Understanding Chronic Autoimmune Thyroiditis

Chronic autoimmune thyroiditis also referred to as Hashimoto's disease or autoimmune thyroiditis affects 1% to 2%¹ of the US population and is more common among women than men. While it is treatable, chronic autoimmune thyroiditis can be life-threatening if left to persist without medical intervention.

What is chronic autoimmune thyroiditis?

Chronic autoimmune thyroiditis is an autoimmune condition where your body's immune system mistakenly attacks and destroys the thyroid gland. This attack compromises the thyroid's ability to produce thyroid hormone that regulates digestion, metabolism, brain function, and other vital bodily processes.

Chronic autoimmune thyroiditis can thus result in hypothyroidism or an underactive thyroid, where the thyroid gland does not produce or release enough thyroid hormone into the bloodstream. A shortage of these hormones causes your other body systems to slow down.

Hashimoto's disease can also result in goiter, a condition in which the thyroid gland enlarges due to swelling or inflammation. Treatment is required to alleviate the symptoms and halt the progression of either hypothyroidism or goiter.

What are the symptoms of chronic thyroiditis?

Hashimoto's thyroiditis symptoms vary between individuals and may go unnoticed for years. A goiter or hypothyroidism, the two most common complications of Hashimoto's disease, may cause your discomfort.

Signs and symptoms of chronic thyroiditis include:

• Dry, flaky skin and weak, crumbly nails

• Expansion of the tongue and voice hoarseness

• Fatigue and slow speech

• Sensitivity to cold

• Hair loss

• Weight loss and high blood pressure

• Aches and pains in the joints

• Bleeding heavily during menstruation

• Depression and memory lapse

Chronic autoimmune thyroiditis symptoms among children

Even though it is often associated with adults, chronic autoimmune thyroiditis is the most common endocrine ailment among school-age children². Every cell requires thyroid hormones to function normally.

If a child has a thyroid disease, it may have a wide range of physical effects on the body. The child may have the following symptoms:

• Constipation and dry skin

• Fatigue and hair loss

• Sluggishness and slow growth

• The child may be cold

• Memory lapse and trouble concentrating

Hypothyroidism may be congenital³, meaning it may be present at birth. Therefore, in most cases, doctors screen infants for hypothyroidism at birth. Hypothyroidism may also be acquired, often manifesting in late childhood or adolescence.

Teen and adult chronic autoimmune thyroiditis symptoms

Chronic autoimmune thyroiditis may cause identical symptoms in teenagers and adults. However, they may additionally display the following symptoms:

• Dry and cold skin

• Swelling of the face

• Elevated blood pressure

• Slow speech and a hoarse voice

• Heavy menstrual flow

• Decreased sweating and nerve deafness

• Muscle cramps and joint pains

• Dementia and depression

• Decreased energy

Hashimoto's disease has a broad range of symptoms that are not unique to the condition. To get an accurate and fast diagnosis, you should visit your doctor as soon as possible if you are experiencing any of these symptoms.

What are the causes and risk factors for developing chronic autoimmune thyroiditis?

It is essential to understand the causes of chronic autoimmune thyroiditis to establish the risk factors that can predispose you to the condition. As with many autoimmune disorders, chronic autoimmune thyroiditis is caused by an immune system failure in which immune cells target healthy tissues rather than protect them.

In chronic autoimmune thyroiditis, attacks by invading immune cells impair the thyroid gland's capacity to produce sufficient hormones. Additionally, the invading immune cells induce inflammation and swelling of the thyroid, which may develop into a noticeable and bothersome lump in the neck called goiter. The onset of illness may be attributed to one or more of the following factors:

• Triggers in the environment including illness, stress, or radiation exposure

• Genetic factors

• Environmental and genetic interactions

Risk factors for contracting chronic autoimmune thyroiditis

The following variables enhance your risk of developing Hashimoto's disease:

Gender

Women are more likely to contract chronic autoimmune thyroiditis than men due to hormonal factors. There are an estimated eight cases per 1,000 men¹ and 3.5 points per 1,000¹ females annually in the US.

Age

Hashimoto's disease may strike at any time but is most prevalent in middle age.

Genetics and family descent

You will likely develop Hashimoto's disease if you have a family history of thyroid issues or other autoimmune illnesses.

Pregnancy

Chronic autoimmune thyroiditis may be linked to changes in the immune system during pregnancy.

Radiation exposure

Hashimoto's disease is more common among those exposed to high quantities of radiation from the environment.

Excessive iodine intake

People predisposed to Hashimoto's disease may be more susceptible to its onset if their diets include excessive amounts of iodine.

Other autoimmune diseases

Having other autoimmune conditions, such as rheumatoid arthritis, type 1 diabetes, or lupus, raises your likelihood of acquiring Hashimoto's disease.

Smoking

Smoking may trigger hypothyroidism in people with Hashimoto’s disease.

Chronic autoimmune thyroiditis diagnosis

If you suspect a case of Hashimoto's thyroiditis, visit your doctor to get a physical examination or diagnosis. Your doctor will search for thyroiditis symptoms such as swelling in your thyroid and conduct a thyroid ultrasound to check for abnormal growth.

Along with a medical history, physical examination, and potentially an ultrasound, your doctor will likely prescribe blood tests to evaluate your thyroid function. These tests may assist in determining if you have Hashimoto's disease and rule out other potential diagnoses.

Hashimoto's disease may be diagnosed using three preliminary blood tests:

Free T4 Test

The T4 test determines the quantity of thyroid hormone thyroxine (T4) accessible to your tissues. A low free T4 level may suggest a shortage in thyroid hormone synthesis, indicating Hashimoto's disease.

Thyroid-stimulating hormone test (TSH)

This test measures the amount of TSH released by the pituitary gland in the brain to signal the thyroid gland to produce more thyroid hormones.

A TSH level that is higher than usual may suggest Hashimoto's thyroiditis. It signals that the pituitary gland has detected a decline in thyroid hormone production and is attempting to stimulate the thyroid to produce more. However, an average TSH level does not guarantee that you do not have Hashimoto's.

Test for antithyroid antibodies

This blood test determines whether thyroid-specific antibodies are present and in what quantities. Tests for antibodies include the thyroid peroxidase antibody (TPO) and thyroglobulin antibody (TGB).

A test for antithyroid antibodies is often requested to confirm or rule out Hashimoto's as the cause of hypothyroidism.

Why is chronic autoimmune thyroiditis misdiagnosed?

Misdiagnosis is widespread since symptoms and indicators are non-specific and may confuse other health conditions, such as hypothyroidism or hyperthyroidism.

Since chronic lymphocytic thyroiditis progresses over time, it may present itself with a wide range of symptoms that are difficult to diagnose at first, with most clinics diagnosing it as depression⁴.

Hypothyroidism and Hashimoto's disease cause the body's metabolism to slow down, resulting in fatigue, sadness, and weakness. If you are incorrectly diagnosed with Hashimoto's disease, you need not worry. To be safe, you should be on the lookout for any of these symptoms and notify your doctor right away if you experience any of them.

Chronic autoimmune thyroiditis treatment

Thyroxine replacement therapy is the cornerstone of hypothyroidism treatment and management.

The typical daily dosage is between 1.6mcg/kg and 1.8mcg/kg. However, this might vary from person to person.

Lower dosages are used in people with cardiovascular disease and the elderly. Individuals aged 50 and above should be evaluated after six to eight weeks of treatment.

When levothyroxine isn't working, some individuals find relief by switching to desiccated thyroid extract. However, Medicare does not cover the sections since they are considered high-risk by government health organizations for persons over 65 years.

People with hypothyroidism symptoms who have normal TSH levels may benefit from a combination of synthetic T3 and synthetic T4 as a treatment for Hashimoto's disease. Some people's bodies find it difficult to turn levothyroxine into T3, the active form of thyroid hormone, but this can be alleviated by using synthetic T3.

Is it possible to treat chronic autoimmune thyroiditis by changing your lifestyle?

It's possible. People with chronic autoimmune thyroiditis may benefit from weight reduction and exercise in addition to formal thyroid hormone replacement therapy. Both weight reduction and physical activities are beneficial in lowering inflammation throughout the body, including the thyroid gland.

Is surgery a possibility for chronic autoimmune thyroiditis?

Even though thyroid surgery (thyroidectomy) is very uncommon, doctors may consider it in circumstances when medicine has failed to help a person’s symptoms, and the symptoms have become unbearable.

Are there any complications if left untreated?

Thyroid hormones are required for the proper functioning of several physiological systems. As a result, several issues may emerge when Hashimoto's disease and hypothyroidism are left untreated. These include the following:

Mental health problems

People with Hashimoto's disease may experience depression or other mental health issues early on, worsening over time.

Pregnancy complication

Pregnancy complications such as miscarriage or premature delivery might be worsened by hypothyroidism. Untreated hypothyroidism increases the likelihood of developing autism, speech difficulties, and other abnormalities in children born to mothers.

Goiter

Thyroid enlargement is known as a goiter. The pituitary gland signals the thyroid to produce more hormones when production drops due to Hashimoto's disease. A goiter may develop as a consequence of this cycle.

Although it's usually not painful, having a big goiter may impact your looks and ability to eat and breathe.

Myxedema

Long-term, chronic autoimmune thyroiditis that has gone untreated might lead to the development of this life-threatening but very uncommon illness. A person with myxedema may exhibit drowsiness, followed by extreme lethargy and unconsciousness.

Heart conditions

Poor cardiac function, an enlarged heart, and irregular heartbeats are all possible chronic autoimmune thyroiditis. LDL cholesterol is a risk factor for cardiovascular disease and heart failure when high in the bloodstream.

Sexual and reproductive complications

Hypothyroidism in women may cause a decrease in libido, an inability to ovulate, and abnormal and heavy menstrual flow, among other symptoms. Men with hypothyroidism may experience reduced libido and erectile dysfunction and a lower sperm count.

When should you visit your healthcare provider?

You should visit a healthcare provider if you exhibit a number of the above symptoms. A doctor will give you a clear diagnosis and issue necessary treatment. You must first check whether you receive the proper medicine since specific treatments can result in hypothyroidism.

The lowdown

Chronic autoimmune thyroiditis is an autoimmune disease resulting from a breakdown in the immune system. A previous autoimmune disorder, such as celiac disease, lupus, rheumatoid arthritis, or type 1 diabetes, is the most significant risk factor for chronic autoimmune thyroiditis. At the same time, the condition is also more common in women than in men.

You're more likely to acquire other autoimmune conditions and, to a lesser degree, a particular kind of thyroid cancer if you have Hashimoto's thyroiditis. High cholesterol, heart disease and heart failure, high blood pressure, increased risk of birth abnormalities in pregnant women, and a life-threatening illness known as myxedema are also risk factors predisposing you to the disease.

A diagnosis of Hashimoto's does not alter your total life expectancy since the disease is readily treatable.