Hashimoto thyroiditis: Cause, symptoms, therapy

The autoimmune disease Hashimoto’s thyroiditis is the most common form of thyroiditis – it accounts for about 80 percent of all thyroiditis cases. Women are about nine times more likely to develop Hashimoto’s thyroiditis than men. In most cases the disease occurs between the ages of 40 and 50. Read more about causes, diagnosis and treatment of Hashimoto’s thyroiditis here!

Two forms of progression

Hashimoto’s thyroiditis is also called chronic lymphocytic thyroiditis, chronic Hashimoto’s thyroiditis or (more rarely) Hashimoto’s disease. Sometimes one also comes across the terms autoimmune thyroiditis, Hashimoto syndrome, Hashimoto disease or the short name Hashimoto.

There are two forms of Hashimoto’s thyroiditis:

• In the classic form, the thyroid gland enlarges (struma formation), but loses function.
• In the atrophic form, thyroid tissue is destroyed and the organ atrophies.

In general, the atrophic form of Hashimoto’s thyroiditis is more frequently observed than the classic form.

Hashimoto thyroiditis: Cause

The thyroid disease Hashimoto’s thyroiditis is autoimmune, i.e. the body starts to produce antibodies against thyroid proteins for an as yet unknown reason. This leads to a chronic inflammation of the thyroid gland. In the long run, the permanently inflamed thyroid tissue can be destroyed, which results in hypothyroidism. In fact, Hashimoto’s thyroiditis is the most common cause of hypothyroidism.

Since Hashimoto’s thyroiditis can occur in families, experts suspect that there is a genetic predisposition for the disease. At the moment of updating this article in 2020, we do not have evidence about this yet.

Type C liver inflammation (hepatitis C) also appears to play a role in the development of the disease.

Sometimes patients with Hashimoto’s thyroiditis also suffer from other autoimmune diseases such as Addison’s disease, type 1 diabetes, celiac disease or a severe form of anaemia (pernicious anaemia).

Hashimoto thyroiditis: Symptoms

Hashimoto thyroiditis is painless. There are also hardly any other symptoms, which is why the disease is often only discovered at an advanced stage – when it has led to hypothyroidism. Then there are more obvious complaints such as:

• constant tiredness, weakness and exhaustion,
• Disinterest and unwillingness,
• Problems with concentration and memory,
• Hoarseness,
• Hypersensitivity to cold,
• Constipation,
• Weight gain despite unchanged eating habits,
• dry skin and brittle nails,
• brittle hair and increased hair loss,
• Cycle disorders and reduced fertility, and
• elevated blood lipids.

Hashimoto’s encephalopathy

In connection with Hashimoto’s thyroiditis a disease of the brain can develop. This Hashimoto’s encephalopathy leads to multiple neurological and psychiatric symptoms such as cognitive deficits, confusion, psychosis, temporary drowsiness up to coma, epileptic seizures and movement disorder (ataxia).

Hashimoto’s thyroiditis: diagnosis

At the beginning, the doctor will take the patient’s medical history in a detailed conversation (anamnesis). A subsequent blood test can confirm the suspicion of a functional disorder of the thyroid gland due to Hashimoto’s thyroiditis. The concentration of the thyroid hormones T3 and T4 as well as that of TSH are measured. TSH is a hormone of the pituitary gland, which stimulates the thyroid to produce hormones. The blood sample is also tested for antibodies against thyroid proteins.

An ultrasound examination of the thyroid gland supports the Hashimoto diagnosis as an imaging procedure. This is the typical finding with Hashimoto: thyroid gland smaller than normal and with an evenly dark structure in the ultrasound.

Using fine needle biopsy, the doctor can take a tissue sample from the thyroid gland to examine it more closely: In Hashimoto’s thyroiditis, significantly more white blood cells can be found in the tissue than normal.

To clarify a Hashimoto’s encephalopathy, further examinations may be necessary, such as the analysis of a sample of cerebrospinal fluid (cerebrospinal fluid) as well as a measurement of electrical brain activity (EEG).

Hashimoto’s thyroiditis: therapy

There is no therapy against the cause of Hashimoto. However, symptoms resulting from the occurring hypothyroidism can be treated by replacing the missing thyroid hormone: Patients usually receive lifelong tablets containing the artificial hormone levothyroxine. For optimal absorption into the body, the drug must be taken in the morning on an empty stomach.

If the disease has led to an enlargement of the thyroid gland (goiter), Hashimoto therapy can consist of surgical removal of the organ.

A Hashimoto encephalopathy can usually be treated well with a high-dose cortisone (prednisolone).

Living with Hashimoto: Nutrition

Increased iodine intake can play a role in the development of Hashimoto’s thyroiditis and may also have a negative influence on the course of the disease. Therefore, patients with Hashimoto Iodine in too high doses should avoid taking iodine tablets and keep an eye on the iodine supply through food. Sea fish (such as mackerel, herring, saithe) and seafood, for example, are very rich in iodine.

Hashimoto with children and young people

If children and adolescents with Hashimoto’s thyroiditis get a goiter (struma) or hypothyroidism, the doctor will prescribe the use of thyroid hormones.

Hashimoto thyroiditis: Prognosis

The course of the disease in Hashimoto’s thyroiditis cannot be predicted. Only rarely does the disease regress spontaneously.

The destruction of thyroid tissue caused by chronic inflammation is irreversible. The hypothyroidism that develops in the course of Hashimoto’s thyroiditis usually requires a lifelong intake of thyroid hormones.