Can Hashimoto’s Disease Change The Appearance Of My Face?

Hashimoto's disease commonly causes hypothyroidism, affecting around five in 100 Americans,¹ with women four to ten times more likely to be affected than men.

What is Hashimoto's thyroiditis?

Hashimoto thyroiditis – another name for Hashimoto's disease – is a type of autoimmune disorder that impacts thyroid function, which is a gland in your lower neck shaped like a butterfly. Your thyroid creates hormones responsible for regulating various crucial body functions, such as:

• Body temperature

• Growth and development

• Weight

• Menstrual cycles

• Heart rate

This condition is a type of chronic inflammation that can cause damage to your thyroid and reduce its ability to produce hormones.

While Hashimoto's disease can cause an underactive thyroid (hypothyroidism), it rarely causes an overactive thyroid (hyperthyroidism).

Other names for this condition are autoimmune thyroiditis and chronic lymphocytic thyroiditis.

Causes

The cause of Hashimoto's disease is believed to be a combination of environmental triggers and a genetic predisposition that begins the process of autoimmune damage.

The immune system attacks the thyroid gland, although the trigger is unknown. Other factors that can play a role in developing this condition include gender, heredity, and age.

Typically, your immune system works at protecting your body against things that invade it, such as:

• Bacteria

• Viruses

• Antigens (foreign substances)

In autoimmune disease conditions, your immune system attacks parts of your body itself by mistake. When it comes to Hashimoto thyroiditis, it's the thyroid gland that it attacks.

The autoimmune process leads to thyroiditis (inflammation of the thyroid gland) and results in the thyroid gland not being able to produce hormones, which leads to hypothyroidism.

This causes a reaction from your pituitary gland (a pea-sized gland at the base of your brain), where it increases TSH (thyroid-stimulating hormone) and attempts to stimulate your thyroid gland to start producing more thyroid hormones. This can lead to goiter or growth on the gland.

Complications 

Many people with Hashimoto thyroiditis develop hypothyroidism. When left untreated, this condition can cause various health issues,² including:

• Heart failure and heart disease

• High cholesterol

• Myxedema (a rare disorder where your body's functions slow down to the point of being life-threatening)

• High blood pressure

Hypothyroidism can also lead to issues during pregnancy when left untreated.

Symptoms of Hashimoto's thyroiditis 

Goiter (enlargement of your thyroid) is one of the first signs of Hashimoto's disease that will show on your face.

Depending on how big it is, the enlarged thyroid can make your neck look swollen and interfere with your swallowing and breathing.

As thyroid damage continues over several years, your gland can shrink, and this goiter may disappear eventually.

Other signs and symptoms of Hashimoto thyroiditis that develop over time include:

• Weight gain

• Fatigue

• Constipation

• Trouble tolerating the cold

• Dry skin

• Puffy face/eyes

• Muscle pain and joint stiffness

• Irregular or heavy periods

• Depression

• Slow heartbeat

• Memory issues/difficulty concentrating or thinking

• Trouble becoming pregnant

• Hair loss/thinning hair

Can Hashimoto's disease affect my face? 

Many symptoms and signs of thyroid disease affect the face (and skin). Some Hashimoto's disease face and thyroid disease symptoms to keep an eye out for include:

• Dull facial expressions

• Slow speech

• Swollen and puffy face

• Dry, coarse, and thickened skin

• Sides of eyebrows fall out or are thin

• Coarse, sparse, and dry hair

• Hoarse voice

• Facial palsy³

When to see a medical professional about your symptoms

Hashimoto’s thyroiditis symptoms can vary widely and aren't specific to the condition. Since these symptoms can be due to any number of other conditions, you must see your doctor right away for a timely and proper diagnosis.

Individuals with hypothyroidism who develop changes in mental status or behavior, fever, increased swelling in the feet and hands, or slowness of breath should go to the emergency department.

How is Hashimoto's disease diagnosed?

You must receive a proper diagnosis and treatment for Hashimoto thyroiditis.

If you're experiencing potential Hashimoto thyroiditis symptoms, see your doctor. They'll perform a physical examination and take your medical history.

Your doctor will examine your thyroid and check for signs of swelling. They may order an ultrasound of your thyroid to check for nodules (abnormal growths).

Along with the physical exam, medical history, and potential ultrasound, your doctor will most likely order blood work to test your thyroid function. These blood tests can help your doctor diagnose Hashimoto thyroiditis and rule out other potential diagnoses.

There are three primary blood tests that doctors typically order to diagnose Hashimoto's disease:

TSH test

This test checks your TSH (thyroid-stimulating hormone) blood level, which your brain's pituitary gland releases to inform your thyroid gland that it's time to produce more thyroid hormones.

An above-normal TSH range can indicate hypothyroidism (and potentially Hashimoto thyroiditis) since it shows that your pituitary gland has perceived a reduction in the production of the thyroid hormone and is, therefore, attempting to stimulate the thyroid to produce more. However, you can have normal TSH levels and still have Hashimoto thyroiditis.

Antithyroid antibodies test

This blood work evaluates the levels of antibodies produced when your immune system attacks your thyroid gland by mistake. Antibodies the doctor may test you for include the thyroglobulin and thyroid peroxidase antibodies.

Doctors often order an antithyroid antibodies test to rule out or confirm Hashimoto's disease as the cause of hypothyroidism. When there are antithyroid antibodies, it suggests there's an autoimmune disorder at work.

Free T4 Test

This blood test measures how much T4 or thyroid hormone thyroxine is freely accessible to your tissues. 

If you have a low free T4 level, it can mean you have a thyroid hormone production deficiency, which can be important information to have since it can help your doctor diagnose Hashimoto's disease, particularly if you have a normal TSH level.

Treating Hashimoto's disease 

The way your doctor will treat Hashimoto thyroiditis will likely depend on whether your thyroid is damaged enough to lead to hypothyroidism.

If you're not experiencing hypothyroidism, your doctor may just regularly check your thyroid hormone levels and symptoms.

Levothyroxine

If you are experiencing hypothyroidism, your doctor will prescribe you levothyroxine, which is the same as the natural thyroid hormone thyroxine (T4).

This pill has been prescribed in pill form for years. However, it's now available in a soft gel capsule and liquid form. These forms may help people who are dealing with digestive issues that affect how their bodies absorb the thyroid hormone pill.

Certain supplements and foods can negatively affect how your body absorbs this medication. Examples include:

• Espresso coffee

• Grapefruit (inc. juice)

• Soy

• Multivitamins containing calcium or iron

Taking levothyroxine on an empty stomach in the morning, approximately 30 to 60 minutes before eating your breakfast, can help prevent this.

The doctor will provide you with blood testing around six to eight weeks after you start taking the medication and, if required, adjust your dose. You'll need another blood test each time your dose is changed.

Once you've reached the ideal dose that works for you, your doctor will most likely give you another blood test in six months and annually after that.

Don't stop taking your medication or change your dose without speaking with your doctor first. Taking too much thyroid hormone medication could lead to severe issues, such as osteoporosis or atrial fibrillation.¹

Thyroid hormone medication can control hypothyroidism well as long as you take the medication as directed by your doctor and have routine follow-up blood work.

Will my face go back to normal?

A common symptom of hypothyroidism that individuals experience is a swollen face, which is frequently referred to as myxoedema by medical professionals.

Typically, myxoedema is a more advanced sign of hypothyroidism, which generally occurs alongside other symptoms, such as:

• Weight gain

• Tiredness

• Constipation

If you're experiencing a swollen face, it's best to have your thyroid tested since it is a common potential hypothyroidism symptom. You have a higher chance of recovering from myxedema if it's detected and treated early with supportive care and thyroid replacement therapy.

Along with thyroid hormone replacement medicine treatment, your doctor will likely recommend exercise and weight loss if you have Hashimoto's disease. Physical activity and weight loss⁴ help decrease body inflammation, including inflammation of your thyroid gland.

The lowdown

There's no proven method or treatment to prevent the autoimmune dysfunction with the coinciding inflammation that can lead to low thyroid hormone and Hashimoto's thyroiditis.

However, Hashimoto's disease is a highly treatable condition. Therefore, you should immediately let your doctor know about any potential symptoms to enable treatment to start early.

Recognizing Hashimoto's disease face symptoms early can help you avoid complications and prevent the progression of this disease.

Not all people with this condition will develop hypothyroidism. Since you have a greater risk of developing hypothyroidism if you have antibody levels that are consistent with this disease, your doctor will likely choose to closely monitor your condition and keep an eye out for any changes in the health of your thyroid.