Table of Contents > Allergies > Hashimoto's thyroiditis Print

Hashimoto's thyroiditis

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Related Terms
  • Autoantibodies, autoimmune, autoimmune disease, autoimmune disorder, autoimmunity, goiter, FANA, fluorescent antinuclear antibody test, chronic thyroiditis, Hashimoto's disease, hormone replacement therapy, hormones, HRT, hypothyroidism, immune, immune defense system, immune system, myxedema, thyroid, thyroid gland, thyroid hormone, thyroidectomy, thyroxine, underactive thyroid, white blood cells.

Background
  • Hashimoto's thyroiditis, also called autoimmune thyroiditis or Hashimoto's disease, occurs when the immune system attacks the patient's thyroid gland, causing the thyroid to swell. The thyroid gland, located in the neck, produces a hormone called thyroxine that controls growth and the rate at which the body uses energy (metabolism).
  • Hashimoto's thyroiditis is a type of autoimmune disorder. In healthy individuals, the immune system fights off harmful invaders, such as bacteria and viruses, which cause infections and disease. Autoimmune disorders occur when the immune system attacks body cells because they are mistaken for harmful invaders. Autoimmune disorders can destroy body tissues, cause abnormal organ growth, and/or impair organ function.
  • The inflammation caused by Hashimoto's disease often leads to an underactive thyroid gland, called hypothyroidism. When hypothyroidism develops, another gland in the body, called the pituitary gland, releases hormones to stimulate the thyroid to release more hormones. This may lead to an enlarged thyroid gland called a goiter.
  • With treatment, patients are able to live normal, healthy lives. Patients receive medications called hormones for the rest of their lives to make up for the underactive thyroid. Some patients may need to have their thyroid gland surgically removed. With lifelong hormone supplementation, these patients are also able to live normal, healthy lives.
  • Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States. Although the condition can develop at any age, it is most common among middle-aged women.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Thyroid Association. . Accessed March 29, 2009.
  2. Carli AF, Lottini M, Testa M, et al. Surgical treatment of Hashimoto's thyroiditis. Minerva Chir. 2002 Apr;57(2):117-22. .
  3. Hidaka Y. Chronic thyroiditis (Hashimoto's disease. Nippon Rinsho. 2005 Oct;63 Suppl 10:111-5. .
  4. Kasagi K. Painful Hashimoto's thyroiditis. Intern Med. 2006;45(6):351-2. Epub 2006 Apr 17. .
  5. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed March 29, 2009.
  6. Thomas CG Jr, Rutledge RG. Surgical intervention in chronic (Hashimoto's) thyroiditis. Ann Surg. 1981 Jun;193(6):769-76. .
  7. Thyroid Foundation of America. . Accessed March 29, 2009.

Causes
  • Hashimoto's thyroiditis occurs when the patient's immune system starts to attack the thyroid gland. Researchers have not discovered why the immune system mistakes the thyroid for a harmful invader, such as a virus. It has been suggested that many factors lead to the disorder, including age, heredity, and gender. This is because the condition is most common among middle-aged women. It also common among biological family members.

Symptoms
  • Symptoms of Hashimoto's thyroiditis develop when the condition prevents the thyroid from producing sufficient levels of thyroid hormone. Patients may experience no or minimal symptoms for several years because the disease progresses slowly. Without treatment, symptoms will continue to worsen. The most obvious sign of severe hypothyroidism is a goiter. A goiter is a severe swelling of the thyroid gland in the front of the neck.
  • Common symptoms include sensitivity to cold temperatures, mild weight gain, fatigue, constipation, small thyroid gland, enlarged neck, dry skin, hair loss, muscle cramps, heavy and irregular menstruation, and difficulty thinking or concentrating. Less common symptoms main include facial swelling and joint stiffness.

Diagnosis
  • Blood test: A blood test that measures the amount of thyroid hormone in the blood is the standard diagnostic test for an underactive thyroid. If the patient has low levels of thyroid hormone in the blood, the patient is diagnosed with hypothyroidism.
  • Fluorescent antinuclear antibody (FANA) test: The fluorescent antinuclear antibody (FANA) test may be performed to detect abnormal antibodies, called autoantibodies. The autoantibodies bind to components of an individual's own cells and cause the immune system to attack the body.
  • During the procedure, a small sample of blood is taken from the patient and sent to a laboratory. The scientist adds methyl alcohol to a microscope slide that contains human tissue culture cells. This makes the cells permeable before they are combined with the patient's blood.
  • Then the patient's blood is added to the microscope slide. Fluorescent antibodies that detect the binding of human antibodies to the cells are also added. The scientist uses a fluorescent microscope to view the staining intensity and binding pattern of the cells. If autoantibodies are detected, a positive diagnosis is made for an autoimmune disorder.
  • If a patient has a positive FANA result and has low levels of thyroid hormone in the blood, Hashimoto's thyroiditis is diagnosed.

Treatment
  • General: Once patients with Hashimoto's thyroiditis shown signs of an underactive thyroid (hypothyroidism), they receive man-made hormones to make up for the decreased hormone levels. Treatment is life-long. Some patients may need to have their thyroid gland surgically removed. These patients will need to take hormones for the rest of their lives, but they are able to live normal, healthy lives.
  • Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment. For instance, a blood pressure drug called cholestyramine (Questran®), an ingredient in some antacids called aluminum hydroxide, sodium polystyrene sulfonate (Kayexalate®), an ulcer drug called sucralfate (Carafate®), iron supplements, calcium supplements, and soy may interact with treatment.
  • Hormone replacement therapy (HRT): Patients receive thyroid hormone replacement therapy with levothyroxine (Levothroid®, Levoxyl®, Synthroid®, or Unithroid®). This man-made hormone is identical to the natural thyroid hormone called thyroxine. The medication is taken by mouth every day for life to help the body return to normal functioning.
  • Patients should visit their healthcare providers every six to12 months to monitor their hormone levels. Over time, the dosage may be changed. If the dose is too high, patients may develop a condition called osteoporosis, which causes the bones to become hollow and brittle. Also, excessive doses may lead to irregular heartbeats (arrhythmias). In order to prevent complications of overdose, patients with a history of heart disease, osteoporosis, or severe hypothyroidism may receive smaller doses that are gradually increased over time.
  • Surgery: If a patient develops a goiter that does not respond to hormone therapy, the thyroid may need to be surgically removed. Although goiters generally do not cause pain, a large goiter can interfere with swallowing or breathing and it may affect the patient's appearance and self-esteem. Individuals can live long, healthy lives without the thyroid gland. However, they must take hormone pills called levothyroxine (Levothroid®, Levoxyl®, Synthroid® or Unithroid®) for the rest of their lives.

Integrative therapies
  • Strong scientific evidence:
  • Iodine: Iodine has been used to prevent goiters that are caused by iodine deficiency, but not autoimmunity. Iodine is an element that the human body needs to make thyroid hormones. Iodine deficiency is one of the causes of goiter (hypertrophy of the thyroid gland because it tries to make more thyroid hormone in the absence of iodine). Other causes of goiter include autoimmune thyroiditis, excess iodine, other hormonal disorders, radiation exposure, infectious causes, or inborn errors of metabolism. Although goiter due to low iodine intake is rare in developed countries, it may occur in regions with endemic low iodine levels. For goiter prevention due to iodine deficiency in the United States, table salt is enriched with iodine ("iodized" salt), and iodine is added to cattle feed and used as a dough conditioner. Iodine supplementation is generally not recommended in developed countries where sufficient iodine intake is common, and excess iodine can actually cause medical complications (including goiter).
  • Iodine supplementation should be considered in cases of known iodine deficiency, and should be administered with medical supervision if possible. Notably, the treatment of goiter usually involves administration of thyroid hormone, most commonly levothyroxine sodium (Synthroid®, Levoxyl®, or Levothroid®). Iodine generally does not play a role in the acute management of this condition.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Unclear or conflicting scientific evidence:
  • Gamma oryzanol: Gamma oryzanol occurs in rice bran oil and it has also been extracted from corn and barley oils. Preliminary evidence has indicated that gamma oryzanol affects several parts of the endocrine system and may reduce thyroid-stimulating hormone (TSH) in patients with hypothyroidism. As a result, this may reduce the chance of a goiter developing. More studies are needed in this area and other areas of endocrinology to establish gamma oryzanol's effects.
  • Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs, drugs that alter blood sugar levels, immunomodulators, luteinizing hormone, luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering agents, thyroid drugs, or herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, or high cholesterol. Avoid if pregnant or breastfeeding.
  • Iodine: Iodine is an element that the human body needs to make thyroid hormones. Iodine has been suggested as a possible treatment for goiters that are caused by iodine deficiency, not autoimmunity. Although goiter due to low iodine intake is rare in developed countries, it may occur in regions with endemic low iodine levels. Further research is warranted to better clarify the effectiveness of iodine for goiter treatment.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. Several methods, including exercises, stretches, traction, electrical stimulation, and massage, may be used. There is currently insufficient available information on physical therapy as a treatment for thyroiditis. Additional research is needed before a conclusion can be made.
  • Not all physical therapy programs are suited for everyone and patients should discuss their medical history with their qualified healthcare providers before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However complications are possible. Treatment options should be considered carefully. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Reports of major side effects are lacking in the available literature, but caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andis often combined with bladderwrack in kelp preparations. Bladderwrack contains variable levels of iodine. As a result, it has been used to treat thyroid disorders including goiter caused by low levels of iodine, but not autoimmunity. While the evidence does suggest thyroid activity, there is not enough research to support this use of bladderwrack.
  • Avoid if allergic or hypersensitive to Fucus vesiculosus and iodine. Avoid with history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Selenium: Selenium is a mineral found in soil, water, and some foods. Thyroid function is thought to depend on selenium, and thyroid problems are common in patients with selenium deficiency. Selenium has been suggested to improve goiter, as well as inflammatory activity in chronic autoimmune thyroiditis. Further research is needed before selenium supplementation can be recommended for thyroid conditions.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Zinc: Case report data suggest that zinc supplementation may improve thyroid hormone levels (particularly T3) among women with hypothyroidism.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

Prevention
  • There is currently no known method of prevention for Hashimoto's thyroiditis.
  • Patients can prevent complications of the disease by taking medications exactly as prescribed.

Complications
  • General: In general, complications of Hashimoto's disease only develop if the condition is left untreated or if patients do not take their medications as prescribed.
  • Birth defects: If pregnant women with Hashimoto's thyroiditis do not receive treatment, their babies are more likely to have birth defects. Babies may have intellectual and developmental problems. Researchers have identified a connection between underactive thyroids during pregnancies and brain, heart, and kidney problems in infants.
  • Goiter: When a patient's thyroid is not producing enough hormones, the pituitary gland constantly stimulates the thyroid to release more hormones. As a result, the thyroid may become enlarged, causing the neck to look swollen. This condition is called a goiter. Although goiters generally do not cause pain, a large goiter can interfere with swallowing or breathing and it may affect the patient's appearance and self-esteem. In many cases, goiters will be cured once hormone replacement therapy is started. However, some patients may need to have their goiter surgically removed.
  • Heart problems: If Hashimoto's thyroiditis is not properly treated, patients may have an increased risk of developing heart disease. The patient's heart may enlarge, and in rare cases, this may lead to heart failure. Researchers have also found a connection between hypothyroidism and high cholesterol.
  • Mental functioning: Untreated Hashimoto's disease may also lead to slowed mental functioning. Patients may become confused or have trouble thinking or concentrating. Once treatment is started, these symptoms will go away.
  • Mental health: If the disease is untreated or poorly managed, patients may suffer from depression. Patients who are depressed experience sadness, low self-esteem, loss of pleasure, apathy, and sometimes, difficulty functioning. If these problems persist for two weeks or more for unknown reasons, patients should consult their healthcare providers.
  • Some males and females may experience a decrease in sexual desire (libido).
  • Myxedema: In rare cases, long-term Hashimoto's thyroiditis that has not been treated may lead to a life-threatening condition called myxedema. This condition causes swelling of the skin and other tissues, especially near the eyes and cheeks. Symptoms may include drowsiness followed by extreme tiredness and unconsciousness. Patients who experience symptoms of myxedema should seek immediate medical treatment at the emergency department of a nearby hospital.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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