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Hashimoto's Thyroiditis

What is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis (also called autoimmune or chronic lymphocytic thyroiditis) is the most common thyroid disease in the United States. It is an inherited condition that affects approx imately 14 million Americans and is about 7 times more common in women than in men. Hashimoto’s thyroiditis is characterized by the production of immune cells and auto anti bodies by the body’s immune system, which can damage thyroid cells and compromise their ability to make thyroid hormone. Hypo thy roidism occurs if the amount of thyroid hormone which can be produced is not enough for the body’s needs. The thyroid gland may also enlarge in some patients, forming a goiter.

Symptoms of Hashimoto’s thyroiditis

Many patients with Hashimoto’s thyroiditis may have no symptoms for many years, and the diag no sis is made incidentally when an enlarged thy roid gland or abnormal blood tests are discover ed as part of a routine examination.

When symptoms do develop, they are either related to local pressure effects in the neck caused by the goiter itself, or to the low levels of thyroid hormone. The first sign of this disease may be painless swelling in the lower front of the neck. This enlargement may eventually become easily visible and may be associated with an uncomfortable pressure sensation in the lower neck. Left untreated, a person may begin to have trouble swallowing or even breathing.

Although many of the symptoms associated with thyroid hormone deficiency occur commonly in patients without thyroid disease, patients with Hashimoto’s thyroiditis who develop hypothyroidism are more likely to experience the following:

Hashimoto's Thyroiditis

  • Fatigue
  • Drowsiness
  • Forgetfulness
  • Difficulty with learning
  • Dry, brittle hair and nails
  • Dry, itchy skin
  • Puffy face
  • Constipation
  • Sore muscles
  • Weight gain
  • Heavy menstrual flow
  • Increased frequency of miscarriages
  • Increased sensitivity to many medications

The thyroid enlargement and/or hypo thyroidism caused by Hashimoto’s thyroiditis tends to progress in many patients, causing a slowor sening of symptoms. Therefore, patients with either of these findings should be recog nized and adequately treated with thyroid hor mone. Optimal treatment with thyroid hor mone will eliminate any symptoms due to thyroid hor mone deficiency, usually prevent further thy roid enlargement, and may some times cause shrinkage of an enlarged thyroid gland.

Treatment for Hashimoto’s thyroiditis ?

For patients with thyroid enlargement (goiter) or hypothyroidism, thyroid hormone therapy is clearly needed, since proper dosage corrects any symptoms due to thyroid hormone deficiency and may decrease the goiter’s size. Treat ment consists of taking a single daily tablet of levothyroxine. Older patients who may have underlying heart disease are usually started on a low dose and gradually increased, while young er healthy patients can be started on full replacement doses at once.

Thyroid hormone acts very slowly in the body, so it may take several months after treatment is started to notice improve ment in symptoms or goiter shrinkage. Because of the generally permanent and often progressive nature of Hashimoto’s thyroiditis, it is usually necessary to treat it through out one’s lifetime and to realize that medicine dose requirements may have to be adjusted from time to time.

Optimal adjustment of thyroid hormone dosage, based on laboratory tests rather than symptoms, is critical, since the body is very sensitive to even small changes in thyroid hormone levels. The tablets come in over 10 different strengths, and it is essential to take them in a consistent manner every day. If the dose is not adequate, the thyroid gland may continue to enlarge and symptoms of hypo thyroidism will persist, and may be associated with increased serum cholesterol levels, which may increase the risk for atherosclerosis and heart disease. If the dose is too strong, it can cause symptoms of hyper thyroidism, creating excessive strain on the heart and an increased risk of developing osteoporosis.

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