What You Should Know About New Treatments For Hashimoto's Thyroiditis

Hashimoto's thyroiditis is an autoimmune disease that provokes the immune system to attack healthy thyroid gland tissue. Eventual scarring slows down thyroid hormone production, causing hypothyroidism (underactive thyroid).

Untreated, Hashimoto’s thyroiditis causes many bodily functions to become irregular. Though serious, it is usually very treatable.

This article provides a detailed overview of Hashimoto's thyroiditis, including symptoms, diagnosis, and its most current treatment options.

What is Hashimoto's thyroiditis?

Hashimoto's thyroiditis is an autoimmune disease that affects the thyroid gland, named after Japanese doctor Hakaru Hashimoto. Thyroiditis refers to the inflammation of the thyroid gland. One of the primary symptoms of untreated Hashimoto's thyroiditis is a swollen thyroid (goiter).

An estimated 1–2% of the US population is diagnosed with Hashimoto’s thyroiditis. (It is also commonly known as autoimmune thyroiditis, Hashimoto’s syndrome, or Hashimoto's disease). Hashimoto's thyroiditis is most prevalent in females between the age of 45–65 years old¹.

Signs and symptoms

• Goiter (swelling on the front of the neck)

• Weight gain

• Fatigue

• Loss of appetite

• Dry skin, brittle nails

• Increased sensitivity to cold

• Memory loss

• Hair loss

• Depression

• Irritability

• Constipation 

• Menstrual cycle changes (irregular or heavy period)

Causes

Hashimoto's thyroiditis involves your immune system malfunctioning, and lymphocytes — a type of white blood cell — mistakenly attack the thyroid gland. Researchers aren’t fully clear on what sets off Hashimoto’s thyroiditis.

In addition to a tendency for Hashimoto’s thyroiditis to run in families, other possible triggers may include: insufficient iodine in your diet, having another autoimmune condition (such as Celiac disease), or being exposed to radiation in your environment.

Complications associated with Hashimoto's thyroiditis

If Hashimoto's thyroiditis is left untreated, it can lead to complications such as:

• Irregular heartbeat or enlarged heart

• Mental health issues like depression 

• Sexual dysfunction such as low libido

• Miscarriage or poor pregnancy outcomes

• Skin thickening (myxedema)

How is Hashimoto's thyroiditis diagnosed?

Evaluating for Hashimoto's thyroiditis is considered when a person presents with symptoms of hypothyroidism and goiter (enlarged thyroid gland in the neck). If you experience any of the symptoms above, be sure to speak with a qualified healthcare professional as soon as possible.

Upon seeing a doctor, they will perform a physical exam to check for signs of swelling on your thyroid gland area. They may also order a thyroid ultrasound if there is a noticeable lump on your neck.

Blood tests are a common tool to test your thyroid function and rule out other diseases. The panel will likely include a:

• Thyroid-stimulating hormone test (TSH)

• Thyroxine test (T4)

• Thyroid antibody test (TPO)

These indicators are interrelated, have a normal range, and will be slightly different for everyone. Depending on your levels, your doctor will determine whether or not you have hypothyroidism and if Hashimoto’s thyroiditis is the cause.

The treatment mainstay: T4 replacement

Many people with Hashimoto's thyroiditis receive T4 replacement, also known as synthetic thyroid hormone replacement. One widely drug brand is called levothyroxine.

A doctor will usually monitor your TSH levels for six to 10 weeks to determine the optimal dosage for your condition. You will then have to take follow-up tests every year to monitor your progress. In most cases, levothyroxine is taken daily for the rest of your life.

Although synthetic thyroid hormone replacement can be effective for some people, there is plenty of reason for new and improved treatment options to be pursued:

• Clinical research² indicates that it can be quite challenging for doctors to identify the ideal dosage.

• Synthetic thyroid hormone replacement may be unsuitable for those with other health issues, such as insomnia, anxiety, or heart problems.

New and evolving treatment options for Hashimoto's thyroiditis

Metformin

A drug historically used to treat insulin resistance (diabetes) is not yet approved by the FDA for use in Hashimoto’s thyroiditis treatment, but early research³ indicates that it has a beneficial a TSH-lowering effect.

So far, most researchers have examined metformin’s efficacy in mice and during in vitro (test tube) experiments. Therefore, further clinical research with human patients is a crucial next step.

DTE or LT4/T3 combination therapy

According to a 2021 randomized clinical study⁴ with 75 patients, treating hypothyroidism with animal-derived desiccated thyroid extract (DTE), or levothyroxine/liothyronine (LT4/T3 combination therapy) can provide similar effectiveness as levothyroxine.

It’s important to note that this particular study evaluated people with various types of hypothyroidism (a subset of whom have Hashimoto’s thyroiditis). Therefore, more research is needed.

Surgery

A 2019 study conducted in Norway⁵ comparing the benefits of thyroidectomy (thyroid removal) in patients with Hashimoto's thyroiditis versus medication alone showed that surgery had improved results over medication only. The indicators used included general health scores, fatigue scores, and TPO antibody levels.

However,  thyroidectomy for patients with severe Hashimoto’s thyroiditis does not eliminate the need for the patient to take medication.

Pending further clinical research, surgery for treating Hashimoto's thyroiditis is typically recommended only when the thyroid gland enlarges to the point of causing swallowing and breathing problems.

The lowdown

Once diagnosed, Hashimoto's thyroiditis is a manageable autoimmune disease.

In recent years, treatment has focused mainly on the therapeutic use of synthetic thyroid hormone replacement drugs.

However, the drug metformin, desiccated thyroid extract, or a combination of levothyroxine/liothyronine are promising in clinical trials.

In severe cases, surgery may also be recommended. Ultimately, larger human trials have a vital role in advancing safe and effective treatment options.

If you would like to take part in a clinical trial to advance treatment for Hashimoto’s thyroiditis, we can help. Search for the condition here, answer a few questions, and we will help match you with eligible trials.