Hashimoto's Disease

What is Hashimoto's disease?

Thyroid and Pituitary Glands Hashimoto's disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease. An autoimmune disease is a disorder in which the body's immune system attacks the body's own cells and organs. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

In Hashimoto's disease, the immune system attacks the thyroid gland, causing inflammation and interfering with its ability to produce thyroid hormones. Large numbers of white blood cells called lymphocytes accumulate in the thyroid. Lymphocytes make the antibodies that start the autoimmune process.

Hashimoto's disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesn't make enough thyroid hormone for the body's needs. Thyroid hormones regulate metabolism-the way the body uses energy-and affect nearly every organ in the body. Without enough thyroid hormone, many of the body's functions slow down. Hashimoto's disease is the most common cause of hypothyroidism in the United States.

What are the symptoms of Hashimoto's disease?

Many people with Hashimoto's disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful. After many years, or even decades, damage to the thyroid causes it to shrink and the goiter to disappear.

Not everyone with Hashimoto's disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinical-mild and without symptoms, especially early in its course. With progression to hypothyroidism, people may have one or more of the following symptoms:

Who is more likely to develop Hashimoto's disease?

Hashimoto's disease is much more common in women than men. Although the disease often occurs in adolescent or young women, it more commonly appears between 30 and 50 years of age.

Hashimoto's disease tends to run in families. Researchers are working to identify the gene or genes that cause the disease to be passed from one generation to the next.

Possible environmental factors are also being studied. For example, researchers have found that consuming too much iodine may inhibit thyroid hormone production in susceptible individuals. Chemicals released into the environment, such as pesticides, along with certain medications or viral infections may also contribute to autoimmune thyroid diseases.

People with other autoimmune diseases are more likely to develop Hashimoto's disease. The opposite is also true-people with Hashimoto's disease are more likely to develop other autoimmune diseases. These diseases include:

How is Hashimoto's disease diagnosed?

Diagnosis begins with a physical exam and medical history. A goiter, nodules, or growths may be found during a physical exam, and symptoms may suggest hypothyroidism. Your physician will then perform blood tests to confirm the diagnosis. Diagnostic blood tests may include the following:

Your physician may also order imaging tests, including an ultrasound or a computerized tomography (CT) scan.

How is Hashimoto's disease treated?

Treatment generally depends on whether the thyroid is damaged enough to cause hypothyroidism.

Hashimoto's disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. Synthetic T4 such as Synthroid is preferred over synthetic T3 because T4 stays in the body longer, ensuring a steady supply of thyroid hormone throughout the day.

For patients taking synthetic thyroid hormone, the physician will routinely test the blood and adjust the hormone dose as necessary, typically based on the result of the TSH test. Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed.

How does Hashimoto's disease affect pregnant women?

During pregnancy, hypothyroidism is usually caused by Hashimoto's disease and occurs in three to five out of every 1,000 pregnancies.2 Uncontrolled hypothyroidism raises the chance of miscarriage, premature birth, stillbirth, and preeclampsia-a dangerous rise in blood pressure in late pregnancy.

Untreated hypothyroidism during pregnancy may also affect the baby's growth and brain development. Thyroid medications can help prevent these problems and are safe to take during pregnancy. Women with Hashimoto's disease should discuss their condition with their Cardio-Med physician before becoming pregnant.

Eating, Diet, and Nutrition

Iodine is an essential mineral for the thyroid. However, people with Hashimoto's disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodine-such as seaweed, dulse, or kelp-may cause or worsen hypothyroidism.

Women need more iodine when they are pregnant-about 220 micrograms a day-because the baby gets iodine from the mother's diet. Women who are breastfeeding need about 290 micrograms a day. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Pregnant women should choose iodized salt-salt supplemented with iodine-over plain salt and take prenatal vitamins containing iodine to ensure this need is met.

To help ensure coordinated and safe care, discuss any use of complementary and alternative medical practices, including use of dietary supplements such as iodine, with your Cardio-Med physician.

Points to Remember


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Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases

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