Hashimoto Thyroiditis Case Studies

Hashimoto Thyroiditis

Hashimoto thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis is an autoimmune disease (An illness that occurs when the body tissues are attacked by its own immune system) that attacks the thyroid gland causing inflammation and interfering with its ability to produce thyroid hormones. Hashimoto thyroiditis is known to be the most common form of thyroiditis and also the most common thyroid disorder in America. According to Womenshealth.gov (May 18, 2010) Hashimoto’s has been known to affect women seven times more than men. Patients who have been diagnosed with Hashimoto’s disease often have family members who have thyroid or other autoimmune diseases.

The thyroid is a butterfly shaped

gland located in the lower area of the neck and weighs less than one ounce. The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). The active hormone is T3 and is made from T4 (NIDDK, May 2014). The purpose of the thyroid gland is to produce hormones that help regulate a wide variety of critical body functions, such as growth and development, body temperature, heart rate, menstrual cycles, and weight. Patients who have been diagnosed with Hashimoto thyroiditis have an increased risk of developing other autoimmune disorders such as vitiligo (a disorder in which white patches of skin appear on different parts of the body.), rheumatoid arthritis (a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility.), Addison’s disease(a disease characterized by progressive anemia, low blood pressure, great weakness, and bronze discoloration of the skin.) , type 1 diabetes( a chronic condition in which the pancreas produces little or no insulin.) , multiple sclerosis(a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord), and pernicious anemia(a deficiency in the production of red blood cells through a lack of vitamin B12) (Genetics Home Reference, November 2, 2015).
Hashimoto’s disease could go unnoticed for years, due to no symptoms of the disease. One of the first signs of Hashimoto thyroiditis is a swollen neck caused from an enlarged thyroid, also known as a goiter. Depending on the size of the goiter, patients could experience difficulty breathing and swallowing. Other possible signs of Hashimoto thyroiditis could include, fatigue, thin and dry hair, slow heart rate, unexplainable weight gain or difficulty losing weight, joint or muscle pain, constipation, pale, puffy face and feel cold even when others around them are warm. Difficulty concentrating and depression can also be signs of an underactive thyroid. Women who are affected by Hashimoto thyroiditis could experience heavy or irregular menstrual cycles and difficulty conceiving a child. (Genetics Home Reference, November 2, 2015).
The diagnosis of Hashimoto’s disease begins with a family medical history, any symptoms you may be experiencing and physical examination. During the exam, if the provider feels a goiter or swelling in your lower neck where your thyroid is located, it could be an indication of hypothyroidism. The provider will order blood test such as a thyroid-stimulating hormone test (TSH), free T4, and an anti-thyroid antibody test (ATA). An ultrasound is another test the provider may use in diagnosing Hashimoto’ disease; the images can show the size and texture of the thyroid, as well as a pattern of typical autoimmune inflammation, helping the health care provider confirm Hashimoto’s disease. The images can also show nodules or growths within the gland that suggest a malignant tumor. In some cases of Hashimoto’s disease, a CT scan is used to examine the placement and extent of a large goiter, and to show a goiter’s effect on nearby structures (NIDDK, May 2014).
Hashimoto’s disease is treated with a single daily tablet of levothyroxine, which is a man-made form of T4 thyroid hormone.

Levothyroxine is also known as thyroid replacement therapy, because it restores back to normal the T4 that the damaged thyroid can no longer produce. The exact dose of levothyroxine depends on Age, weight, and the severity of the underactive thyroid. Other considerations include if the patient has other health issues or if the patient is taking other medications that could interact with levothyroxine. Once a patient begins treatment they will need to schedule a follow up TSH test so the provider can fine tune the dose. If the dose of the medication is too high it causes the thyroid hormone levels to become too high, causing hyperthyroidism. Heart problems and bone loss can be a result of too much thyroid hormone. So it is imperative to find the correct dosage. Thyroid hormones act very slowly in the body taking it several months for the patient to notice any improvements of their symptoms. The provider will need to see a patient less often once the TSH levels become normal. An annual checkup and blood test are recommended to evaluate the TSH levels and insure that the patient is maintaining proper levels of thyroid hormone. Usually, the same treatment dose works for many years and often does not need to be adjusted until the patient reaches the age of 70 or 80 (womenshealth.gov, May 18,

2010).
In summary if Hashimoto thyroiditis is left untreated the disease may progress and the symptoms of an underactive thyroid can worsen. Further problems could include high cholesterol, infertility, miscarriage, and giving birth to a baby with birth defects (womenshealth.gov, May 18,2010). If you know that your family has a history of thyroid disease, or any other autoimmune disease it is recommended that you consult your provider to schedule an exam even if you are not experiencing any symptoms. Having a base line of what is normal will help the provider to quickly identify any changes in your health.