Hashimoto's is an autoimmune disease in which the immune system attacks healthy body tissue. The body produces antibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG), which destroy the gland's follicular cells. It leads to disorders in the production of thyroid hormone and further to the development of hypothyroidism.
Hashimoto's may initially be mild and without symptoms, but as the disease progresses, symptoms of hypothyroidism begin to appear. The most common symptoms include drowsiness, menstrual disorders, or weight gain.
As a result of an abnormal immune response, B lymphocytes transform into plasma cells that produce antibodies against thyroglobulin (a protein that stores thyroid hormones, specifically thyroxine and triiodothyronine) and thyroperoxidase (an enzyme involved in the synthesis of thyroxine). Additionally, T lymphocytes play a significant role in Hashimoto's disease's pathogenesis by destroying the follicular cells of the thyroid gland.
The changes typically progress gradually. In the initial phase, the condition is often asymptomatic. During this stage, the thyroid gland is of standard size, hormone levels are within the normal range, and the patient does not exhibit any symptoms. The only abnormality usually noticed is the presence of antithyroid antibodies.
Sometimes, the destruction of thyroid tissue can temporarily release stored hormones, leading to hyperthyroidism (or thyrotoxicosis). However, this condition is short-lived, and the outcome of Hashimoto's disease is usually hypothyroidism.
This condition has a complex but well-known background.
When it comes to the causes, the importance of genetic and environmental factors is indicated. Their joint interaction leads to the loss of the immune system's tolerance of its tissues. As a consequence, the immune system starts to attack and destroy the thyroid gland cells.
The development of autoimmune diseases is significantly influenced by disorders of the immune response. In individuals with a genetic predisposition, these diseases can be triggered by various environmental factors, such as bacterial and viral infections, smoking, and exposure to chemicals like phthalates. Interestingly, living in nearly sterile conditions, which limits exposure to environmental factors, is also linked to a higher incidence of allergic and autoimmune diseases, including Hashimoto's disease. Additionally, diet plays a role in the natural progression of these conditions. Research has shown a connection between excessive iodine intake and a fourfold increase in the incidence of Hashimoto's disease.
The occurrence of Hashimoto's disease is greatly affected by genetic factors. The occurrence of the disease in the family increases the risk of the condition.
The most important environmental determinants that can trigger this process are:
Much also depends on environmental factors, which include:
Hashimoto's disease has a chronic course, which is why signs do not occur immediately. We can notice changes that suggest thyroid problems. During this disease, metabolic changes slow down. It leads to symptoms like:
In addition, women may notice menstrual disorders, and men can detect a decrease in libido.
Hashimoto's disease causes noticeable changes in the face. The features may become thicker, and swelling can occur around the eyelids. The skin may also become dry, cold, and pale. There can be excess buildup of skin cells, especially on the elbows and knees. Hair may become thinner, dry, and brittle, and some people might experience excessive loss of eyebrows.
Chronic changes in thyroid hormone levels cause:
Hashimoto's disease also affects the nervous system. The following may appear:
The first step in the diagnosis is to suspect the disease based on the collected interview. To confirm, the patient must perform the necessary blood test. The levels of thyroid hormones – thyroxine (T4) and triiodothyroxine (T3) are determined. Particular care should be taken to ensure that the result includes the free fraction of thyroxine (fT4) because this is a form not bound to proteins in the blood that is absorbed by cells that only transform it into triiodothyronine inside them.
Since the discussed disease is an autoimmune disease, it will also be required to determine the concentration of antithyroid antibodies. The first of these are antibodies against thyroperoxidase (anti-TPO), which is an enzyme necessary for the production of T3 and T4. Their elevated levels are a characteristic feature of Hashimoto's disease.
The basic package of tests for this condition also includes anti-TG, or antibodies against thyroglobulin, which is involved in the production and storage of hormones in the thyroid gland. Their elevated levels most often occur at the beginning of the disease and decrease over time. The next key laboratory parameter is TSH. This hormone is produced in the pituitary gland and is responsible for controlling the functioning of the thyroid gland – a low level of TSH may be a sign of its hyperactivity, while a high level – of hypoactivity, including that resulting from Hashimoto's disease.
The disease rarely proceeds without changes in size, which is why patients are referred for a thyroid ultrasound. It can be used to estimate the volume of the gland, assess vascularity, and detect changes such as cysts or nodules that may be the result of inflammation or even the starting point for cancer. It is recommended to perform a thyroid ultrasound not only for diagnostic purposes but also to monitor the course of the disease, for this reason, in chronic thyroiditis, the test should be repeated every two years.
Hashimoto's disease can be diagnosed with certainty in a patient with overt hypothyroidism and concomitant elevated anti-TPO levels and changes in the ultrasound image. In the case of observing isolated elevated anti-TPO or characteristic changes in the ultrasound image, the diagnosis of the disease requires observation and analysis of the collected data resulting from the tests to differentiate it from other diseases.
Unfortunately, there is no cure for Hashimoto's disease. Treatment focuses on balancing hormone levels. For hypothyroidism, the thyroid hormone level needs balancing through L-thyroxine supplements. Patients should regularly check their TSH, fT3, and fT4 levels, and adjust the medication dose as needed.
For those in the thyrotoxicosis stage, treatment involves antithyroid drugs like thiamazole. Patients with a small goiter and normal hormone levels (euthyroidism) only need regular monitoring of their condition.
Surgical treatment of Hashimoto's disease is used only in exceptional situations. Indications for surgery include:
Complete, full recovery is not possible, the patient should be under the constant supervision of an endocrinologist and take medication.
The treatment for Hashimoto's disease uses L-thyroxine to help with hypothyroidism. If a patient is planning to become pregnant, small doses of L-thyroxine may also be advised if thyroid function is normal.
The key medication is L-thyroxine, which is an artificial drug that acts like the hormone made by the thyroid gland. There are many L-thyroxine preparations available on the market. It is recommended to try to take the same preparation due to slight differences in the effects of the drugs. L-thyroxine taken by patients causes the symptoms characteristic of hypothyroidism to subside and normalizes the concentration of thyroid hormones and TSH.
It is crucial to follow the rules for L-thyroxine dosing. It should be taken in the morning, necessarily on an empty stomach, at least half an hour before a meal. The dose of the drug is individually determined by the doctor based on the concentration of hormones and other comorbidities. This treatment usually lasts for life.
Currently, researchers are studying the treatment of selenium for this condition.
Hashimoto's disease during pregnancy needs careful monitoring by doctors from at least two areas: a gynecologist for pregnancy care and an endocrinologist, preferably one who specializes in thyroid issues. The patient should take their medications regularly and have their thyroid hormone levels checked. If pregnant women have untreated hypothyroidism, it can harm their children's health. The reason is that untreated hypothyroidism during pregnancy may cause developmental defects in the fetus.
Good nutrition is essential for our health and well-being, especially when dealing with diseases. Hashimoto's is an autoimmune disease, so it’s significant to check for other related conditions like celiac disease, insulin resistance, or lactose intolerance.
If you have more than one of these issues, diet becomes even more crucial for managing this condition. Avoiding gluten or lactose may help if you have trouble digesting these ingredients.
A good diet should remove allergens and include anti-inflammatory foods. It can help lower antibodies and improve your immune system function.
The principles of the Hashimoto diet are:
Iodine is one of the most significant microelements needed for the proper functioning of the thyroid gland and the secretion of thyroxine and triiodothyronine because it is an essential component of the aforementioned hormones. The presence of iodine in the soil and feed of farm animals generally determines its content in food consumed by humans.
Taking into account the information published so far in the professional literature, supplementation with preparations containing high concentrations of iodine in patients with Hashimoto's disease should be abandoned, because it is not beneficial and potentially even dangerous to health.
The thyroid is the organ with the highest selenium content per gram of tissue, which is related to the expression of selenoproteins involved in the metabolism of hormones synthesized by the thyroid gland. Selenium is considered one of the key micro elements found in food due to its pleiotropic effects, starting with antioxidants, through anti-inflammatory, and ending with stimulation of active production of triiodothyronine and thyroxine. Of at least 30 selenoproteins, selenoenzymes, such as glutathione peroxidases, thioredoxin reductases, iodothyronine deiodinases, and selenoprotein P, seem to play the most significant role in optimal functioning of the thyroid gland and maintaining hormonal balance in humans.
Vitamin D deficiency is undoubtedly a significant health problem in our country, which, without taking appropriate preventive measures, may continue to develop as a result of unfavorable eating habits, lifestyle changes, and limited supply of it from natural sources (food and UVB radiation). Currently, it is increasingly common in specialist literature to read that vitamin D is no longer considered solely a fat-soluble vitamin but also a steroid hormone that plays an essential role in the regulation of bone homeostasis and calcium-phosphate metabolism in close interaction with parathyroid hormone, affecting, among others, bone tissue, kidneys, intestines, and parathyroid glands.
A long-term lack of the appropriate quality and quantity of iron consumed in the diet adversely affects thyroid metabolism. Thyroid peroxidase, which is responsible for the production of thyroid hormones, is a heme enzyme and therefore contains iron. Moreover, this enzyme becomes active on the apical surface of thyrocytes only after binding heme. In patients with chronic lymphocytic thyroiditis, iron deficiency is relatively often observed due to the fact that autoimmune gastritis, which impairs iron absorption, is a phenomenon that usually accompanies Hashimoto's disease.
Zinc has antioxidant and anti-inflammatory effects, is indirectly involved in the metabolism of proteins, fats, and carbohydrates, and is responsible for the proper functioning of the immune system. In addition, it is a component of triiodothyronine receptor proteins, and its deficiency impedes the proper binding of this hormone and increases the concentration of antithyroid antibodies a-TPO and a-TG, as well as reduces the concentration of T3 and T4 in the blood. Another result of insufficient zinc in the body may be a slowdown in the rate of hormone metabolism.
Inflammation is a chronic disease. Very often, it leads to the development of permanent hypothyroidism. If the disease is treated correctly, it does not cause serious consequences. In sporadic cases, Hashimoto's disease can transform into primary malignant lymphoma of the thyroid gland.
Properly treated Hashimoto's disease, with normalized thyroid hormone levels, does not cause dangerous complications. On the other hand, uncompensated hypothyroidism is hazardous to health, causing slower metabolism, hypercholesterolemia, and consequently cardiac complications, and in the case of children – mental retardation, growth disorders, and puberty disorders.
Sometimes, in the course of Hashimoto's inflammation, papillary thyroid cancer develops.
Hashimoto's is a direct consequence of hypothyroidism. In addition, this disease coexists with other diseases or is often their cause or effect. These include:
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