Does Hashimoto's Thyroiditis Have A Cure?

Hashimoto’s thyroiditis,¹ commonly known as ‘Hashimoto's disease’, is an autoimmune disorder that causes your immune system to produce antibodies that attack the thyroid gland leading to hypothyroidism — a condition where your thyroid gland does not produce enough thyroid hormone.² 

Hashimoto's thyroiditis is the most common type of hypothyroidism and can occur at any age. However, it is most common among women, older adults, and families with a history of thyroid diseases.

Your doctor may recommend that you get tested for the disease if you exhibit symptoms such as:

• Swollen thyroid gland

• Puffy or pale face

• Underactive thyroid (low thyroid hormones levels)

• Swollen tongue

• Heavy or irregular menstrual periods

• Fatigue

• Weight gain

• Dry skin

Can Hashimoto's thyroiditis be cured?

While there is no cure for Hashimoto's thyroiditis, there are treatment options that can balance the levels of thyroid hormones in your body and help manage the condition.

To establish whether you have the condition, your doctor will take a history and perform an examination to assess physical signs such as an enlarged thyroid gland. They’ll conduct several tests before diagnosing you with Hashimoto's thyroiditis. For instance, they will recommend a blood test to establish the thyroid-stimulating hormone (TSH) level, and if this is increased, they will test for T4 and TPO levels.

Based on your symptoms and the test results, your doctor will recommend one of three treatment options.

What are the treatments to manage Hashimoto's thyroiditis?

There are three treatments used to manage the condition, depending on the severity of your symptoms and other factors. The treatment options are:

• Conservative treatment

• Synthetic thyroid hormone (T4) medication

• Thyroid gland surgery

Conservative treatment

This is offered when you have no hypothyroid symptoms, or if they are mild.

For example, if your test results show that you have slightly elevated TSH but normal T4 and T3, this indicates that you have mild or subclinical hypothyroidism.³ You might not show any physical signs and symptoms. In this situation, your physician will recommend watchful waiting and will continue monitoring you instead of prescribing medication.

Synthetic thyroid hormone (T4) medication

Thyroid hormone replacement treatment involves taking medication that balances the levels of thyroid hormones in your body. The medication is usually levothyroxine, a synthetic version of T4 hormones.

Your doctor will only prescribe hormone replacement pills if the condition is severe enough for this treatment to be required. You will have to take the drugs daily for the rest of your life to keep your thyroid hormone levels balanced.

The process of administering levothyroxine medication may start with a trial period of six to eight weeks. Your doctor will perform a blood test at the end of that period to monitor your TSH levels and determine if the dose is correct.

Levothyroxine might cause a few side effects such as:

• Appetite changes

• Headache

• Joint pain

• Leg cramps

You will still need regular medical checkups even when taking levothyroxine because thyroid hormone levels in your body may increase to the level of causing hyperthyroidism. Regular monitoring will allow your doctor to adjust your levothyroxine dose accordingly.

Another possible treatment approach for Hashimoto’s thyroiditis is adding a synthetic version of T3 to your T4 medication. The thyroid produces two types of hormones — T3 and T4. Your body then naturally converts T4 into T3, the active form of thyroid hormone. But some people’s bodies are less capable of converting levothyroxine (a synthetic version of T4 hormones). Adding synthetic T3 alongside the T4 can help them achieve the required level of thyroid hormones. 

However, this is not the standard treatment and is not very popular. Experts do not agree on how much this treatment option benefits the patient over the standard levothyroxine prescription.

Thyroid gland surgery

One symptom of Hashimoto's thyroiditis is a goiter — the swelling of the thyroid gland.⁴ Thyroid hormone replacement medication will prevent the goiter from getting larger, but it may not cause it to decrease in size or resolve completely.

Surgery is not often recommended, unless the goiter gets so big that it constricts the airway, causing breathing and swallowing difficulties.

While a goiter seldom causes pain, it may result in other complications such as breathing difficulties or growing nodules which may develop into cancer.

Treatment if your test results are borderline

Doctors use a test reference range to interpret your test results for Hashimoto's thyroiditis.⁵ Numbers between the high and low ends of this range are considered normal, while those near the upper and lower limits are considered borderline. Numbers outside the reference range limits are considered abnormal, and that points to a problem with your thyroid function. 

Note that these reference ranges may slightly differ from lab to lab, and you should use one lab for all your tests to guarantee consistency.

If you have only mild hypothyroid symptoms or none at all, your doctor may recommend conservative treatment, such as waiting and testing.

If your symptoms are more severe and your TSH is at the upper end of the borderline spectrum, your doctor may prescribe levothyroxine. Your physician may recommend continuous use of levothyroxine medication if it relieves your hypothyroid symptoms or may stop it if it doesn't help.

They may also carry out a second examination to rule out other possible reasons for your symptoms. This is important to ensure you are not taking thyroid medication you don’t need. Taking thyroid medication such as levothyroxine if you have a borderline underactive thyroid can cause side effects such as insomnia, irregular heart rhythms, and loss of bone density.

Clinical trials for Hashimoto's thyroiditis

Clinical trials help researchers and health practitioners determine if a new treatment is both effective and safe. Trials also provide knowledge about a condition that may help improve people's health in the future.

There have been several clinical trials on treatment options for Hashimoto's thyroiditis. Some have been concluded, while others are still ongoing. Here are some examples:

Management of thyroid function in Hashimoto's thyroiditis during pregnancy

Centro Diagnostico Priamar is the lead sponsor for this trial. Hashimoto's thyroiditis can induce thyroid dysfunction, and this is a cause for concern among pregnant women. If their thyroid is not functioning normally, they are at risk of preterm birth and miscarriage,⁶ and post-natal risks to the child such as speech delay.

This study acknowledges the importance of managing Hashimoto's thyroiditis before and during pregnancy.⁷ The research aims to test "adherence to guidelines in the management of thyroid function in pregnant women with Hashimoto's thyroiditis."

The research is a one-year observational study targeting adult pregnant women with Hashimoto's thyroiditis and nodular goiter (hypothyroidism). This research excludes pregnant women with critical medical conditions such as renal failure, cardiac failure, and severe liver disease.

To take part, women must be aged 18 years or above and must give signed consent.

Metabolic biomarkers in Hashimoto's thyroiditis and psoriasis

This is a clinical trial sponsored by the University of Crete to study metabolic pathways to identify biomarkers in Hashimoto's thyroiditis and psoriasis. The research acknowledges that Hashimoto's disease and psoriasis significantly affect an individual's life quality, hence the need for critical management and prognosis.⁸

The study points out that the two conditions share a common pathway related to their pathogenesis caused by similar lifestyle choices. Research will analyze whether changes in diet can unravel the connection between quality of life and the metabolic pathways linking Hashimoto thyroiditis and psoriasis.

The research will be conducted as follows:

1. Patients aged 18–60 years with Hashimoto's thyroiditis and with psoriasis, as well as healthy individuals will be recruited.

2. The patients will be randomly divided into two groups: an intervention group and a control group

3. The intervention group will follow a Mediterranean diet that combines nutraceuticals for six months, and the control group will follow a normal diet plan.

The researchers will collect data at baseline at the end of the study. They will then analyze the levels of organic and fatty acids, lifestyle and anthropometric measurements, adherence to the Mediterranean diet, and disease-specific quality of life for both groups.

The lowdown

If you develop symptoms of Hashimoto's thyroiditis, such as heavy menstrual periods, fatigue, swollen thyroid gland, and dry skin, you should see your doctor for a medical evaluation. They will examine your symptoms, conduct a physical and blood test, then suggest the best treatment option.

Hashimoto's thyroiditis has no definite cure. However, if you're diagnosed with it, there are several treatment options that can help balance your thyroid hormone levels and manage the condition. These include conservative treatment, synthetic thyroid hormone (T4) medication, and thyroid gland surgery.

Starting treatment early helps control the disease or reduces the risk of developing serious complications such as heart problems and myxedema.