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Hashimoto Thyroiditis: Causes, Symptoms and Treatment

Hashimoto thyroiditis is a chronic autoimmune disease of the thyroid gland in which the immune system attacks its own thyroid tissue, often leading to an underactive thyroid (hypothyroidism).

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Things worth knowing about "Hashimoto"

Hashimoto thyroiditis is a chronic autoimmune disease of the thyroid gland in which the immune system attacks its own thyroid tissue, often leading to an underactive thyroid (hypothyroidism).

What Is Hashimoto Thyroiditis?

Hashimoto thyroiditis, also known as chronic lymphocytic thyroiditis, is a chronic inflammatory condition of the thyroid gland caused by an immune system malfunction. The immune system produces antibodies that mistakenly target the body´s own thyroid tissue, leading to ongoing inflammation and progressive destruction of thyroid cells. The condition is named after Japanese physician Hakaru Hashimoto, who first described it in 1912. It is one of the most common causes of hypothyroidism (underactive thyroid) in developed countries.

Causes

The exact cause of Hashimoto thyroiditis is not fully understood. It is believed to result from a combination of factors:

Genetic predisposition: The condition tends to run in families, suggesting a hereditary component.
Hormonal factors: Women are significantly more affected than men, indicating a possible role of sex hormones.
Environmental triggers: Excessive iodine intake, viral infections, chronic stress, and smoking may contribute to the onset of the disease.
Other autoimmune conditions: People with Hashimoto thyroiditis have an increased risk of developing other autoimmune diseases such as type 1 diabetes or rheumatoid arthritis.

Symptoms

Symptoms of Hashimoto thyroiditis develop gradually and are often non-specific in the early stages. As the disease progresses, signs of an underactive thyroid typically become more prominent:

Persistent fatigue and exhaustion
Unexplained weight gain
Sensitivity to cold
Depression and difficulty concentrating
Dry skin and brittle hair or nails
Constipation
Slow heart rate (bradycardia)
Swelling in the neck area due to an enlarged thyroid gland (goiter)

In the early phases, some individuals may temporarily experience symptoms of an overactive thyroid, such as palpitations, anxiety, and weight loss -- a phase sometimes referred to as Hashitoxicosis.

Diagnosis

Diagnosis is established through a combination of clinical examination, blood tests, and imaging:

Blood tests: Measurement of TSH (thyroid-stimulating hormone), free thyroid hormones (fT3, fT4), and specific autoantibodies (TPO antibodies, thyroglobulin antibodies).
Thyroid ultrasound: A typical finding is an inhomogeneous, hypoechoic (darker than normal) appearance of the thyroid tissue.
Fine needle aspiration biopsy: Rarely needed, but may be used to rule out other thyroid conditions such as malignancy.

Treatment

There is currently no cure that addresses the underlying autoimmune process. Treatment focuses on managing symptoms and correcting hormone levels:

Thyroid hormone replacement: When hypothyroidism is confirmed, levothyroxine (synthetic T4) is prescribed to restore normal hormone levels. The dose is individually adjusted based on regular monitoring.
Regular follow-up: TSH levels and antibody titers should be monitored regularly to adjust treatment as needed.
Diet and lifestyle: A selenium-rich diet may help reduce antibody levels according to some studies. A gluten-free diet is recommended for those with concurrent celiac disease.
Stress management: Since stress can worsen autoimmune activity, relaxation techniques such as yoga or meditation may be beneficial.

Prognosis and Long-Term Outlook

Hashimoto thyroiditis is a lifelong condition, but it can be effectively managed with the right treatment. Many patients live normal, symptom-free lives with adequate thyroid hormone replacement therapy. Regular medical check-ups are essential, as hormone requirements may change over time.

References

Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4-5):391-397. PubMed PMID: 24434360.
Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459262/
World Health Organization (WHO): Thyroid disorders overview. Available at: https://www.who.int

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