Will I Need Surgery For Hashimoto’s Thyroiditis?

Hashimoto's thyroiditis is an autoimmune disease in which the immune system attacks the thyroid gland. Eventually, the thyroid becomes unable to produce sufficient thyroid hormones. These hormones play a crucial role in metabolic functions, like regulating your body temperature, heart rate, or the rate at which you burn calories.

The go-to treatment for Hashimoto's disease is synthetic thyroid hormone medication, taken daily.

Many people experience fewer symptoms and stabilize their thyroid hormone levels about a month into treatment. However, the timeframe for doctors to work out your optimal dosage may be longer.

Surgery for Hashimoto's thyroiditis may be beneficial if you respond poorly to medication or find that your symptoms persist even after taking medication. 

In addition, several other physical factors make surgery appropriate, such as having problems swallowing or breathing.

Keep reading to learn more.

Symptoms

Hashimoto's disease leads to an underactive thyroid (hypothyroidism) that slows down many bodily processes. Symptoms often include:

• Dry skin

• Fatigue

• Sensitivity to temperature

• Muscle aches, weakness, and stiffness

• Joint pain

• Excessive menstrual bleeding

• Anxiety

• Depression

• Hair loss

• Generalized weakness

• Swelling of the thyroid (goiter)

• Weight gain

• Puffy face

What triggers Hashimoto's thyroiditis?

What triggers Hashimoto’s disease — or what makes the immune system attack normal thyroid cells — is still unclear and needs further research.

Most cases of Hashimoto's are both genetic and environmental. In other words, some people are born predisposed to Hashimoto's disease. However, it may take certain environmental triggers to "activate" the condition.

Some people with Hashimoto's have anti-thyroid antibodies. These antibodies are called antithyroglobulin, anti-thyroid peroxidase, and TSH receptor blockers. Each antibody attacks specific thyroid parts, partially destroying the gland over time.

 Still, around 10–15% of people with Hashimoto’s thyroiditis don’t have those antibodies¹.

(Note that the severity of Hashimoto's disease is not directly linked to thyroid antibody levels).

You may have a greater risk of Hashimoto’s disease if you

• Have another autoimmune disorder such as Celiac disease, or rheumatoid arthritis

• Have too much iodine in your diet

• Are a female between the ages of 30–50

• Hashimoto’s disease runs in your family

• Are vitamin D deficient

Environmental triggers may include

• Taking certain drugs (lithium, for example)

• Exposure to chemical toxins (heavy metals)

• Infections (such as hepatitis C)

How is Hashimoto's disease diagnosed?

Hashimoto's disease is diagnosed by thyroid function tests combined with thyroid antigen tests.

These screenings look for the levels of thyroid-related hormones (TSH, T4, and sometimes T3) or for specific thyroid antigens (anti-TPO, anti-Tg) to find abnormalities.

Suppose your hormone levels are outside the normal range. In that case, your doctor may consider repeating blood tests, especially if you have had a recent viral infection. 

Can surgery treat Hashimoto's disease?

Thyroid surgery (thyroidectomy) may be appropriate for people with Hashimoto’s thyroiditis who do not respond well to conservative therapy or if thyroid enlargement makes swallowing or breathing difficult.

A 2019 randomized trial² with 150 patients found that thyroidectomy for those who had ongoing symptoms even on thyroid hormone replacement had better health outcomes and lower fatigue than with continued thyroid hormone therapy alone. 

When should surgical management be considered?

Most people with Hashimoto's disease are successfully treated with synthetic thyroid hormones. Often, surgery is reserved for those with goiter swelling and pain.

However, the role of thyroidectomy in the treatment of Hashimoto's disease is evolving. Consult your doctor if your symptoms persist, even with thyroid hormone replacement therapy.

Thyroidectomy surgery is decided on a case-by-case basis.

Potential surgery complications

Annually, over 150,000 thyroidectomies³ are performed in the US. Most thyroidectomies are performed without issue, and thyroidectomy is considered a generally safe procedure. However, as with any surgery, there are risks.

Since your thyroid is close to your voice box, there is a risk of causing permanent vocal cord issues or nerve damage.

Researchers have found a thyroidectomy performed by a high-volume surgeon (one who performs 30 or more thyroidectomies per year) is associated with improved outcomes and fewer complications³. 

The lowdown

Hashimoto's thyroiditis (Hashimoto’s disease) is caused by your immune system attacking your thyroid. Hashimoto's disease is more common in females, those between the ages of 30 and 50, and those with close family members who have the disease.

In addition, some cases of Hashimoto's disease may be caused by environmental factors such as toxins, excessive iodine consumption, and certain viruses.

Most people with Hashimoto's disease are treated with synthetic thyroid hormone replacement therapy.

A small study² indicates that thyroid surgery may benefit patients with symptoms despite thyroid hormone therapy, but further research is needed to confirm this finding.

Currently, surgery is mainly for thyroiditis patients with severe thyroid enlargement or symptoms even after receiving hormone replacement.

Talk with your doctor if you have questions about whether or not a thyroidectomy could be beneficial for you.