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Hashimoto's disease is a chronic autoimmune disease of the thyroid gland. The thyroid gland is a gland located in the front of the neck. It is a butterfly shaped gland that controls the metabolism of the body. In Hashimoto's disease, there is inflammation of the thyroid gland that causes damage to the gland. The damage to the gland causes an underactive gland and "hypothyroidism". Hashimoto's disease represents the most common cause of low thyroid condition in the US.
The thyroid gland makes T4 and T3, the thyroid hormones. These circulate through the body and act on every cell and tissue in the body. They affect brain development, metabolism, breathing, heart rate and nervous system function, body temperature, muscle strength, skin moisture levels, menstrual cycles, weight, and cholesterol levels.
Normally the thyroid hormone production occurs as a result of positive influence of thyroid stimulating hormone or TSH, which is made in the pituitary gland. When the T4 and T3 levels are low, it triggers the pituitary gland to put out more thyroid stimulating hormone so that it is elevated in hypothyroidism and in Hashimoto's thyroiditis. The opposite is true when the T4 and T3 levels are elevated.
Hashimoto's disease is an autoimmune condition which means that the body creates antibodies against otherwise normal thyroid tissue. This blocks the ability of the thyroid gland to function and hypothyroidism ensues.
The symptoms of Hashimoto's thyroiditis might be absent. As the disease progresses, the thyroid gland might be enlarged or swollen. This is called having a goiter. It is generally not a painful disease. After many years of having the disease, the thyroid gland shrinks and can disappear. Not everyone who has Hashimoto's disease actually develops hypothyroidism. If you have hypothyroidism from thyroiditis, you get the following symptoms: weight gain, fatigue, cold intolerance, muscle pain or joint pain, constipation, depression, dry and thin hair, irregular menses and infertility, and a slow heartbeat.
Hashimoto's thyroiditis is about seven times more common among women than in men. It is especially common in adolescence and in younger women. It also seems to have a peak in the age range of 40 to 60 years of age. It tends to be hereditary in nature. There can be environmental causes of the disease such as excess consumption of iodine. Some drugs or infection from some types of viruses can contribute to Hashimoto's disease. Those with other types of autoimmune diseases are more likely to get thyroiditis, such as those with rheumatoid arthritis, vitiligo, Addison's disease, pernicious anemia or type I diabetes.
The diagnosis of Hashimoto's thyroiditis includes a thorough history and physical exam, showing an enlarged or shrunken thyroid gland. Blood tests will show anti-thyroid antibodies and low T3 and T4 levels with an elevated TSH level. A TSH level is ultrasensitive and is the best first test for a low thyroid condition. The test for anti-thyroid antibodies includes an anti-TPO antibody test, which looks for the presence of autoantibodies to the thyroid gland.
Treatment of Hashimoto's thyroiditis depends on whether or not the thyroid hormone levels are low or are high. If there is hypothyroidism, this is treated. If there is goiter, this is treated by giving hormones to block the thyroid gland output of thyroid hormones. In some cases, the disease does not need to be treated at all.
Medications such as thyroid extract or Synthroid, which is synthetic, need to be given to replace the lost thyroid hormone. Synthroid is synthetic T4, which can turn into T3 in the body. The dose depends on what normalizes the thyroid hormone in the body and the TSH is followed on a regular basis to make sure the thyroid hormone levels are within normal limits.
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