Thyroiditis

Autoimmune process where the body mistakes the thyroid gland as something foreign and attacks it with antibodies targeting specific thyroid proteins.

Constant attack of the thyroid results in inflammation (thyroiditis), scarring (heterogenous/ irregular appearance on ultrasound), possible atrophy (shrinkage) of the gland, and potential compromised function (hypothyroidism – low thyroid hormone).

Affects ~ 10% of the U.S. population, 9:1 female to male ratio, increased incidence in white population, typically begins between the ages of 30 and 50.

• High genetic / hereditary component – tends to run in families.
• Increased risk if you have another autoimmune disease.
• Increased incidence in societies that have higher intake of iodine in their diet such as the US and Japan.
  • There may be other environmental components as well, but this is not well understood at this time.

Can cause compromised function of the thyroid (hypothyroidism), which can be chronic or fluctuating overtime.

• Overt Hypothyroidism is defined by low T4 and elevated TSH levels.
• Subclinical hypothyroidism is defined by T4 levels in the low-normal range and TSH levels that are elevated.
• Symptoms of hypothyroidism include: fatigue, cold sensitivity, constipation, dry skin, unexplained weight gain, brittle nails, delayed puberty, or slow growth.

Can be diagnosed with elevated thyroid antibody levels in the blood.

• Thyroid Peroxidase Antibody (TPO Ab).
• Thyroglobulin Antibody (Tg Ab).

Sometimes symptoms and thyroid hormone levels can fluctuate between hyperthyroidism and hypothyroidism in the beginning stages of Hashimoto’s thyroiditis thus complicating the diagnosis.

• Trending thyroid hormone / antibody labs overtime and evaluation by an Endocrinologist can help make this diagnosis on these challenging occasions.

Medical treatment in the form of a once daily thyroid hormone replacement medication is considered for overt hypothyroidism or in patients with symptomatic subclinical hypothyroidism.

• Immune suppressing medications used for the treatment of other autoimmune diseases are not considered in Hashimoto’s thyroiditis given that the side effects of these medication are far worse and greatly outweighed by the safe treatment with thyroid hormone replacement.
• It is highly debated whether diet and/or supplements are effective in controlling Hashimoto’s thyroiditis.
  • This underscores the lack of complete understanding in the underlying causes, variability between different patients, and need for further research into this topic.

Surgery to remove the entire thyroid (total thyroidectomy) can be considered if:

• Goiter (enlarged thyroid) has formed and is causing compressive symptoms and/or is cosmetically concerning.
  • Occasionally the thyroid will enlarge and form a goiter to compensate for the compromised hormone production.
• Widely fluctuating thyroid hormone levels and symptoms that are difficult to control with thyroid hormone replacement medication.
  • For reasons that are not well understood, when and how much the body attacks the thyroid can vary over time, causing thyroid hormone levels and symptoms to fluctuate unpredictably.
  • Removing the thyroid gland completely eliminates fluctuating hormone levels and simplifies the dosing of thyroid hormone replacement medications.