Hashimoto Thyroiditis

Original Editors - Kerri Falk and Tori Kute Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Amelia Cantrell, Kerri Falk, Elaine Lonnemann, Lucinda hampton, Kim Jackson, Admin, Tori Kute, 127.0.0.1 and WikiSysop

Introduction

Hashimoto thyroiditis is an autoimmune disorder. In this condition the thyroid cells are destroyed via cell and antibody-mediated immune action. In developed countries it is the most common cause of hypothyroidism, whereas worldwide the most common cause is a deficient dietary intake of iodine.

Epidemiology/Etiolgy

Hashimoto thyroiditis (HT) is a common autoimmune disorder. The prevalence of thyroid disease increases with age.

• Women are affected 7–10 times more often than men

• Develops because of genetic susceptibility, X chromosome inactivation patterns modulated by environmental factors as well as microbiome composition

The above leads to an imbalance in self-tolerance mechanisms, that goes on to cause thyroid infiltration by lymphocytes, leading to a destruction of thyrocytes.

Other factors that may play a role in acquiring Hashimoto’s disease include;

• Pregnancy - Pregnancy affects the thyroid. Some women have thyroid problems after having a baby, which usually go away. But about 20 percent of these women develop Hashimoto's disease in later years. This suggests that pregnancy might trigger thyroid disease in some women.
• Too much iodine and some drugs may bring about the onset of thyroid disease in people susceptible to acquiring it.
• Radiation exposure has been shown to trigger autoimmune thyroid disease. This includes radiation from the atomic bomb in Japan, the nuclear accident at Chernobyl, and radiation treatment of Hodgkin's disease.

BupaHealth UK. How a thyroid gland can become underactive.

Characteristics/Clinical Presentation

Hypothyroidism

Hashimoto Thyroiditis does not present with any unique signs and symptoms. The condition progresses very slowly over many years, people with Hashimoto’s thyroiditis may not have any symptoms early on. Hashimoto’s thyroiditis can go on to cause the symptoms of hypothyroidism. Hypothyroid symptoms may include fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle aches and reduced exercise tolerance, and irregular or heavy menses. Sometimes, the thyroid becomes enlarged.

Diagnosis

Hashimoto’s thyroiditis is usually diagnosed when patients present with symptoms of hypothyroidism, often along with a goiter on physical examination. Laboratory testing of hypothyroidism shows elevated thyroid stimulating hormone (TSH) with or without a low thyroid hormone (Free thyroxine [Free T4]) levels.

Medical Management

The central component of treatment for hypothyroidism is thyroid hormone replacement. The drug used commonly is titrated levothyroxine sodium administered orally. Note the formation of thyroxine varies worldwide and there can be problems with absorption in patients with disorders of the gastric mucosa.

Physical Therapy Management

Physical therapy is not standard treatment for patients with this disorder. Physical therapists should know to screen for it.  Physical therapists also need to be aware of the disease because they may have a patient that has Hashimoto Thyroiditis as a co-morbidity.

A physical therapy screening for Hashimoto Thyroiditis should include:

• Subjective questioning
• Upper and/or lower quarter clearing exam - depending on the patient's complaints
• MMT - for the specific muscle(s)/area
• ROM - for the specific muscle(s)/area
• Special tests - for the specific joint/area
• Palpation - thyroid and any other areas that are suspected as the cause of the symptoms
• Any other measure that the physical therapist deems necessary for the patient's specific complaints
  

If the above screening does not indicate a musculoskeletal issue, the physical therapist should refer the patient to the appropriate health care provider.

Alternative/Holistic Management

For most TH patients, the hormone-replacement therapy with levothyroxine is indispensable. Adhering to nutritional guidelines with a focus on the an anti-inflammatory diet and controlled vitamin D dosing may help individual patients reduce medication, slow diseases course and prevent relapses.

Examples of other supplements include:

• Selenium: Research has found that it aids in the regulation of T3 and T4 hormones.

• Probiotics: Aid in the support of gastrointestinal health

• Vitamin D

• B vitamins: Are important for maintaining energy and metabolic function.

Other Autoimmune Disease Associations

People with other autoimmune diseases are more likely to develop Hashimoto’s disease. The opposite is also true—people with Hashimoto’s disease are more likely to develop other autoimmune diseases. These diseases include

• Vitiligo, a condition in which some areas of the skin lose their natural color.
• Rheumatoid arthritis, a disease that causes pain, swelling, stiffness, and loss of function in the joints when the immune system attacks the membrane lining the joints.
• Addison’s Disease, in which the adrenal glands are damaged and cannot produce enough of certain critical hormones.
• Diabetes Mellitus type I, in which the pancreas is damaged and can no longer produce insulin, causing high blood glucose, also called blood sugar.
• Pernicious Anemia, a type of anemia caused by not having enough vitamin B12 in the body. In anemia, the number of red blood cells is less than normal, resulting in less oxygen carried to the body’s cells and extreme fatigue.
• Celiac Disease, a form of gastrointestinal gluten sensitivity, an autoimmune disorder in which people cannot tolerate gluten because it will damage the lining of the small intestine and prevent adsorption of nutrients. Gluten is a protein found in wheat, rye, and barley and in some products.
• Autoimmune Hepatitis, or nonviral liver inflammation, a disease in which the immune system attacks liver cells.