Hashimoto's Disease: Causes, Symptoms, And Treatment

Hashimoto's disease is an autoimmune disorder that affects the thyroid gland. The thyroid gland is a butterfly-shaped gland located below Adam's apple on the front of the neck. It produces thyroid hormone that influences growth, metabolism, development, and body temperature.

An autoimmune disease is one in which the immune system attacks healthy tissues. In the case of Hashimoto's disease, the immune system attacks the thyroid gland causing it to produce less thyroid hormone and can lead to hypothyroidism. Hashimoto's disease is most common among middle-aged women, although it may affect other categories.

Hashimoto's disease is also called Hashimoto's thyroiditis, chronic autoimmune thyroiditis, or chronic lymphocytic thyroiditis.

What causes Hashimoto's disease?

The exact reason why the body's immune system attacks its healthy cells is unknown, but several factors can be attributed to the development of this disease. They include:

Genes

There is no direct link¹ to the cause of many autoimmune diseases. Still, a person’s genes, in combination with environmental exposures and other infections, can play a significant role in the development of the disease.

Hormones

Women are more likely to get Hashimoto's disease than men. Although the disease can occur in young women and teens, it is more common among women between 30–50 years².

Some women experience Hashimoto's disease during pregnancy which could mean that the immune changes during pregnancy may be a cause.

Exposure to environmental radiation

The thyroid gland is highly vulnerable to radiation. Therefore, if you get constant exposure to high radiation levels, you will likely get Hashimoto's disease.

Many cases of Hashimoto's disease and other thyroid diseases have been reported among people exposed to high radiation, including the Chernobyl nuclear accident³, radiation treatment for Hodgkin's disease, and atomic bombs victims in Japan.

Other autoimmune diseases

There is an association between type 1 diabetes, lupus,  rheumatoid arthritis⁴, and Hashimoto's disease.

Symptoms of Hashimoto's disease

Hashimoto's thyroiditis develops gradually, usually mild at first but becomes more severe with time. You can live with it for a long time without symptoms.

As with other thyroid diseases, Hashimoto's can cause enlargement of the thyroid, also known as goiter. Goiter makes the front of your neck swollen and may cause difficulty swallowing, though it rarely causes pain.

Other common symptoms of Hashimoto's disease include:

• Chronic fatigue

• Constipation

• Weight gain

• Puffiness or paleness of the face

• Dry skin

• Depression

• Joint and muscle pain and stiffness

• Sensitivity to cold

• Enlargement of the tongue

• Heavy or irregular menstrual periods

• Difficulty getting pregnant

• Problems with memory and concentration

• Hair loss or thinning of hair

• A slowed heart rate

What are the complications of Hashimoto's disease?

The thyroid gland plays an essential part in the functioning of your body, so when left untreated, it can cause the following complications.

Goiter

Goiter is an enlarged thyroid that can develop from Hashimoto's disease. When the thyroid hormone production declines, the pituitary gland senses this decrease and stimulates the thyroid to produce more thyroid hormones.

When this cycle continues, you can develop goiter. Goiter is painless, but it can affect your appearance and cause difficulty swallowing and breathing.

Sexual and reproductive dysfunction

Hashimoto's thyroiditis can cause irregular and heavy menstrual bleeding, inability to ovulate, infertility,  and low sexual desire in women. It can cause low sex drive, erectile dysfunction, and low sperm count in men.

Heart problems

Hashimoto's disease can challenge the normal functioning of the heart by stiffening the muscles of the arteries, thus affecting the tone and resistance of blood vessels. It can also cause irregular heartbeats, also known as arrhythmias, that can cause heart disease/ heart failure or give rise to cardiomyopathy.

Poor pregnancy outcomes

In pregnant women, Hashimoto's disease can cause miscarriage, pre-term births⁵, low-birth weight, and congestive heart failure.

Children born to mothers with untreated Hashimoto's disease can have developmental disorders like autism, speech delays, and reduced intellectual abilities⁶.

Mental health challenges

One of the early symptoms of Hashimoto's disease is depression⁷. When the condition is left untreated, the depression can intensify over time, affecting your overall mental health.

Myxedema

Myxedema refers to the deposition of chains of sugar molecules in the skin. It occurs when Hashimoto's disease goes untreated, causing hypothyroidism.

A person with myxedema gets swelling in the legs, face, and tongue and becomes intolerant to cold. This disease is rare but can be fatal.

How Hashimoto's disease is diagnosed

Symptoms of Hashimoto's disease can be similar to those of other conditions, so you should go for a thorough medical checkup to determine the cause of the symptoms before taking any medications.

When you visit your doctor, they will most likely carry out the following tests for Hashimoto's disease.

Thyroid-function test

This test is done to measure the levels of thyroid-stimulating hormone (TSH) in the body. The pituitary gland produces the TSH to prompt the thyroid to produce more hormones when the hormones are less in the body.

If the test proves that you have high TSH in the body, it can mean you have Hashimoto's disease.

Your doctor might also request to measure the levels of  T4 and T3 hormones in your blood. Thyroxine (T4) and triiodothyronine hormone (T3) are the primary hormones produced by the thyroid.

Low amounts of these hormones in the body could indicate that you have a thyroid problem caused by Hashimoto's disease.

Antibody testing  test

The antibodies test is carried out to measure the levels of thyroid antibodies in the body to diagnose an autoimmune thyroid disorder like Hashimoto’s. The presence of thyroid peroxidase (TPO)  in your body is an indication that you have Hashimoto's disease.

What questions will the doctor ask during an appointment?

Your healthcare provider may refer you to an endocrinologist — a specialist in hormone disorders. During the appointment, they are likely to ask you the following questions:

• What symptoms have you been experiencing?

• When did you start noticing them?

• Did the symptoms begin suddenly, or have they developed gradually over time?

• Are there any changes in your energy level or mood?

• Have you noticed any weight gain or skin dryness?

• Have your bowel habits changed? How?

• Do you experience muscle or joint pain?

• Are you sensitive to cold?

• Do you feel more forgetful than usual?

• Have you noticed any changes in your sex interest?

• For women, has your menstrual cycle changed? Are your periods heavier than usual?

• What medications do you take? What are these medications treating?

• Are you taking any herbal remedies, vitamins, or other dietary supplements?

• Is there a history of thyroid disease in your family?

Can Hashimoto's disease be cured?

There is no cure for Hashimoto's disease, but you can replace your hormone using medication to regulate the hormone levels and restore the body's regular metabolism. Your doctor will prescribe you pills based on your age, weight, the intensity of the disease, and other health problems.

They may request a full thyroid function test to monitor the thyroid's functions and ensure that you take the proper medication. The test will include the measurement of T4, T3, TSH, and thyroid antibodies.

Thyroid hormones have an effect on the target glands within minutes to hours, and symptoms usually self-normalize as the inflammation of the gland dies down following the initiation of medication.

A goiter may or may not shrink with thyroid hormone replacement, but persistent large goiter causing symptoms can be surgically treated.

What medication is used to treat Hashimoto's disease?

The treatment for Hashimoto's often depends on whether the thyroid gland has been damaged enough to cause hypothyroidism.

If you have mild or no hypothyroidism, your doctor may choose to monitor your thyroid hormone levels through regular tests and help you control your symptoms.

The following treatments are prescribed to patients with Hypothyroidism:

T4 hormone replacement therapy

To control metabolism, your body produces two primary thyroid hormones, triiodothyronine or T3 and thyroxine or T4. If you don't have enough of the two hormones, your body's metabolism slows down, causing decreased body heat and a slower heartbeat.

Although T3 is the stronger of the two hormones, taking synthetic T4 hormone is considered the appropriate treatment for hypothyroidism. This is because the body naturally converts T4 hormones into T3 by making the T4 hormones lose the extra iodine atom when it comes to contact with other cells.

Replacing the T4 hormone means that you are allowing your body to perform its natural duties, which is changing T4 into T3.

Your doctor will prescribe a synthetic hormone called levothyroxine (Levoxyl or Synthroid) for you to take daily. This synthetic hormone functions like the T4 hormones produced by the thyroid.

However, it is essential to understand that hormone replacement may work differently for everybody because it will depend on how your body will absorb the hormones induced.

How should levothyroxine be taken?

Your healthcare provider will give you a dose of levothyroxine appropriate for your weight, age, current thyroid production, and other medical issues.

Levothyroxine can either come as a capsule or a tablet, and you should take it once daily on an empty stomach, preferably 30 minutes to one hour before breakfast⁸. You should follow the prescription given carefully and not take less or more than prescribed.

You should take the capsule whole and should not chew or crush it unless it is for an infant or child who cannot swallow the medicine whole. If you happen to crush the medicine, mix it with one to two tablespoons of water. Only water should be used and not food or infant formula.

Your doctor will probably start you off on a low dose and increase it over time. They will also recommend a full thyroid function test after six to ten weeks to determine whether the medication is working as needed.

What precautions should I take when taking levothyroxine?

Before taking levothyroxine, make sure to do the following:

• Inform your doctor whether you have any allergy to levothyroxine or any ingredient contained in it. You can ask your doctor for the list of ingredients if you are not sure.

• Inform your doctor of any prescription or non-prescription medication, supplements, or vitamins that you are taking so they can determine whether they will inhibit the functioning of levothyroxine.

• If you are taking an iron supplement or calcium carbonate, make sure to take them four hours before or after taking levothyroxine.

• Inform your doctor if you are pregnant, breastfeeding, or planning to get pregnant. Also, if you become pregnant while taking levothyroxine, make sure to inform your doctor.

• Discuss your medical history with your doctor before taking the medication. If you have adrenal insufficiency, diabetes, anemia, atherosclerosis, or any cardiovascular disease, it is essential to let the doctor know.

What should I avoid when taking levothyroxine medication?

Some foods and beverages, especially those containing soybeans⁹, and dietary fiber¹⁰, can affect how your body absorbs levothyroxine. Iron and calcium¹¹ supplements can also inhibit the absorption of levothyroxine, and it is important to avoid them or talk to your doctor about it.

You should eat calcium-rich foods like cheese, yogurt, and milk at least four hours before or after taking levothyroxine. It would also be best to avoid caffeinated drinks like tea, coffee, and some fizzy drinks that can reduce the amount of levothyroxine that your body absorbs.

What are the possible side effects of levothyroxine?

Levothyroxine doesn't always cause side effects. However, you can experience some mild symptoms. If they become severe or do not go away, talk to your doctor about it. The mild side effects can include:

• Headache

• Changes in appetite

• Leg cramps

• Changes in the menstrual cycle

• Diarrhea

• Sensitivity to heat

• Hair loss

• Weight gain or loss

• Joint pain

Call your doctor immediately and get emergency medical treatment if you experience shortness of breath, nausea, stomach pain, wheezing, rash, swelling of your hands and feet, flushing, or stomach pains.

Frequently asked questions about levothyroxine

How long does levothyroxine take to work?

The medication begins working immediately, but the symptoms may take a few weeks or months to disappear completely.

How long will I take levothyroxine?

Levothyroxine is a lifelong medication you will take for the rest of your life. Your symptoms may resurface if you stop taking them.

Does it have long-term side effects?

If you take the correct dose of levothyroxine, it is unlikely to get side effects. However, high doses of levothyroxine over a long time can cause the weakening of bones, a condition known as osteoporosis.

It would be best to get thyroid function tests to ensure that your hormone levels are within normal limits.

Can I drink alcohol?

Alcohol does not affect how the medication works, so it is not prohibited. However, if you have side effects like flushing and headaches, alcohol can make them worse.

Can I drive or operate machinery after taking levothyroxine?

Levothyroxine does not affect your ability to drive or operate machinery in any way.

Can levothyroxine affect my contraception?

Levothyroxine does not affect any form of contraception, even emergency contraception or combined pill. However, the combined pill contains estrogen, which can reduce the amount of levothyroxine absorption. Therefore, you should talk to your doctor if you start or stop taking the pill as your dose of levothyroxine might need to change.

Is taking levothyroxine during pregnancy safe?

Levothyroxine is safe to take during pregnancy, and pregnant women may be required to take a higher dose of levothyroxine. This is because higher levels of thyroid hormones are needed during pregnancy for the development of the fetus. Low thyroid hormone levels in the mother can cause miscarriage or pre-term birth¹².

If you realize you are pregnant while taking the medication, you should talk to your doctor about it.

What should I do if I skip medication?

If you realize that you skipped your medication, you should take it as soon as you remember. However, if it is almost time to take the following dose, you should wait until then and continue with your usual dose. Do not take a double amount to compensate for the missed dose.

What other ways can I use to treat Hashimoto's disease?

Besides taking levothyroxine, there are several more ways that you can use to manage Hashimoto's thyroiditis. They include dietary and lifestyle changes and taking some supplements.

Dietary changes

Most dietary and lifestyle modifications in Hashimoto’s thyroiditis are suggestive rather than prescriptive. They help improve your health and act as supportive treatment in managing Hashimoto's disease. You can try the following:

Grain and gluten-free diets

A gluten-free diet reduces thyroid antibody levels¹³ in the body and improves thyroid function and vitamin D levels. When following a gluten-free diet, you will need to avoid barley, wheat, and rye products.

Also, most bread, pasta, and soy sauces contain gluten, but you can find gluten-free alternatives.

Autoimmune protocol diet

An autoimmune protocol diet removes any potentially harmful foods¹⁴ for people with Hashimoto's disease. Foods like grains, added sugars, oils, nuts, seeds, coffee, nightshades, and food additives are removed from the diet.

Your healthcare provider should supervise the autoimmune protocol diet as it is an elimination diet.

Focus on anti-inflammatory foods

Inflammation can drive Hashimoto's disease¹⁵ to develop, so taking anti-inflammatory foods like fruits, vegetables, and fatty fish can help you keep inflammation at bay.

Supplements

Several supplements can help lower inflammation and thyroid antibodies in people with Hashimoto's disease. They include:

Selenium

Studies show that selenium (at least 200mcg) per day can help reduce antithyroid antibodies¹⁶ and improve the quality of life for patients with Hashimoto's disease.

Zinc supplements

Zinc is essential for thyroid function¹⁷, and taking zinc supplements can help improve thyroid function in people suffering from Hashimoto's thyroiditis.

Lifestyle changes

Changing some aspects of your life can also positively impact the management of Hashimoto's disease. Activities like regular exercise, maintaining a healthy diet, and managing stress effectively can improve your quality of life.

Is Hashimoto's disease treated differently from hypothyroidism?

The treatment of Hashimoto's disease and hypothyroidism is the same since hypothyroidism is a consequence of having Hashimoto’s disease.

However, this does not mean every case of hypothyroidism is caused by Hashimoto's disease. So, it is essential to ensure that your hypothyroidism results from Hashimoto’s disease before taking medication.

If you have mild Hashimoto's disease, your doctor might decide to monitor your thyroid hormones and offer medication to help get rid of your symptoms.

The lowdown

Hashimoto's disease is an autoimmune disorder that can lead to hypothyroidism. It exhibits symptoms such as constipation, weight gain, puffiness or paleness of the face, dry skin, and depression. Goiter is also a symptom of Hashimoto's disease.

The best method to treat Hashimoto's disease is through T4 hormone replacement therapy that involves levothyroxine medication. However, when you use levothyroxine, you might encounter mild side effects such as headaches, sensitivity to cold, and joint pains.

If you experience extreme symptoms like shortness of breath, wheezing, and vomiting, you should seek immediate medical attention.

Changing your lifestyle, eating healthier, and taking supplements may also help improve your general health and help manage Hashimoto's disease.

When left untreated, Hashimoto's disease can lead to other complications like heart problems, myxedema, depression, and sexual dysfunction. Therefore, it is essential to go for a checkup after noticing any symptoms related to Hashimoto's disease. You should also take your medication as prescribed.

Hashimoto's disease does not mean a reduced quality of life. You can still live a long and fulfilling life with Hashimoto's disease by taking the proper treatment.