dose is taken, serum TSH remains elevated and individuals might 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.

For further information about Dr. Stengler’s practice and his clinic in San Diego, California, please visit our website at MarkStengler.com or give us a call at (760) 274-2377