Hashimoto’s Disease, Information for Patients

Last Updated on 15 October 2021

Hashimoto’s Thyroiditis is a very common and widespread disease nowadays. My Hashimoto’s disease was diagnosed in 1983, when I was only 12 years old and ever since, I have always struggled with the consequent disorders caused by this illness. With this article, I wanted to share my experience, hoping that it will be helpful to you, also.

Hashimoto’s Disease: What Is It?

Hashimoto’s disease is caused by an alteration of our immune system that produces antibodies aimed to attack some components of the cells of thyroid. The latter is the endocrine gland placed in the front of the neck and producing hormones that regulate our metabolism.

The disease is also called Chronic Autoimmune Thyroiditis (AIT) or Chronic Lymphocytic Thyroiditis. This medical term depends on the fact that, with this disease, the tissue of thyroid presents a massive infiltration of lymphocytes, known as lymphomatous struma.

Lymphocytes are the cells our immune system uses to protect us from infections and tumors. In the case of Hashimoto’s disease, lymphocytes attack thyroid as if it is an external virus, tumor, or bacteria. In short: these cells don’t recognize that the gland is an important organ of our body! In Hashimoto’s disease, thyroid is recognized as a foreign body or an enemy to destroy.

The process is gradual and impairs many thyroid functions and our same wellness. The destruction of thyroid, in fact, is the final stage of Hashimoto’s disease. Indeed, when I am undergone to ultrasound examination, doctors say that my thyroid is severely damaged, but not destroyed, yet and with a normal level of hormones.

Unfortunately, the problems caused by Hashimoto’s Thyroiditis are in other areas of our body. They often represent the intermediate stages of the disease with all their destabilizing consequences, such as food sensitivities, hair loss, and mental disorders, only to mention a few of them.

These disorders are often regarded as secondary problems or even overlooked, sometimes. With Hashimoto’s disease, patients may feel bad, but the most of doctors will tell them to have imaginary symptoms.

This shallow approach finished to transform this disease in a silent killer which does not kill us physically, but strikes us in every moment of our life. However, before deepening the further implications of Hashimoto’s disease, I would like to dive into its history, because even though it seems a modern disease, it is much more ancient than you think.

Hashimoto’s Thyroiditis History

Hashimoto’s disease was diagnosed for the first time in 1912 by Japanese doctor Hakaru Hashimoto. He was born on May 5, 1881 in the small village of Midai, a few kms away from Iga Ueno, the seat of the school for Ninjas. Hashimoto entered the medicine faculty in 1900 at the subsidiary seat of the university of Kyoto, in Fukuoka, and was the first student who graduated in 1907.

Between 1905 and 1909, the young Japanese doctor studied four patients who had been undergone to a partial thyroidectomy due to goiter, but after further examinations, he noticed that the goiter was full of lymphoid cells. The histological test showed that the tissue was like Graves’ disease, but with different lymphocytes triggered by an unidentified factor.

While Graves’ disease, indeed, was and is an autoimmune illness characterized by hyperthyroidism (with more thyroid hormone production), the new disease discovered by Hashimoto was characterized by hypothyroidism (low thyroid hormone).

The discovery was published in 1912 by the same Hashimoto on a German journal. However, in Germany, the discovery was not considered as a new disease, but only as a variant of Riedel thyroiditis.

Only in 1931, a British surger at the Cleveland Clinic, Graham, confirmed that the lymphomatous struma (the type of lymphocytic infiltration in thyroid) described by Hashimoto was a different disease. Germany included Hashimoto’s disease in its own scientific literature in 1935, a year later the death of the Japanese doctor.

The term Hashimoto’s thyroiditis was, then, worldwide recognized in 1939. However, in the following years, the disease was still rare. In 1956, two immunologists from Buffalo, Witebsky and Rose, injected rabbit thyroglobulin, along with an adjuvant, to trigger antibodies production and a lymphocytic infiltration like the one of Hashimoto’s Thyroiditis. Ever since, Hashimoto’s disease has been affecting millions of people all over the world. Why?

Why Hashimoto’s Disease Is so Widespread?

Even though Hashimoto’s thyroiditis is still considered an unexplainable disease, people who struggle with thyroid problems are over 6 million only in Italy and from 4 to 13% in the United States. According to the research by Dana L. Mincer and Ishwarlal Jialal, published on the website of The National Center for Biotechnology Information, the Hashimoto’s thyroiditis” incidence is estimated to be 0.8 per 1000 per year in men and 3.5 per 1000 per year in women”.

An interesting article by Italian endocrinologist Serena Missori reveals that the increase of this type of autoimmune disease might to be related to the environmental causes, such as plastic pollution. Plastic, in fact, is considered an “endocrine disruptor”. Even the European Union affirmed that plastic is dangerous for our health, because it contains two toxic compounds: phthalates and bisphenol.

These two toxic substances bind to hormonal receptors, altering our metabolism. They also may alter the cells of our thyroid. In addition to that, we also live in a very stressful age and this condition makes increase a hormone that reduces thyroid metabolism: it is the so called Reverse 3. Always the Italian endocrinologist, affirms that Hashimoto’s Thyroiditis could be caused by intestinal disorders, because many autoimmune diseases start from intestine, first.

Official medical research, instead, affirms that the main cause of Hashimto’s disease is genetic, even though environmental influences are likewise considered in addition to sex hormones. The above-mentioned research, indeed, reads that “79% of predisposition is due to genetic factors, allotting 21% for environmental and sex hormone influences”.

As regards sex hormone, this data is referred to female sex hormones, above all, estrogens. These may increase the Reverse 3 hormone that influences our thyroid. That is why women are more affected by Hashimoto’s disease than men.

This latter category of patients may develop the disease for genetical and environmental factors. Anyway, hereditary factors play a crucial role for the transmission of Hashimoto’s disease.

The illness is not contagious, obviously, no autoimmune disease is, unless it is caused by external factors, such the immunodeficiency caused by HIV. Chronic autoimmune thyroiditis is often passed down from mother to son. In my case, the disease has been transmitted from my mother: she has Hashimoto’s disease, too.

Hashimoto’s Disease: How it is Diagnosed?

Sometimes, autoimmune thyroiditis occurs with a large goiter. This may be the first sign leading to the diagnosis. Usually, doctors treat the goiter with synthetic thyroid hormone (levothyroxine). That is the treatment I have had when I was a teenager. I was treated with levothyroxine for 8 years ( from 12 to 20 years of age).

Doctors tried stopping the natural functions of the gland in order to reduce my goiter and soothe thyroiditis. Blood tests and thyroid scans confirmed that I had a euthyroid goiter, but with high antithyroid antibodies: over one million! During the treatment, I suffered amenorrhea, severe stomach pain and depression.

Doctors always said to me that treatment couldn’t heal my chronic autoimmune disease, but only prevent Hashimoto’s disease from destroying the gland and causing hypothyroidism. Hence, I took tons of pills to prevent a symptom which was not appeared, yet. Even today, I am an euthyroid patient with high antithyroid antibodies, but I no longer have goiter.

Indeed, another evidence of Hashimoto’s disease are antithyroid peroxidase (anti-TPO) antibodies. These are another sign that conducts to the diagnosis of Hashimoto’s disease. These antibodies, sometimes, along with the antithyroglobulin ones, are thought to cause lymphocyte infiltration and fibrosisin in the tissue of thyroid and destroy the related cells: thyrocytes.

These cells are responsible to produce the thyroid hormones thyroxine (T4) and triiodothyronine (T3) under the stimulation of TSH (thyroid stimulating hormone). Hence, to diagnose the disease, you need a blood test that measures the presence and the level of these antibodies!

However, according to the medical research mentioned above, “There is a small subset of the population, no more than 10-15% with evident disease, who are serum antibody-negative”. In this case, to diagnose Hashimoto’s disease, you’ll also be undergone to echographia, to verify the lymphocyte infiltration in the tissue of thyroid.

Hashimoto’s Disease Symptoms

In the most of cases, this autoimmune disease has no clear symptoms. However, Hashimoto’s thyroiditis can also lead to annoying and sometimes severe symptoms in other areas of our body, because thyroid is the center of our metabolism and regulates other functions and organs, such as intestine, brain, heart, fertility, hair, skin, muscles, and bones.

Another evident symptom of Hashimoto’s disease is the inflammation of thyroid. Inflammation is the process triggered by small proteins called cytokines. These proteins serve to fight diseases, they are a weapon of our immune system. Cytokines bring a stream of blood to the organ affected by the illness, causing swollen and reddening (fibrosis in the case of thyroid).

That is a reaction that should help us get rid of the inflammation. Unfortunately, with Hashimoto’s disease, the thyroid inflammation is persistent. To soothe it, our body releases another hormone: cortisol. If the latter is high, inflammation gets worse.

Chronic autoimmune thyroiditis is, hence, a sort of vicious circle, where we can feel strange and subtle symptoms over our life without never knowing if they are caused by the disease, cytokines, or cortisol.

The current approach of doctors is to prevent hypothyroidism, but Hashimoto’s disease can go across different stages. For this reason, it is also called intermittent disease. During adolescence, we can have goiter, and high antibodies.

They can reduce over time and in the adult age, but other conditions, such as stress, pregnancy, menopause and over, can trigger other symptoms. Many patients with Hashimoto’s disease report symptoms such as:

  • dairy and gluten sensitivities
  • fatigue
  • irritability
  • anxiety
  • depression
  • mood swings
  • hair loss
  • intestinal irregularity
  • miscarriage
  • early menopause
  • tachycardia
  • nausea
  • anemia

Many of the mentioned symptoms are considered signs of subclinical hypothyroidism, namely normal T3 and T4 hormones and high TSH. However, they also occur in patient with normal T3, T4 and normal TSH. The explanation or hypothesis relates to periodical hormonal fluctuations that cause the passage from hyper to hypothyroidism.

That is why patients can lose or gain weight in different stages of their life. Irritability and anxiety may mark hyperthyroidism stages, while hair loss, depression and intestinal irregularity may mark hypothyroidism stages.

Hashimoto’s Disease and Depression

Recent studies have investigated the correlation among psychiatric disorders and Chronic Autoimmune Thyroiditis.

One of these studies has been published on the website of the American Medical Association and reveals that “inflammatory processes have been described to be related with symptoms of major depressive disorder, especially by increasing levels of circulating pro-inflammatory cytokines”. “Importantly- the research says – thyroid metabolism has been shown to modulate the brain serotonin system by reducing the sensitivity of 5-HT1A autoreceptors in the Raphé area, and by increasing 5-HT2 receptor sensitivity. Concerning anxiety, it is likely that the thyroid-catecholamine system interaction (via noradrenalin and T3) and its influence on sympathetic nervous system activity affect symptoms such as high blood pressure or sensible nightly tachycardia”.

In short: thyroid metabolism is associated with the brain serotonin system that regulates our mood. Severe depression often occurs with hypothyroidism, but thyroid inflammation obviously can also alter thyroid metabolism, influencing the secretion of serotonin, the hormone that regulates the nervous system.

Medical research, however, have not still confirmed the close correlation between Hashimoto’s disease and depression, but only the potential vulnerability of this type of patients. Many of them, in fact, report remarkable irritability, anxiety, and low stress tolerance.

To tolerate stress, we need a good level of serotonin, if this hormone is influenced by the inflammatory processes of Hashimoto’s disease, patients may develop severe mental disorders. These disorders cause deep suffering and has a negative impact on the quality of life.

Depression from Hashimoto’s disease is very disabling, because patients are very sensitive to anything and even a little disappointment can unleash unexpected emotional reactions.

It is as if the perception of emotions was amplified in patients with Hashimoto’s disease. The most of times they are considered as imaginary patients or childish people. They deserve only a bit more of respect, instead.

Long lasting depression often leads to Vitamin B depletion with further negative effects. In the following paragraphs, we’ll explore further connections among Hashimoto’s disease and other clinical conditions.

Hashimoto’s Disease and Pregnancy

Hashimoto’s disease is considered harmful for pregnant women and for fetus, especially if it is not treated. During pregnancy, one of the most frequent effects of the is, in fact, miscarriage. Since the disease is autoimmune, namely caused by unbalanced immune system, even miscarriage might be autoimmune. It is as if the immune system treated fetus like a foreign body to eliminate.

Obviously, there are also women with Hashimoto’s disease who have had optimal pregnancy and beautiful children. Before pregnancy, the most important thing is to set the proper treatment with endocrinologist and gynecologist, in order to follow up the conditions and the hormone levels of thyroid.

During pregnancy, indeed, a thyroid inflamed by Hashimoto’s disease may cause hypothyroidism and brain damages to the developing fetus.

To prevent this risk, before pregnancy, endocrinologist can prescribe the treatment with levothyroxine. The hormone supplement avoids any hypothyroidism during pregnancy and consequent damages for the newborn. The second side effect of Hashimoto’s disease is infertility. Women with Hashimoto’s thyroiditis may have difficulty to get pregnant.

The mechanism of this difficulty may always be autoimmune and linked to the pro-inflammatory cytokines that attack the pelvic tissue, preventing conception. However, many reported infertility cases are related to women with thyroiditis who got pregnant in a mature age.

Don’t forget this autoimmune condition can also causes early menopause and a late pregnancy could be impossible to be achieved. In turn, menopause in women with Hashimoto’s disease can lead to develop hypothyroidism, with the increase of weight and a worsening of depressive symptoms.

Hashimoto’s Disease and Covid -19

Nowadays, there is another clinical condition that is scaring patients with Hashimoto’s disease: the severe respiratory syndrome caused by Covid-19. The latter is just caused by an autoimmune reaction and by an abnormal level of pro-inflammatory cytokines. Since patients with Hashimoto’s disease have already a high level of cytokines, may this condition unleash the deadly reaction against this virus? There aren’t studies confirming this risk.

It has been also seen that patients with thyroiditis who got affected by Sars have had a decreased level of thyroid hormones, this diminution is likely due to the inflammation triggered during the infection.

However, international guidelines say that patients with Hashimoto’s disease without hypothyroidism must be treated like other patients, because, currently, there is no scientific data about a correlation between Hashimoto’s Disease and the new virus of Sars.

Indeed, always according to these guidelines, Hashimoto’s disease with a normal level of hormones does not give us the right to obtain the disability check. This right is recognized only when thyroiditis causes hypothyroidism.

Hashimoto’s Disease and Diet

This autoimmune disease is often characterized by a high intestinal permeability that conducts to develop food allergies and intolerances. The most troublesome are dairy and gluten sensitivities.

Proteins in milk and gluten, in fact, imitate the same structure of thyroid, triggering the autoimmune reaction and a long chain of annoying symptoms, such as headache, nausea, dry skin, irritable bowel syndrome, insufficient absorption of vitamins, especially B and D, that play a crucial role to keep a good emotional and intestinal balance.

The shortage of D vitamin, for example, may led to osteoporosis, bone and muscle aches and depression, while the shortage of B vitamin, besides the nervous system, may damage hair and skin. A healthy diet for Hashimoto’s disease must aim to avoid food intolerances, foster the good functioning of thyroid and replenish the missing vitamins.

Yes to:

  • Eggs
  • Fish
  • White meat
  • Fruit and Vegetables
  • Organic cereals.

No to things that cause inflammation, such as refined sugar and processed food.

Yes to Vitamin D supplements and Legumes, excluding soy because the latter causes hypothyroidism.

Hashimoto’s Disease Evolution

Chronic Autoimmune Thyroiditis evolves gradually. Symptoms and consequences vary from person to person. Many patients may remain euthyroid for their lifetime, other may go into hypothyroidism, others may develop thyroid cancer, or nodules, other may have hyperthyroidism. Others may have only depression and intestinal problems.

I don’t know people who died from Hashimoto’s thyroiditis. Maybe, someone died for other secondary conditions due to this disease, such as other more severe autoimmune illnesses or coronary disease due to hypothyroidism.

Women with Hashimoto’s thyroiditis may have an intense menstrual flow with consequent anemia. The final stage of hypothyroidism (when it occurs) leads to an increase in weight and cholesterol.

In my case, Hashimoto’s thyroiditis caused depression, anxiety, food sensitivities and intestinal problems. The only things I know is that this disease does not go away, you can only keep it under control.

Hashimoto’s Disease Treatment

International guidelines say that Hashimoto’s thyroiditis with normal hormones does not need treatment. The latter is necessary in case of hypothyroidism.

However, even with normal levels of thyroid hormones, Hashimoto’s disease can cause subclinical hypothyroidism, namely the same symptoms of those who have unbalanced thyroid hormones.

These symptoms can’t be left untreated, because they cause severe discomfort, such as hair loss, fatigue, anxiety, food intolerance, frequent inflammations, and gastric reflux.

Fortunately, an Italian study, published on the Journal of Translational Endocrinology, paved the way to defeat the symptoms of subclinical hypothyrodism triggered by Hashimoto’s disease.

During this study, patients who suffer from Hashimoto’s, and don’t take any thyroid hormone, have been administrated orally with Aloe juice for three months. After the treatment, the serum level of thyroperoxidase autoantibodies (TPOAb) showed a significant decrease, with improvement of the symptoms of subclinical hypothyroidism.

To treat this condition, in fact, endocrinologists usually prescribe titrated levothyroxine sodium. The medication must be taken orally, in the morning and on an empty stomach. In case of shortage of Vitamin D, doctors can prescribe vitamin D supplements.

Annually, patients must do blood tests and ultrasound examination to check the level of hormones, antibodies, and the condition of the gland. Too soothe the thyroid inflammation and lower antithyroid antibodies, doctors can prescribe Selenium and Zinc supplements. These minerals, along with Vitamin B6, balance the immune system.

Moreover, Zinc prevents thyroid nodules. A balanced intake of minerals and vitamins can make Hashimoto’s disease more curable.

Conclusion

Hashimoto’s disease is also my disease. I have many of the symptoms I described here. As usual, I used medical sources to write this post, even though many details come from my same experience and condition. An autoimmune disease is always a critical condition, especially if it lasts for the entire life. Its symptoms are still today underestimated, as if it was an invisible illness.

But an unbalanced immune system is a burden that forces us to struggle with ongoing ups and downs! For the rest of life! I would like this disease to get curable and definitively defeated! If you recognized yourself in my symptoms, I’ll be happy to know it through your comment. I am sure that we’ll both feel less alone!

References & Bibliography

  1. Dr. Giuseppe Papa – Tiroidite di Hashimoto (tiroidite cronica autoimmune)  www.idoctors.it/patologia-tiroidite-di-hashimoto–tiroidite-cronica-autoimmune–26767
  2. Dr. Vincenzo Piazza – Biografia di Hashimoto – PDF file www.vincenzopiazza.it/file_pdf/Biografia_di_Hashimoto.pdf
  3. Dana L. Mincer; Ishwarlal Jialal – Hashimoto Thyroiditis – August 10, 2020 www.ncbi.nlm.nih.gov/books/NBK459262/
  4. Dr. Serena Missori -Tiroidite di Hashimoto e intestino: che relazione c’è e cosa è importante sapere www.serenamissori.it/tiroide-autoimmune-e-intestino/
  5. Eva-Maria Siegmann, Helge H. O. Müller, Caroline Luecke – Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis A Systematic Review and Meta-analysis – May 2, 2018 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2679767?resultClick=24
  6. Dr. Massimiliano Andrioli – SISTEMA ENDOCRINO E CORONAVIRUS (COVID-19) – March, 31, 2020 www.endocrinologiaoggi.it/2020/03/sistema-endocrino-e-coronavirus-covid-19/
  7. Dr. Cristina Tomasi – Quali minerali influenzano la tiroide? – April 17, 2017 www.cristinatomasi.com/quali-minerali-influenzano-la-tiroide/.

Author: Rosalba Mancuso
Rosalba Mancuso is a medical journalist, an international content writer credited at the University of Washington and a blogger born in Sicily. She is popular for founding four websites in English. On Modernhealthinfo.com, Rosalba writes well researched and detailed health articles backed by her experience as a medical writer for pharma companies and as a PR assistant for a clinical analysis laboratory. She is also a member of the AHCJ, American Association of Health Care Journalists and Center for Excellence in Health Journalism.

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