What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Lymphocytic Thyroiditis
• Hashimoto's Disease

What is Hashimoto’s Thyroiditis? (Definition/Background Information)

• Hashimoto’s Thyroiditis or Hashimoto’s Disease is an autoimmune condition that results in the body’s immune system attacking the thyroid gland. Damage to the thyroid gland results in a deficient production of thyroid hormone, consequently resulting in hypothyroidism
• The thyroid gland is a butterfly-shaped gland located in the front of the neck. It is responsible for secreting thyroid hormones (such as thyroxine) that monitor our body temperature, heart rate, blood pressure, and weight
• Since, Hashimoto’s Thyroiditis is a chronic condition, any damage to the thyroid gland leads to chronic hypothyroidism. This can result in several symptoms and complications, particularly if the condition is left undiagnosed and/or untreated
• Middle-aged women are reported to be more susceptible to Hashimoto’s Thyroiditis than individuals of any other age and gender. Some risk factors for developing the condition include a medical and/or family of other autoimmune conditions, smoking tobacco, excess consumption of iodine, and the use of certain drugs
• Generally, there are no specific signs and symptoms of Hashimoto’s Thyroiditis; however, if it results in hypothyroidism, then the condition may present an enlarged neck, weight gain, irritability, cold intolerance, dry skin, constipation, slow heartbeat, sweating, and fatigue
• Thyroid hormone replacement is the most effective treatment for Hashimoto’s Thyroiditis, when hypothyroidism is observed. There are no known preventative measures for this condition. However, Hashimoto’s Thyroiditis may remain stable for many years without worsening of the signs and symptoms with appropriate management of the condition

Who gets Hashimoto’s Thyroiditis? (Age and Sex Distribution)

• The prevalence of Hashimoto’s Thyroiditis is reportedly between 3 to 15 cases per 10,000 individuals annually
• Individuals of any age may be affected, but commonly the condition is noted during middle-age
• Females have a much higher incidence of the condition than males; per literature, the female-male ratio ranges from between 4:1 to 10:1
• Young teens and adult women also present Hashimoto’s Thyroiditis; however, a majority of the cases affect women in the 40-60 years’ age group
• All racial and ethnic groups may be affected

What are the Risk Factors for Hashimoto’s Thyroiditis? (Outcomes/Resolutions)

Some risk factors known to be associated with Hashimoto’s Thyroiditis include:

• Female gender, particularly middle-aged women
• Presence of other autoimmune conditions such as:
  • Celiac disease
  • Rheumatoid arthritis (RA)
  • Systemic lupus erythematosus (SLE)
  • Type 1 diabetes
  • Vitamin B12 deficiency anemia
• Family history of autoimmune or other thyroid conditions
• High iodized salt intake
• Smoking history
• Excessive exposure to radiation
• Postpartum thyroiditis is known to increase the risk for Hashimoto’s Disease
• Use of certain medications
• Viral infections

Hashimoto’s Thyroiditis is known to be associated with another endocrine abnormality, namely autoimmune polyglandular syndrome type 2, which are a group of conditions that include Addison’s disease, hypogonadism, and type 1 diabetes.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hashimoto’s Thyroiditis? (Etiology)

• Hashimoto’s Thyroiditis is caused by the dysregulation of an individual’s own immune system. The immune system creates antibodies, which destroy the thyroid gland, resulting in thyroid hormone deficiency and manifestations of symptoms. Since the involvement of lymphocytes (a type of white blood cells) are noted, the condition is also known as Chronic Lymphocytic Thyroiditis
• Hashimoto’s Thyroiditis is the most common cause of primary hypothyroidism in many parts of the world. According to medical experts, a complex interaction of genetic, immune, and environmental factors are responsible for the development of Hashimoto’s Thyroiditis
• Some of the triggering factors that are reported for the development of Hashimoto’s Disease, apart from one’s genetic susceptibility, includes a high intake of iodine, pregnancy, occupational exposure to ionizing radiation, infections, sex hormones, stress, and female gender

What are the Signs and Symptoms of Hashimoto’s Thyroiditis?

In many cases, during the early stages of Hashimoto’s Thyroiditis, there are no signs and symptoms. The condition progresses gradually and no specific symptoms unique to the condition are reported. However, following the onset of hypothyroidism, an associated set of signs and symptoms may be noted, which include:

• Enlarged or swollen thyroid gland; small or shrunken thyroid gland (late in the disease); large-sized thyroid gland may present swallowing difficulties and neck discomfort
• Difficulty concentrating or thinking
• Fatigue and tiredness
• Dry skin
• Hair loss, which may be in excess while showering
• Constipation or difficult bowel movements
• Weight gain that may be slow and gradual
• Heavy and irregular periods (in women)
• Abnormal sensitivity to cold; the affected individuals may not tolerate cold very well
• Decreased tolerance to exercises

How is Hashimoto’s Thyroiditis Diagnosed?

Hashimoto’s Thyroiditis develops slowly, and it may not be clinically apparent for many months or years. The diagnosis of this disorder generally involves the following tests and procedures:

• Complete evaluation of medical history and a thorough physical examination
• Assessment of the signs and symptoms
• Blood tests to evaluate the levels of:
  • T3 and T4; thyroid hormones produced in the thyroid gland
  • Serum TSH (thyroid stimulating hormone)
  • Antithyroid peroxidase antibody (anti-TPO); antibodies against thyroid peroxidase, an enzyme in the thyroid gland
  • Antithyroglobulin antibody; antibodies interacting with thyroglobulin, a protein found on the thyroid cells
• Ultrasound scans of the thyroid gland
• Fine needle aspiration (FNA) biopsy or core biopsy of the thyroid gland, if needed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hashimoto’s Thyroiditis?

The potential complications of Hashimoto’s Thyroiditis that generally arise from severe hypothyroidism include:

• Simultaneous development of other autoimmune disorders
• Severe mental health issues
• Infertility
• There is an elevated risk for heart diseases, including heart failure
• Pregnant women are at an increased risk for miscarriage
• High blood pressure during pregnancy or pre-eclampsia
• Infertility
• Fetal death
• Jaundice, poor muscle tone, large-sized head, feeding problems, umbilical hernia, and poor physical and mental development in newborns
• Birth defects in newborn children
• Premature birth and low birth weight
• Myxedema coma: A medical emergency caused by severely deficient levels of thyroid hormones
• In some rare cases, the development of thyroid cancer such as thyroidal lymphoma

How is Hashimoto’s Thyroiditis Treated?

The treatment of Hashimoto’s Thyroiditis depends on the presence or absence of hypothyroidism (causing a deficiency in thyroid hormone production).

• When hypothyroidism is absent: Patients are generally monitored for the progression of the disease and development of hypothyroidism
• When hypothyroidism is present: Thyroid hormone replacement therapy may be considered

Apart from the above, the following measures may be considered:

• Symptomatic treatment through medications; bringing about certain lifestyle changes (food, exercise, and stress control)
• Considering early adequate treatment of autoimmune disease, genetic conditions, and infections associated with Hashimoto’s Disease
• A careful and periodic monitoring of pregnancy (including close fetal monitoring) is advised and recommended

How can Hashimoto’s Thyroiditis be Prevented?

Currently, no effective preventive methods have been reported for Hashimoto’s Thyroiditis. However, early detection, prompt treatment, and regular monitoring of the condition can help combat the disorder and keep its progression under control.

The following factors may be considered to reduce the risk for Hashimoto’s Thyroiditis:

• Knowledge about one’s family history is helpful in assessing future risks for the condition
• Smoking cessation
• Avoiding nutritional (iodine) deficiencies through proper dietary control
• Early detection and prompt treatment of causative conditions

Regular medical screening at periodic intervals with tests and physical examinations are necessary, especially for pregnant women.

What is the Prognosis of Hashimoto’s Thyroiditis? (Outcomes/Resolutions)

• The prognosis of Hashimoto’s Thyroiditis is generally good with proper treatment and regular check-ups
• Even though this thyroid disorder is a chronic condition, it can remain stable for many years with adequate and sustained treatment (lifelong thyroid replacement medication)

Additional and Relevant Useful Information for Hashimoto’s Thyroiditis:

Healthcare providers generally term this condition as Hashimoto’s Thyroiditis, if there is a swollen thyroid gland associated with it. If the thyroid gland is shrunken, then the condition is called atrophic thyroiditis.