Hashimoto Thyroiditis

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Original Editors - Amelia Cantrell fromBellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Hashimoto's Thyroiditis, also referred to as chronic lymphocytic thyroiditis, is where one's immune system attacks one's theyrodi gland.¹  The inflammation that results leads to hypothyroidism.¹ 

WashingtonDeceit. Histopathology Thyroid--Hashimoto thyroiditis. Available at:http://www.youtube.com/watch?v=jx1nfcT3CCo&feature=BF&playnext=1&list=QL&index=1 [last acessed 3/3/11]

Prevalence

Hashimoto's Thyroidities "is the is the most common cause of hypothyroidism in the United States."¹  Hashimoto Thyroiditis is found most often in "middle-aged women and tends to run in families."¹  However, the disease is sometimes diagnosed in "teens and young women."²  The disease is "7 times more common in women than in men."²  

Characteristics/Clinical Presentation

Hashimoto Thyroiditis does not present with any unique signs and sympoms.¹  The disease "progresses slowly over a number of years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels."¹  The patient may present with "a feeling of fullness in the throat" or they they may be having difficulty swallowing.² 

 Signs and Symptoms:¹

• Fatigue and sluggishness
• increased sensitivity to cold
• Consitipation
• Pale, dry skin
• A puffy face
• Hoarse voice
• An elevated blood cholesterol level
• Unexplained weight gain--ocurring infrequently and rarely exceeding 10 to 20 pounds, most of which is fluid
• Muscle aches, tenderness and stiffness, expecially in your shoulders and hips
• Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet
• Muscle weakness, especially in your lower extremities
• Excesses or prolonged menstrual bleeding
• Depression

Without treament the signs and symptoms increase in severity and include:¹

• Goiter
• Forgetfullness
• Slowing of the thought processes
• increased depresssion

Picture of a Goiter.

http://upload.wikimedia.org/wikipedia/commons/d/de/Thyroid_cancer.jpg

 

Associated Co-morbidities

Hashimoto's Thyroiditis is often diagnosed in individuals with other autoimmune diseases.² These include:² 

• Vitiligo
• Rheumatoid Arthritis
• Addison's Disease
• Type 1 Diabetes
• Graves' Disease
• Pernicious Anemia
• Lupus
  

Medications

Levothyroxine: "man-made form of T4 hormone."²  This medication "almost always"² needs to be taken for the rest of a person's life and in the same manner each day.²
Dosage depends on:²

• Age
• Weight
• Severity of the underactive thyroid
• Other health problems
• Use of other medicines that can interact with levothyroxine

If the patient goes untreated the patient may face:²

• Infertility
• Miscarriage
• Giving birth to a baby with birth defects
• High cholesterol

Severe hypothyroid complications can "rarely lead to:"²

• Heart failure
• Seizures
• Coma
• Death

Diagnostic Tests/Lab Tests/Lab Values

Thyroid function tests can be performed.²  The tests measure one's TSH and T4 levels.²  If there is "an above normal level of TSH is a sign of an underactive thyroid."²  This is becasue as they thyroid starts to fail the pituitary galnd megins to produce and increased amount of TSH to get the thyroid to produce more thyroid hormone.²  The thyroid is able to meet the increased demands on it for a time, and therefore tests will show normal T4 levels accompianed by slighly increased TSH levels.²  This condition is referred to as "subclinical hypothyroidism."²  As time goes on, "the damaged thyroid cannot keep up, and they T4 levels will drop below normal while the TSH levels are high."² 

Another test that is perfored is the 'Antibody Test.'  This test looks for a specific antibody that is typically not found in individuals who do not have Hashimoto Thyroiditis, however, :some people have the antibodies...but have normal thyroid function.² 

Etiology/Causes

Hashimoto Thyroiditis is caused when one's "immune system creates antibodies that damage [one's] thyroid gland."¹  The cause of the autoimmune disease is unknown, but there are some theories and factors that may play a role.

Theories:^{1 & 2}

1. Virus or bacterium trigger
2. Genetic flaw
3. Gender
4. Pregnancy
5. Too much iodine and some drugs
6. Radiation exposure

BupaHealth. How a thyroid gland can become underactive. Available at: http://www.youtube.com/watch?v=2AFiMipv63k&feature=related [last acessed 3/3/11]

Systemic Involvement

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Medical Management (current best evidence)

The patient will take the synthetic hormone for their entire life, as discussed above.¹  The physian may see the patient to check the patient's "level of TSH after a few weeks of treatment."¹  According to the Mayo Clinic, the patient's physician will most likely check their TSH level every 6-12 months.¹ 

Physical Therapy Management (current best evidence)

Physical Therapists typically do not treat patients with this disorder. However, they should know to screen for it, and they may have a patient that has Hashimoto Thyroiditis as a co-morbidity.

Alternative/Holistic Management (current best evidence)

Natural extracts such as Armour Thyroid are sometimes used.¹  They contain "levothyroxine and triiodothyronine (T-3).¹  
Concerns regarding this supplement:¹

• Balance of T4 and T3 in animals is not the same as humans
• Exact amounts of T4 and T3 can vary due to the unpredictable amount in one's blood

Differential Diagnosis

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Case Reports/ Case Studies

A. M. McGregor, D. F. Roberts, and R. Hall.  A study of triplets with Hashimoto's thyroiditis.  Postgrad Med J. 1979 December; 55(650): 894–896.  Click here for article.

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Recent Related Research (from Pubmed)

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References

1. Mayo Clinic Staff. Hashimoto's Disease. MayoClinic.com. February 3, 2011. Available at: http://www.mayoclinic.com/health/hashimotos-disease/DS00567/METHOD=print. Accessed: February 22, 2011.
2.  Cooper DS.  Hashimoto's Disease.  U.S. Department of Health and Human Service, Office on Women's Health.  May 18, 2010.  Available at: http://www.womenshealth.gov/faq/hashimoto-disease.pdf.  Accessed: February 22, 2011.