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What is Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis develops due to the negative reaction of the immune system against the cells of the thyroid gland, causing destruction. It is among the most common causes of hypothyroidism, after iodine intake deficiency. In Hashimoto’s thyroiditis, antibodies attacking the thyroid tissue cause tissue destruction and fibrosis. Thyroid hormone production decreases in areas where fibrosis develops.
Hashimoto’s thyroiditis can sometimes be a part of the autoimmune disease complexes seen in other organs of the body. In particular, it can be part of MEN Type 2. Therefore, it may be necessary to investigate other possible diseases. It may even be associated with pernicious anemia, adrenal insufficiency and celiac disease.
Hashimoto’s thyroiditis is 4 times more common in women. It is thought to develop due to genetic susceptibility at a rate of 80% and environmental factors at a rate of 20%.
In Hashimoto’s disease, the amount of lymphocyte cells in the thyroid gland increases. As a result of the immune reaction of lymphocytes to the thyroid gland, fibrosis develops in the thyroid tissue. Thyroid tissues, whose normal integrity is disrupted, become unable to produce thyroid hormone. Therefore, the patient develops hypothyroidism.
Symptoms and diagnosis of Hashimoto’s thyroiditis:
In Hashimoto’s patients, findings related to immune reaction are seen. As thyroid hormones decrease, the level of TSH hormone, which stimulates thyroid hormone secretion, has increased. In addition, antibody elevations due to this immune reaction may also be seen in the blood. Especially in the acute active phase, high levels of antithyroid peroxidase (anti-TPO) antibodies can be observed in the blood.
Thyroid imaging shows that the thyroid gland enlarges symmetrically, the thyroid capsule remains intact, and there is no necrosis or calcification.
The manifestations of Hashimoto’s disease in tissues and organs are variable. In the initial stages of the disease, thyroid hormones in the thyroid tissues are released into the blood due to the excessive destruction of the thyroid tissues. Even hyperthyroidism exacerbations may occur in patients during this release phase. In later stages, this oscillation ends and patients may develop symptoms of hypothyroidism.
A rare but distinctive feature of hypothyroidism due to Hashimoto’s thyroiditis is edema due to glycosaminoglycan accumulation in the tissues. It is seen in rare and severe cases. Dry skin may also occur. Hair may be dry, coarse, dull and brittle. Sometimes alopecia may also develop.
Since the pump power of the heart will decrease due to the development of hypothyroidism, the heartbeat may slow down. Fatigue, exertional dyspnea, goose weakness and weakness can be seen in these patients.
In Hashimoto’s thyroiditis, sometimes the symptoms may not be felt very much. It may be lighter. In the early period, patients may express constipation, fatigue, dry skin and weight gain. In the following periods, symptoms such as neck pressure symptoms, hoarseness become evident due to cold intolerance, decreased sweating, peripheral neuropathy, decreased energy, depression, dementia, memory loss, muscle cramps, joint pain, hair loss, apnea, menorrhagia and goiter growth.
Diagnosis of Hashimoto’s thyroiditis starts by examining the thyroid hormone profile. Generally, TSH is elevated and T3, T4 is low. Anti-thyroid peroxidase and anti-thyroglobulin antibodies are elevated. However, in 10% of patients these antibodies may be negative.
In some patients, kidney function may also be impaired. Anemia may be seen in the blood. Prolactin levels may be elevated.
Thyroid ultrasonography can also be performed in Hashimoto’s thyroiditis. Ultrasonography evaluates thyroid size, echo tissue, and presence of thyroid nodules.
Treatment of Hashimoto’s thyroiditis:
In the hypothyroid phase of Hashimoto’s thyroiditis, the symptoms of hypothyroidism can be suppressed by external thyroid hormone replacement. For hyperthyroidism that develops in the early stages, antithyroid treatment can be applied if necessary, depending on the thyroid hormone level and clinical symptoms.
An appropriate daily dose of levothyroxine is sufficient for hypothyroidism. Levothyroxine should be drunk alone so that absorption does not decrease. Especially drugs that reduce stomach acid can make absorption insufficient. It may be necessary to increase the dose of levothyroxine in pregnant women and patients with short bowel syndrome.
Autoimmune gastritis cases are also seen in approximately one third of Hashimoto’s thyroiditis patients. Even iron deficiency anemia may develop due to gastritis. Thyroid hormone levels should be monitored in patients given levothyroxine. In addition, it may be necessary to repeat the neck examination periodically against the risk of lymphoma development in Hashimoto patients.