Hashimoto's thyroiditis: everything you need to know about the most common thyroid disease at a glance
Hashimoto's thyroiditis is a disease that affects around 1-1.5 million people in Germany [1]. Here you can find out about the causes and symptoms of the disease and what treatment options are available.
Hashimoto's thyroiditis: What is it exactly?
Hashimoto's thyroiditis, often referred to as Hashimoto's or autoimmune thyroiditis, is an autoimmune disease in which the immune system attacks the thyroid gland: T lymphocytes, especially CD4+ T cells, mistakenly recognize thyroid tissue as foreign and attack it. Over time, this chronic inflammation leads to damage to the thyroid gland and can ultimately lead to hypothyroidism [1]. The opposite of hypothyroidism is hyperthyroidism.
Hashimoto's disease was first described in 1912 by the Japanese doctor Hakaru Hashimoto, after whom it is named. Since then, our understanding of this disease has expanded considerably.
Hashimoto's vs. Hashimoto's thyroiditis: Is there a difference?
Many people wonder whether there is a difference between Hashimoto's and Hashimoto's thyroiditis. The answer is simple: no, there is no difference. Hashimoto's is just a short form for Hashimoto's thyroiditis. Both terms refer to the same autoimmune disease of the thyroid gland.
The forms of Hashimoto's thyroiditis
Although people often talk about “the” Hashimoto's thyroiditis, there are actually different forms of this disease:
Classic Hashimoto's thyroiditis: This is the most common form, in which the thyroid gland is slowly destroyed and leads to hypothyroidism.
Atrophic thyroiditis: In this form, the thyroid gland shrinks instead of enlarging.
Hashimoto's encephalopathy: A rare form in which the brain is also affected and neurological symptoms can occur [2].
Postpartum thyroiditis: This form occurs after pregnancy and can be temporary [3].
The development of Hashimoto's thyroiditis
The development of Hashimoto's thyroiditis is gradual:
- Genetic predisposition: At this stage, people have an increased risk due to their genetic disposition, but do not yet show any symptoms.
- Silent autoimmunity: Antibodies against the thyroid gland are detectable, but thyroid function is still normal.
- Subclinical hypothyroidism: The TSH value rises slightly, but T3 and T4 are still within the normal range.
- Manifest hypothyroidism: The thyroid hormones drop and clinical symptoms appear.
- Advanced hypothyroidism: The thyroid gland is severely damaged and the symptoms are pronounced [4].
What are the causes and risk factors for Hashimoto's thyroiditis?
The exact cause of Hashimoto's thyroiditis is not yet fully understood. However, it is assumed that a combination of genetic and environmental factors play a role.
The risk factors include [4]:
Genetic predisposition: There are familial clusters of the disease.
Gender: Women are more frequently affected than men.
Age: The disease often occurs between the ages of 30 and 50.
Other autoimmune diseases: People with other autoimmune diseases have an increased risk.
Environmental factors: Stress, infections and certain medications can possibly contribute to the development of the disease.
Symptoms: When the thyroid gland gets out of sync
The symptoms of Hashimoto's thyroiditis can be varied and non-specific, which often makes diagnosis difficult. Typical symptoms of hypothyroidism that can occur during the course of the disease are [4]:
- Tiredness and exhaustion
- Weight gain despite unchanged diet
- Sensitivity to cold
- Dry skin and brittle nails
- Hair loss
- Constipation
- Depressive moods
- Concentration difficulties
- Muscle and joint pain
Important: The symptoms mentioned can also occur with other illnesses. A thorough medical examination is therefore essential.
What is the difference to thyroiditis de Quervain, Addison's disease and Graves' disease?
Addison's disease, Graves' disease and Hashimoto's thyroiditis are autoimmune diseases in which the immune system mistakenly attacks the body's own tissue. These diseases can be linked, as people with one autoimmune disease have an increased risk of developing others. For example, Addison's disease (a disease of the adrenal glands) often occurs together with Hashimoto's thyroiditis - this combination is known as Schmidt's syndrome. Graves' disease, an autoimmune disease that causes hyperthyroidism, can also occur together with Hashimoto's, as both affect the thyroid gland.
Thyroiditis de Quervain, on the other hand, is a different type of thyroid inflammation that is not autoimmune. It often occurs suddenly, for example after a viral infection, and causes flu-like symptoms and pain in the thyroid gland. In contrast to Hashimoto's, this inflammation usually heals on its own [5].
Is Hashimoto's thyroiditis dangerous?
In most cases, the condition is easily treatable and does not lead to serious complications if treated appropriately. However, untreated hypothyroidism can lead to various health problems in the long term, including
- Increased risk of cardiovascular disease [6]
- Infertility or pregnancy complications [7]
- Depression [7]
- Elevated cholesterol levels [7]
- Osteoporosis [7]
In addition, patients with Hashimoto's thyroiditis have a slightly increased risk of developing other autoimmune diseases, such as type I diabetes, type II diabetes or coeliac disease. Regular medical monitoring and adjustment of therapy is therefore particularly important [8].
How is Hashimoto's thyroiditis diagnosed?
The diagnosis of Hashimoto's thyroiditis requires a comprehensive approach that combines various examination methods. Doctors usually start with a thorough clinical examination and then rely on a series of blood tests and imaging techniques to identify and confirm the disease.
Blood tests are a central component of the diagnosis. The TSH value (thyroid-stimulating hormone) is measured first, an increase in which can indicate a possible hypothyroidism. This is also referred to as latent hypothyroidism. In addition, the levels of the free thyroid hormones T3 and T4 are determined, which provide information about the current functionality of the thyroid gland.
The presence of certain autoantibodies in the blood is particularly characteristic of Hashimoto's thyroiditis. Elevated TPO-AK (TPO antibodies) against thyroid peroxidase can be detected in around 90% of patients. In addition, increased Tg antibodies (against thyroglobulin) can be detected in around 70% of those affected.
An ultrasound examination is often performed to visualize the thyroid gland. This makes it possible to detect changes in the structure and size of the organ.
The diagnosis of Hashimoto's thyroiditis is not always clear. Particularly in the early stages of the disease, laboratory values may still be within the normal range, even though antibodies are already detectable.
How is Hashimoto's thyroiditis treated?
Hashimoto's thyroiditis is a chronic disease that requires lifelong treatment. The good news is that with the right therapy, most patients can lead a normal, symptom-free life. Treatment for Hashimoto's thyroiditis aims to normalize thyroid function and relieve symptoms as the disease progresses. The most important approach in the treatment of Hashimoto's in internal medicine is substitution therapy with thyroid hormones [4]:
Hormone replacement therapy: The synthetic thyroid hormone L-thyroxine is administered in tablet form to balance hormone levels. The dose is adjusted individually and checked regularly.
Regular checks: TSH levels and thyroid hormones should be checked regularly to adjust therapy if necessary.
Lifestyle measures: A balanced diet, regular exercise and stress reduction can alleviate symptoms and improve general well-being.
Iodine restriction: In some cases, an iodine-reduced diet may be recommended, as iodine can increase the autoimmune response.
Treatment of concomitant diseases: Frequently occurring vitamin D deficiencies or iron deficiency should be compensated for.
The right diet for autoimmune thyroiditis
There is no specific Hashimoto's diet. Nevertheless, diet can play an important role in managing the disease:
Balanced, nutrient-rich diet: A diet rich in vegetables, low-sugar fruit and high-quality protein sources supports the health of the thyroid gland and the entire body.
Avoiding highly processed foods: Avoiding processed foods and fast food can reduce inflammatory processes in the body and alleviate symptoms.
Adequate intake of selenium and zinc: Selenium is essential for the proper functioning of the immune system and the thyroid gland, while zinc is also important for thyroid function.
Be careful with iodine-rich foods: Although iodine is important for thyroid function, too much intake can be problematic for Hashimoto's patients and should be controlled.
A gluten-free diet can be beneficial for some patients: If gluten intolerance is suspected, a gluten-free diet can improve thyroid function and reduce the autoimmune response.
Tip: Dietary changes should always be discussed with a doctor or nutritionist. This way you can ensure that you are consuming all the important nutrients in sufficient quantities.
11 important tips for living with Hashimoto's
Most people with Hashimoto's thyroiditis can lead an active and fulfilling life. It is important that those affected take the following points into account:
- Taking your medication: Take your thyroid medication regularly and as prescribed. Ideally in the morning on an empty stomach, about 30 minutes before breakfast. This ensures optimal absorption.
- Sufficient sleep and rest: Plan to get enough sleep, as tiredness is a common symptom. Make sure you have a regular bedtime and create a quiet sleeping environment.
- Regular exercise: Stay active, but don't overexert yourself. Light to moderate activities such as walking, swimming or yoga can stimulate your metabolism and improve your mood. Listen to your body and adjust the intensity accordingly.
- Stress management: Learn and practise techniques to reduce stress. Meditation, deep breathing or progressive muscle relaxation can help to reduce stress and support the immune system.
- Dietary changes: A balanced, nutritious diet can alleviate symptoms. Experiment carefully with a gluten-free or anti-inflammatory diet, always in consultation with your doctor.
- Regular medical check-ups: Stay in close contact with your doctor. Regular blood tests and medication adjustments are important for an optimal setting.
- Self-help groups and exchanges: Contact with other sufferers can be emotionally supportive and provide practical tips. Look for local self-help groups or online forums.
- Holistic approach: Consider complementary therapies such as acupuncture or osteopathy, which can help alleviate symptoms in some patients.
- Mindfulness in everyday life: Pay attention to your boundaries and learn to say “no” when something becomes too much for you. Plan regular breaks into your daily routine.
- Positive attitude: Focus on what you can do despite the illness rather than on limitations. A positive attitude can make it easier to deal with the illness.
- Food supplements: Selenium, zinc and vitamin D can be helpful in some cases to prevent a vitamin deficiency, but should only be taken after consulting a doctor.
Psychological aspects of Hashimoto's thyroiditis
The psychological effects of Hashimoto's thyroiditis are often underestimated [9]. Many patients not only experience physical symptoms, but also suffer from emotional and cognitive changes. The most common psychological aspects include:
Depression and anxiety disorders: The changes in hormone levels can lead to mood swings and depressive moods.
Cognitive impairment: Many patients report difficulty concentrating and memory problems, often referred to as brain fog.
Fatigue and chronic exhaustion: Persistent fatigue can lead to social isolation and reduced quality of life.
Body image disturbances: Weight changes and skin problems can affect self-image.
Stress and adjustment difficulties: Dealing with a chronic illness can cause considerable stress.
Research and future prospects
Research into Hashimoto's thyroiditis is making steady progress. Scientists are working to better understand the exact mechanisms of the disease and to develop new treatment approaches. It is hoped that the various research approaches will lead to improved diagnosis and treatment options in the future.
Hashimoto's is easily treatable
Hashimoto's thyroiditis is a complex autoimmune disease that cannot be cured, but is treatable in most cases. With the right understanding, appropriate medical care and a healthy lifestyle, sufferers can lead a normal and fulfilling life.
If you notice symptoms that could indicate thyroid disease, do not hesitate to consult your doctor. The earlier the diagnosis is made, the better possible complications can be avoided.
And always remember: you are not alone with this disease. Millions of people worldwide live with Hashimoto's thyroiditis and lead an active, healthy life. With the right knowledge and support, you too can take control of your health and improve your quality of life!
Sources:
[1] https://www.bioscientia.de/gesundheitsthemen/hashimoto-thyreoiditis/
[2] https://www.medicoverhospitals.in/hashimotos-encephalopathy/
[3] https://www.medical-tribune.de/baby-blues-oder-postpartale-thyreoiditis
[4] https://www.netdoktor.de/schilddruesenentzuendung/hashimoto-thyreoiditis/
[5] https://www.forum-schilddruese.de/schilddruese-subakute-thyreoiditis
[6] https://www.lunow.de/hashimoto-thyreoiditis-schilddruesenentzuendung
[7] https://www.endokrinologie.net/krankheiten-schilddruese-hashimoto
[8] https://www.hashimoto-thyreoiditis.de/symptome/begleit-folgeerkrankungen
[9] https://www.vorsorge-online.de/bei-depression-und-angststoerung-schilddruesenerkrankungen-abklaeren/
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