Internal Medicine

Hashimoto's thyroiditis

introduction

The word "Hashimoto“Most of them hesitate and would not be able to classify it as a disease. But actually that also as chronic lymphocytic thyroiditis significant Autoimmune disease takes its name from the Japanese doctor Hakaru Hashimoto, who discovered the disease.

definition

Hashimoto's thyroiditis is an autoimmune disease. Autoimmune diseases are diseases in which the own immune system recognizes cells in the body as foreign and destroys them.

For this reason, the antibodies that are directed against the body's own cells are called autoantibodies. They are responsible for numerous autoimmune diseases. A list of all autoantibodies and the associated clinical pictures can be found at: Autoantibodies

It is the most common form of chronic inflammatory thyroid gland and the most common cause of an underactive thyroid (hypothyroidism).
The incidence in the general population is 5-10%, the gender distribution is 9: 1 (female: male) and mostly affects people between the ages of 30 and 60.

causes

In this autoimmune disease, the Thyroid cells by the so-called T cells (white blood cells of the so-called "acquired immune defense") destroyed. Additionally be antibody which are directed against antigens of the thyroid gland.
This in turn leads to a chronic inflammation of the thyroid glandwhat ultimately resulted in a Hypothyroidism can lead to a lack of thyroid hormones.

The exact causesthat are still leading to Hashimoto's thyroiditis not sufficiently clarified. One suspects, however, among other things, these triggers:

Family background (genetics)
Intestinal problems and intolerance
stress
Viral diseases (e.g. shingles or glandular fever)
Chronic infections
Excessive iodine intake
Hormonal changes (e.g. puberty, pregnancy, breastfeeding, stopping the pill, premenopause, menopause) that lead to high estrogen and low progesterone levels.
In addition, Hashimoto's thyroiditis can be associated with other autoimmune diseases. Type 1 diabetes is an example.

Symptoms

Symptoms at the beginning of the disease

At the beginning of the disease one usually has no apparitions. Initially, however, an overactive thyroid gland (hyperthyroidism) can occur for a certain period of time (due to an attempt to counter-regulate the body), with the following symptoms:

Autonomic nervous system: cardiac arrhythmias, such as palpitations, high blood pressure, heat intolerance, sweating, hair loss, warm skin, thirst, cravings
Mentally: restlessness, irritability, nervousness, trembling of the hands, sleep disorders, easy fatigue
Gastrointestinal tract: possibly diarrhea
Metabolism: weight loss (despite appetite)
Muscles: weakness and sometimes pain in the legs, especially the thighs
In women: Menstrual cycle disorders
Goiter = Thyroid thickening

Long term symptoms

In the long term, however, it can occur in the course of a lifetime or even at the beginning Underactive thyroid (a hypothyroidism) in which the body simply cannot produce enough thyroid hormones and they have to be replaced with medication. The sub-function is noticeable through:

Weight gain
Cold intolerance
constipation
Slowing your heart rate
Lack of drive, weakness, up to a depressive mood
Cool, dry skin
Brittle hair
Lump or pressure in the throat
Water retention (edema): on the eyelids, face, extremities, or lower legs
In women: missed menstruation (called secondary amenorrhea)

Read more about the topic here: Symptoms of an underactive thyroid

Symptoms depending on age

Unfortunately, the symptoms of Hashimoto's thyroiditis in children are often not recognized, which is why caution is advised here. Depending on age, there can be different characteristic complaints:

a) Babies:

Hypothyroidism: Jaundice, puffy face, laziness to drink, drowsiness, hoarse screaming, bloated stomach, cold extremities, umbilical hernia, large fontanels, indifference
Hyperthyroidism: Difficulty sleeping through the night, sweating, screaming child, diarrhea, strong urge to move

b) (small) children

Hypothyroidism: Late development (delayed growth, late formation of teeth, poor language development), susceptibility to infections, listlessness, dreaminess, paleness
Hyperthyroidism: Growth disorders, early tooth development, clumsiness, fits of anger, warm and damp skin, abdominal pain, diarrhea, need for attention

c) young people

Hypothyroidism: Concentration and memory problems, decline in school performance, anxiety, sensation of cold, dry skin and hair, weight gain, eyelid edema
Hyperthyroidism: Growing pains, as well as disturbed bone growth, sleep disorders, aggressiveness, weight loss, concentration disorders, hyperactivity

Course of disease

The experts do not yet agree on whether the disease will progress in episodes. Some experts then speak of Flare-ups the Hashimoto thyreoidits if some criteria at the same time meet:

Specific symptoms:

Pressure or lump in the throat
Drawing pains, reddened, overheated skin in the thyroid area
Feeling flu (especially hot head)

Measurable effects:

Decrease in size of the thyroid gland
In the blood: increase in antibodies (TPO antibodies, TG antibodies), changes in thyroid parameters (TSH increases, thyroid hormones fT3 and fT4 decrease)

Trigger:

stress
Infectious diseases before
Iodine intake in high doses over the long term
Hormone fluctuations
Quit smoking

Diagnosis

In order to find the disease, on the one hand, you need the Examination of the blood and on the other hand one Ultrasound examination. Usually the patients come with symptoms (an over- or under-function), other times it is an incidental finding.

in the blood the doctor can see if antibody circulate (these antibodies are TPO antibodies, microsomal antibodies (MAK) or TG antibodies) whether the body still has enough Thyroid hormones produced (called fT3, fT4) and whether the body is already in a mechanism of counter-regulation (the so-called TSH value is then increased in the case of underactive and decreased in the case of overactive).

Read more about the topic here: Thyroid levels

However, it should be said here that even normal thyroid values are not an exclusion criterion for Hashimoto's thyroiditis, since the body is often not yet in an overfunction, let alone underfunction.
Therefore there is also a Ultrasonic the thyroid made to see if the thyroid is already Has signs of destruction. In this case the Thyroid inconsistent and not infrequently small appearance. You can often see black oval structures in the tissue in the ultrasound image. A total volume of approx. 18ml for women and 25ml for men would be conspicuous, which could indicate an increased thyroid volume. A total volume of less than 6 ml in women and less than 8 ml in men could indicate tissue atrophy of the thyroid gland.

In addition, the Measurement of blood flow Increased blood flow in the thyroid gland (Doppler examination), indicating inflammation. If anything is unclear, a Scintigraphy, as well as a histological tissue removal in the sense of a puncture.

therapy

General information about therapy

Unfortunately, Hashimoto's thyroiditis is currently still one incurable disease and therefore will not treated causally. If there are no symptoms, the disease does not need to be treated.

However, if symptoms of an underactive thyroid do appear, a creeping replacement of thyroid hormones treated. Here is Every day In the morning, 30 minutes before breakfast a tablet taken. Usually this is L-thyroxine (levothyroxine), the lifelong must be taken.

Medical therapy

The medical therapy an underactive thyroid due to a Hashimoto is mostly inevitable. Some patients also have a T4 to T3 conversion disorder. In this case, a Combination preparation of L-thyroxine and Liothyronine to take.

The important thing is that regular checks the thyroid hormones to the doctor.

Taking iodine

Attention is advisable when taking iodine. Iodine comes mainly from salt, in Sea fishing, in the milk and also in Hard cheese in front. Less is found in spinach, broccoli, lamb's lettuce, potatoes and whole wheat bread.

Although iodine has been deficient in the last few decades, especially in southern Germany, and iodine deficiency symptoms can occur, among other things, it is unfavorable in connection with Hashimoto's thyroiditis.
More than 200µg daily can the Activate antibody formation. You can breathe a sigh of relief, however, as the amount of iodine in food that is usual in Germany does not matter. It is important to avoid drugs, multivitamins and dietary supplements containing iodine.

nutrition

General nutrition tips

Regarding the general diet with Hashimoto's thyroiditis, it should be said that regular food intake is important in order to keep the blood sugar level constant. A high-carbohydrate diet is therefore not necessarily beneficial. So you should especially avoid foods with a lot of sugar, sweet drinks, sweets or white flour products.

Furthermore, it makes sense to avoid foods containing gluten, as the grain protein gluten is suspected of promoting inflammatory reactions in the body in some autoimmune diseases and enhances an immune reaction against tissue of the body.

Some types of vegetables can also be stressful for the body because they contain enzymes that can affect the thyroid gland. Examples are Brussels sprouts, broccoli and kale.

If you want, you can create a nutrition log and try to avoid certain foods and then after a few months see how this affects the symptoms. During this period you could avoid the foods mentioned above: alcohol, coffee, dairy products, eggs, nuts, soy, tomatoes, peppers, eggplants and mushrooms.

Read more about this under Lose weight with hypothyroidism

Taking selenium

selenium is an important one Trace element in connection with the thyroid gland, which has a high need for it. The thyroid needs it 600-1240 µg selenium and is thus that organ richest in selenium our body.

The German Society for Nutrition recommends a daily intake of 30-60µg to healthy adults. However, this amount is easily covered by a balanced diet. At Hashimoto However, in some cases patients can also use the Ingestion of 200 µg selenium help lower the antibodies and slow down the inflammatory response. Selenium is a radical catcher and has an antioxidant effect.

An intake duration from one 3-6 months often shows one improvement; both health and diagnostic parameters. However, in such cases a tight control carried out by the attending doctor.
In patients with longstanding Hashimoto however, is often a treatment with selenium contraindicated, since the inflammatory reaction can no longer be stopped in this way and it may only be to Side effects comes. These could be, for example: nausea, diarrhea, joint pain, tiredness or neurological disorders. In extreme cases it can even be too Heart failure come. Therefore selenium therapy should only be used in close connection with the doctor respectively.

At a acute episode however, selenium can actually help very effectively.

Follow a Hashimoto's

As already described above, in Hashimoto's thyroiditis, the autoimmune reactions can lead to a intermittent compensatory hyperthyroidism come with the respective symptoms.

Read more about: Symptoms of an overactive thyroid

In the long run, however, to one Hypothyroidism. When this occurs varies from person to person. In the case of an underactive thyroid gland, a lifelong intake of L-thyroxine (often 50 µg) is indicated.

Read more about: Symptoms of an underactive thyroid