Hashimoto’s disease is an autoimmune condition in which the immune system mistakingly attacks the thyroid gland. This condition can also be referred to as chronic lymphocytic thyroiditis as this condition ultimately leads to hypothyroidism.
The thyroid is a small, butterfly-shaped gland at the front of the neck that plays a crucial role in regulating the body’s metabolism through the release of hormones. Over time, this immune attack can lead to a build up of white blood cells in the thyroid and hence gradual damage of this structure. This subsequently impairs the thyroids ability to produce certain hormones.
Hashimoto’s is the most common cause of hypothyroidism in developed countries, including Australia. It affects more women than men and is often diagnosed between the ages of 30 and 50.
Signs & Symptoms
Symptoms of Hashimoto’s disease often develop slowly and may be subtle at first. They commonly overlap with those of general hypothyroidism. Common signs and symptoms include:
- Fatigue and sluggishness
- Weight gain (despite no change in diet or exercise)
- Cold sensitivity
- Constipation
- Dry skin
- Puffy face
- Hair thinning or hair loss
- Depression or low mood
- Memory issues or ‘brain fog’
- Menstrual irregularities or fertility problems
- Muscle weakness or cramps
- Swelling in the front of the neck (goitre)
- Slower height growth in children
Diagnosis
Due to the fact that the symptoms of Hashimoto’s develop gradually and often overlap with other conditions, specific tests are needed to confirm the diagnosis accurately.
Diagnosis usually begins with a blood test to check your levels of Thyroid Stimulating Hormone (TSH) and thyroid hormones. A raised TSH level along with low thyroid hormone levels can indicate that the thyroid is underactive. The presence of a goitre (an enlarged thyroid gland) and elevated thyroid antibodies also support a diagnosis of Hashimoto’s.
In some cases, an ultrasound may be used to detect signs of inflammation in the thyroid, especially in the early stages of the condition.
Causes and Contributing Factors
Hashimoto’s is an autoimmune disease, meaning the immune system targets and damages healthy tissue. The exact cause isn’t fully understood, but several factors are known to contribute:
- Genetic Predisposition: People with a family history of thyroid or other autoimmune conditions are at higher risk.
- Gender and Hormones: Women are significantly more likely to develop Hashimoto’s. Hormonal changes during pregnancy, puberty, and menopause may play a role.
- Other Autoimmune Diseases: Conditions such as type 1 diabetes, coeliac disease, and rheumatoid arthritis increase risk.
- Excessive Iodine Intake: Too much iodine can trigger thyroid dysfunction in some individuals.
- Radiation Exposure: Exposure to radiation may increase the risk.
Stages of Hashimoto’s Progression
The progression of Hashimoto’s can be described in the following stages.
- Euthyroid Phase: Thyroid hormone levels are normal; there may be the presence of thyroid antibodies but no symptoms. This is the most common phase of Hashimoto’s.
- Subclinical Hypothyroidism: Thyroid-stimulating hormone (TSH) is slightly elevated, but T3 and T4 levels are still normal; symptoms may or may not be present.
- Overt Hypothyroidism: TSH is high, and thyroid hormone levels are low; clear symptoms are usually present.
- Atrophic Thyroiditis: Long-term damage leads to a shrunken, non-functional thyroid.
Prognosis
Hashimoto’s is a chronic condition, but with proper management, most people can live normal, healthy lives. That being said the risk of developing hypothyroidism increases by 5% every year. The disease itself doesn’t shorten life expectancy, but poorly managed hypothyroidism can lead to complications such as:
- Cardiovascular disease
- Goitre
- Myxedema (a rare, severe form of hypothyroidism)
- Infertility or pregnancy complications
- Mental health issues
Early diagnosis and effective treatment significantly reduce the risk of these complications.
Treatment
Medical Management
- Thyroid Hormone Replacement: The standard treatment is daily oral levothyroxine (a synthetic form of the hormone T4). This helps normalise hormone levels and alleviate symptoms.
- Regular Monitoring: TSH and sometimes T3 and T4 levels are monitored to adjust medication dosage.
Lifestyle and Diet
While medication is the cornerstone of treatment, lifestyle changes can play a supportive role in managing symptoms:
- Balanced Nutrition: A wholefoods-based diet rich in vegetables, fruit, lean protein, and healthy fats supports overall health.
- Regular Exercise: Low-impact activities such as walking, swimming, or Pilates can improve energy, mood, and metabolism.
- Stress Management: Yoga, meditation, and other stress-reduction strategies may help reduce autoimmune flare-ups.
Physiotherapy
Although Hashimoto’s itself is not a musculoskeletal condition, it can indirectly affect physical function and wellbeing. A physiotherapist can assist in managing the physical effects and improving quality of life.
The use of energy conservation techniques alongside a graded exercise program can prove beneficial for building capacity and managing fatigue.
Furthermore, as mentioned above physiotherapy input can help to promote regular exercise and hence improve metabolism and energy levels.