Autoimmune thyroiditis (Hashimoto's disease)

Not all people with autoimmune thyroiditis present with symptoms, as the symptoms only appear when the immune cells have damaged enough of the thyroid gland.

However, some people may present with enlargement of the thyroid gland, which is medically called a goitre. Goitre is usually painless but it can make your neck look swollen. It can make it difficult to swallow. If left untreated, goitre can choke the person as well.

Other symptoms of Hashimoto’s thyroiditis may start developing with time. Some of these symptoms are: 

• Sudden weight gain
• Inability to tolerate the cold (cold intolerance) 
• Fatigue
• Joint pain and muscle pain 
• Joint stiffness
• Constipation 
• Dry skin
• Swollen face and swollen eyes 
• Thinning of hair along with hair loss
• Difficulty in remembering or concentrating
• Heavy periods or irregular menses (periods)
• Inability to conceive
• Slow heart rate (bradycardia)
• Depression

Autoimmune thyroiditis or Hashimoto’s disease is an autoimmune disease, which means that the body’s own immune system starts attacking healthy cells and organs in the body.

Normally, these immune cells protect the body against infections caused by bacteria, viruses and other harmful substances. In Hashimoto’s disease, large numbers of lymphocytes (white blood cells which are part of the immune system) make antibodies against the thyroid gland, which then attack and damage the thyroid tissue.

Due to this continuous attack, the thyroid gland becomes inflamed and is no longer viable to make thyroid hormone. Ultimately, this disease leads to hypothyroidism in the body.

Though this disease can afflict anyone, there are some known risk factors:

• Gender: Researchers have observed that women are eight times more likely to get Hashimoto’s disease than men.
• Age: Though the disease can occur at any age, it usually appears between the ages of 40 years and 60 years.
• Family history: People with a family history of Hashimoto’s disease are also prone to get affected by the disease.
• Other autoimmune diseases: People with other autoimmune diseases are also prone to get Hashimoto’s disease. Some of these autoimmune diseases are:
  • Addison’s disease (hormonal disease)
  • Celiac disease (gastrointestinal disease)
  • Systemic lupus erythematosus
  • Vitamin B12 deficiency or pernicious anaemia 
  • Autoimmune hepatitis (immune system attacking the liver)
  • Rheumatoid arthritis (immune system attacking the joints of the body)
  • Sjogren’s syndrome (a disease that leads to dry eyes, dry mouth and rheumatoid arthritis)
  • Insulin-dependent diabetes or type 1 diabetes
  • Vitiligo (depigmentation of the skin)

Autoimmune thyroiditis cannot be prevented as it can occur to anyone and is an unpredictable action of the immune system.

In order to diagnose autoimmune thyroiditis, the doctor would perform a physical exam and would also take a detailed medical history. The doctor would then order some blood tests which may include:

• Thyroid function test: This test is done to find out the levels of T3, T4 and TSH in the body. High levels of TSH hormone in the body indicate that the thyroid gland is not producing enough T4 hormone (thyroxine).
• T4 test: The doctor may also prescribe T4 test to determine the levels of T4 hormone in the body.
• Antithyroglobulin antibody test: This test is specifically done to check for the presence of antibodies against thyroid peroxidase or thyroglobulin, medically called the thyroperoxidase antibodies (TPO). The presence of antibodies determines autoimmune thyroiditis. 
• Thyroid ultrasound: The doctor may recommend an ultrasound of the thyroid gland to check the size and appearance of the thyroid and to determine if there are any nodules or growths in the neck area.

The treatment of autoimmune thyroiditis usually depends on the extent of damage to the thyroid gland. If the gland is not damaged enough to cause hypothyroidism, the doctor simply monitors the person to see if the disease gets worse. If the thyroid gland is damaged to an extent that it causes hypothyroidism, the doctor would prescribe thyroid medication, available in the form of levothyroxine, to maintain the levels of thyroid hormones in the body. 

Levothyroxine is similar to the T4 hormone produced in the body and is taken in the morning before breakfast. The dose of the medicine would depend upon the levels of TSH in the body. The doctor would also test the level of thyroid-stimulating hormone every six months. 

The doctor would also suggest some dietary changes which may help in better absorption of levothyroxine. (Read more: Diet for hypothyroidism)