A Commonly Overlooked Thyroid Disorder: Hashimoto's Disease

By: Red Hot Mamas

Published: May 26, 2010

Last month’s thyroid disease article was greatly received among our fellow Red Hot Mamas members. Many women were relieved to hear they are not alone in battling the difficulties associated with the thyroid. Grave’s Disease is the most common type of hyperthyroidism (overactive thyroid). This article is about another notable disorder associated with hypothyroidism (an underactive thyroid): Hashimoto’s Thyroiditis. Like Grave’s Disease, Hashimoto’s Thyroiditis is an autoimmune disease. Hashimoto’s is the most common cause of hypothyroidism and is very common in older women.

Thyroid function and menopause are very closely related and can often be problematic. The hormonal balance becomes offset during menopause and quite often, there is an insufficient production of thyroid hormones. Women with thyroid problems should recognize symptoms early. They should frequently screen their hormones (women age 50 and over should be tested for hypothyroidism every few years) and treat the problem to control proper thyroid function.

Seventy-nine percent of all autoimmune disease patients in the US are women. Hashimoto’s is four times more common among women than men. It is a disorder where the body’s own immune system fights off the thyroid cells causing gradual destruction of the thyroid gland. White blood cells (specifically T-lymphocytes) overrun the thyroid tissue and further damage the organ.

The thyroid is a complex part of the body. It is ultimately controlled by the hypothalamus of the brain that produces the Thyrotropin Releasing Hormone (TRH) and releases it to the pituitary gland. Then the pituitary gland manufactures Thyroid Stimulating Hormone (TSH) which stimulates your thyroid gland to produce and secrete thyroid hormones. In very simplified terms, the thyroid absorbs iodine from foods and combines it with the amino acid tyrosine converting it to the thyroid hormones T3 and T4. T3 is the most active thyroid hormone although T4 is more abundantly secreted. These hormones then regulate metabolism. When levels of thyroid hormone are high enough, the thyroid hormones cause the hypothalamus and pituitary gland to slow down, much like a thermostat turns off when the house temperature reaches a set point. Schematically, the process looks something like this:

Hypothalamus (TRH) -> Pituitary Gland (TSH) Thyroid Gland (T4 and T3) -> Metabolic Activity

Although some Hashimoto’s patients may not have symptoms, they are similar to those of hypothyroidism. Hashimoto’s is a “disease” while hypothyroidism is a “condition”. The effect on you is the same. The thyroid’s decreased ability to produce hormones results in the hypothyroid condition and subsequent symptoms. Fatigue, depression, sensitivity to cold, weight gain, muscle weakness, coarsening of the skin, dry or brittle hair, constipation, muscle cramps, increased menstrual flow and goiter (enlargement of the thyroid gland) are common.

An endocrinologist can recognize thyroid abnormalities and conduct wide array of tests to confirm Hashimoto’s Disease. Blood tests can be conducted to measure levels of T3, T4 and TSH. High levels of antibodies fighting thyroglubin (TG) and thyroid peroxidasae (TPO) may also be verified by blood tests if the patient is suffering from hypothyroidism.

Mild cases exist where these levels can appear normal in blood tests but the condition of hypothyroidism still exists. Other tests may be necessary. Physical examination of the gland can also be used to detect abnormalities. Lymphocytes and macrophages can be found by conducting a needle biopsy on the thyroid. Also, an enlarged thyroid can be seen in a radioactive uptake scan or ultrasound. Often your doctor can feel the enlargement which feels like a swollen butterfly or bowtie on the front of your neck.

Proper diagnosis may be a frustrating experience. The condition cannot always be detected right away. For some people, multiple of tests may be necessary. An endocrinologist can assist you in assessing the symptoms, choosing the tests, diagnosis and treatment options.

Specific treatments for Hashimoto’s Disease do not exist yet but patients are regularly treated for hypothyroidism. Hypothyroidism and Hashimoto’s Disease can be treated safely and effectively but require a life-long therapy. Hormone levels can be brought back to a “normal” state with thyroid hormone pills. Different dosages are available. Finding the proper amount for your specific condition is an individualized experience as with any hormone therapy.

Most prescribed therapies involve replacement of the T4 hormone. Even though the T3 hormone is the most active, T4 is more stable. T3 is a much shorter-acting therapy that has to be taken multiple times a day. Most patients have no problems converting the synthetic T4 hormone to T3 naturally in the bloodstream so most doctors treat patients with some type of synthetic T4 therapy.

Depending on your hormone levels and severity of hypothyroidism, other therapies are available. Some people cannot sufficiently convert T4 to T3 and need some replacement to maintain levels of T3. Low doses of T3 can be given if symptoms of hypothyroidism do not improve. Combining T4 and T3 hormones can benefit some patients but it is a controversial topic among many doctors.

Although some patients need the combination, there are disadvantages. Since T3 is faster-acting than T4, patients usually take it two or three times a day. Compounding pharmacists can mix both hormones. Caution should be used and keep in mind FDA’s position on compounding pharmaceuticals, “Whenever possible, the FDA would recommend that patients use an approved drug. We have more data and reporting requirements on those to assure us of their safety and effectiveness.”

If you suspect a thyroid problem, the first step is to ask your primary doctor. Often they will be able to diagnose the problem. If they are not certain or don’t take care of this problem, ask them for help acquiring an endocrinologist. These specialty doctors can assist in the diagnosis and treatment of common conditions including diabetes, thyroid diseases, metabolic disorders, hormone production, menopause, osteoporosis, hypertension, cholesterol disorders, infertility and cancers of the endocrine glands. One word of caution. If you take HT and your dosage changes, it can effect the amount of thyroid hormone your body needs. Generally, the more HT, the more thyroid hormone you need and visa versa. So be sure to ask your doctor about this adjustment if your HT dosages is adjusted.


Wikipedia Online Encyclopedia

Endocrine Disorders and Surgery Information

Rackowski, P., “Thyroid Disease and Menopause”, Thryoid-Info

Thyroiditis Health Center