Can you die from hashimoto’s disease. Hashimoto’s Disease: Can It Be Fatal? Comprehensive Guide to Causes, Symptoms, and Treatments

09.01.197423.09.2021 by alexxlab

What are the potential life-threatening complications of Hashimoto’s disease. How is Hashimoto’s disease diagnosed and treated. Can Hashimoto’s disease lead to thyroid cancer. What lifestyle changes can help manage Hashimoto’s disease symptoms.

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Understanding Hashimoto’s Disease: An Autoimmune Thyroid Disorder

Hashimoto’s disease, also known as Hashimoto’s thyroiditis, is an autoimmune disorder that affects the thyroid gland. In this condition, the immune system mistakenly attacks the thyroid, leading to inflammation and impaired function. While Hashimoto’s disease itself is rarely life-threatening, it can lead to serious complications if left untreated.

The thyroid gland, a butterfly-shaped organ located in the front of the neck, plays a crucial role in regulating metabolism and various bodily functions. When Hashimoto’s disease develops, the thyroid’s ability to produce essential hormones is compromised, often resulting in hypothyroidism.

Prevalence and Risk Factors

Hashimoto’s disease affects approximately 5% of the population in the United States, making it a relatively common thyroid disorder. Several factors increase the likelihood of developing this condition:

Gender: Women are 7-10 times more likely to develop Hashimoto’s disease than men
Age: Most commonly diagnosed between 30-50 years old
Genetics: Family history of thyroid disorders or autoimmune diseases
Other autoimmune conditions: Increased risk in individuals with conditions like rheumatoid arthritis, type 1 diabetes, or lupus
Environmental factors: Exposure to excessive iodine or certain medications

The Underlying Causes of Hashimoto’s Disease

The exact cause of Hashimoto’s disease remains unclear, but researchers believe it results from a combination of genetic susceptibility and environmental triggers. The condition develops when the immune system produces antibodies that attack the thyroid gland, leading to chronic inflammation and gradual destruction of thyroid tissue.

Genetic Factors

Studies have identified several genes associated with an increased risk of developing Hashimoto’s disease. These genes are often related to immune system function and regulation. However, having these genetic markers doesn’t guarantee that an individual will develop the condition.

Environmental Triggers

Various environmental factors may contribute to the onset of Hashimoto’s disease in genetically susceptible individuals:

Infections: Certain viral or bacterial infections may trigger an autoimmune response
Stress: Chronic stress can affect immune system function and hormone balance
Nutritional deficiencies: Inadequate intake of selenium, vitamin D, or iodine may play a role
Toxin exposure: Exposure to environmental toxins or endocrine disruptors

Recognizing the Symptoms of Hashimoto’s Disease

The symptoms of Hashimoto’s disease often develop gradually and can vary in severity. Many individuals may not experience noticeable symptoms in the early stages of the condition. As the disease progresses and thyroid function declines, various signs and symptoms may emerge:

Fatigue and weakness
Weight gain
Increased sensitivity to cold
Dry, thinning hair
Brittle nails
Constipation
Depression or mood changes
Muscle aches and joint pain
Irregular or heavy menstrual periods
Fertility issues
Slowed heart rate
Difficulty concentrating or memory problems

One of the most common early signs of Hashimoto’s disease is the development of a goiter, an enlargement of the thyroid gland that can cause a noticeable swelling in the neck area. While usually painless, a goiter may cause discomfort or difficulty swallowing in some cases.

Diagnosing Hashimoto’s Disease: Tests and Procedures

Diagnosing Hashimoto’s disease typically involves a combination of clinical evaluation, physical examination, and laboratory tests. Healthcare providers use several methods to confirm the diagnosis and assess thyroid function:

Physical Examination

A thorough physical exam includes palpation of the thyroid gland to check for enlargement or nodules. The healthcare provider may also look for other signs of thyroid dysfunction, such as changes in heart rate, reflexes, or skin texture.

Blood Tests

Several blood tests are crucial in diagnosing Hashimoto’s disease and assessing thyroid function:

Thyroid Stimulating Hormone (TSH): Elevated levels indicate hypothyroidism
Free T4: Low levels confirm hypothyroidism
Thyroid Peroxidase Antibodies (TPOAb): Presence of these antibodies supports a Hashimoto’s diagnosis
Thyroglobulin Antibodies (TgAb): Another marker for autoimmune thyroid disease

Imaging Studies

In some cases, imaging tests may be recommended to evaluate the thyroid gland’s structure and identify any abnormalities:

Thyroid Ultrasound: Provides detailed images of the thyroid gland, revealing size, texture, and presence of nodules
Thyroid Scan: Uses radioactive iodine to assess thyroid function and structure

Treatment Options for Hashimoto’s Disease

While there is no cure for Hashimoto’s disease, various treatment options can help manage symptoms and prevent complications. The primary goal of treatment is to restore normal thyroid hormone levels and alleviate symptoms associated with hypothyroidism.

Thyroid Hormone Replacement Therapy

The mainstay of treatment for Hashimoto’s disease is thyroid hormone replacement therapy. This typically involves taking synthetic thyroid hormone (levothyroxine) daily to supplement the body’s insufficient hormone production. The dosage is carefully adjusted based on individual needs and regular blood tests to monitor thyroid function.

Monitoring and Adjusting Treatment

Regular follow-up appointments and blood tests are essential to ensure optimal thyroid hormone levels. Factors such as pregnancy, weight changes, or other medications may necessitate adjustments in the levothyroxine dosage.

Addressing Coexisting Conditions

In some cases, individuals with Hashimoto’s disease may have other autoimmune conditions or nutritional deficiencies that require additional treatment. Addressing these coexisting issues can improve overall health and thyroid function.

Potential Complications of Untreated Hashimoto’s Disease

While Hashimoto’s disease itself is rarely life-threatening, untreated hypothyroidism resulting from the condition can lead to several serious health complications:

Myxedema: A rare, life-threatening condition characterized by severe hypothyroidism, leading to confusion, low body temperature, and potential coma
Cardiovascular problems: Increased risk of heart disease, high cholesterol, and high blood pressure
Mental health issues: Depression, anxiety, and cognitive decline
Fertility problems: Difficulty conceiving and increased risk of miscarriage
Birth defects: Untreated hypothyroidism during pregnancy can lead to developmental issues in the fetus
Goiter complications: Large goiters may cause difficulty breathing or swallowing

Early diagnosis and proper treatment significantly reduce the risk of these complications and improve overall quality of life for individuals with Hashimoto’s disease.

Living with Hashimoto’s Disease: Lifestyle Modifications and Self-Care

In addition to medical treatment, various lifestyle modifications can help manage Hashimoto’s disease symptoms and support overall health:

Dietary Considerations

While no specific diet has been proven to cure Hashimoto’s disease, certain dietary approaches may help reduce inflammation and support thyroid function:

Gluten-free diet: Some individuals with Hashimoto’s disease may benefit from avoiding gluten
Anti-inflammatory foods: Incorporating foods rich in omega-3 fatty acids, antioxidants, and fiber
Adequate iodine intake: Ensuring sufficient but not excessive iodine consumption
Selenium-rich foods: Brazil nuts, fish, and eggs may support thyroid health

Stress Management

Chronic stress can exacerbate autoimmune conditions and affect thyroid function. Implementing stress-reduction techniques can be beneficial:

Regular exercise
Meditation or mindfulness practices
Adequate sleep
Engaging in hobbies or relaxation activities

Supplements and Alternative Therapies

Some individuals with Hashimoto’s disease explore complementary approaches to support thyroid health:

Selenium supplements: May help reduce antibody levels in some cases
Vitamin D: Important for immune system function
Probiotics: May support gut health and immune balance
Acupuncture: Some find relief from symptoms through this traditional Chinese medicine practice

It’s crucial to consult with a healthcare provider before starting any new supplements or alternative therapies, as they may interact with medications or affect thyroid function.

The Importance of Regular Monitoring and Follow-up Care

Managing Hashimoto’s disease is an ongoing process that requires regular monitoring and adjustment of treatment. Consistent follow-up care is essential for several reasons:

Thyroid Function Assessment

Regular blood tests help healthcare providers assess thyroid hormone levels and adjust medication dosages as needed. The frequency of these tests may vary depending on individual circumstances and treatment response.

Monitoring for Complications

Routine check-ups allow healthcare providers to screen for potential complications associated with Hashimoto’s disease, such as cardiovascular issues or osteoporosis.

Addressing Changing Needs

Thyroid hormone requirements may change over time due to factors like aging, weight fluctuations, or pregnancy. Regular monitoring ensures that treatment remains optimal throughout different life stages.

Evaluating Overall Health

Follow-up appointments provide an opportunity to discuss any new symptoms, concerns, or questions related to Hashimoto’s disease and overall health.

By maintaining open communication with healthcare providers and adhering to recommended follow-up care, individuals with Hashimoto’s disease can effectively manage their condition and minimize the risk of complications.

Causes, Symptoms, Diagnosis & Treatments

Overview

The thyroid gland is a butterfly-shaped gland located in the front of the neck. The thyroid gland produces two hormones that control metabolism (how the body turns food into energy) and keep the body working properly.

What is Hashimoto’s disease?

Hashimoto’s disease affects the thyroid gland. It’s also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis or autoimmune thyroiditis. The thyroid gland makes hormones that control virtually all of the body’s metabolic functions (how the body turns food into energy) and keep it working normally. Hashimoto’s thyroiditis is a type of autoimmune disease — your immune system doesn’t recognize your thyroid as your own and attacks it.

Hashimoto’s disease is common and affects about five people in 100 in the United States.

What is hypothyroidism?

Hashimoto’s hypothyroidism happens when the thyroid gland doesn’t make enough thyroid hormones to meet the body’s needs because its immune system has damaged it.

Thyroid hormones regulate metabolism, which is how you turn food into energy. Without enough energy, your body cannot operate normally and its functions begin to slow down.

How does hypothyroidism affect your body?

Hypothyroidism can affect you in ways that can be hard emotionally and physically. For example:

When your metabolism slows due to hypothyroidism, you eventually gain weight, feel tired more often and have little energy.
You can experience fuzzy thinking and memory problems (hypothyroidism is often misdiagnosed as depression).
Women can develop menstrual irregularity and change in flow, and find it harder to become pregnant.
You may be increasingly constipated (trouble having a bowel movement), have heartburn and other digestive problems.
Hypothyroidism can also lead to sexual dysfunction in both men and women.

A slow metabolism can affect almost every part of your body, with effects mild to severe.

Who is most likely to develop Hashimoto’s disease?

Hashimoto’s disease:

Is more common in women than men.
Commonly appears between the ages of 30 and 50.
Tends to run in families (hereditary).
Is more likely to develop in people who have other autoimmune diseases, like certain liver conditions, B12 deficiency, gluten sensitivity, rheumatoid arthritis, type 1 diabetes, lupus and Addison’s disease (an adrenal gland condition).

Symptoms and Causes

What causes Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disease, which means the body’s immune system is attacking its own cells and organs. Normally, the immune system protects the body against infections caused by bacteria, viruses and other harmful substances.

In Hashimoto’s disease, the immune system makes antibodies that attack and damage the thyroid tissue. As a result, the thyroid gland becomes inflamed and the ability to make thyroid hormone becomes damaged, eventually leading to hypothyroidism.

What are the symptoms of Hashimoto’s disease?

Some people may not have any symptoms at first. As the disease slowly progresses, the thyroid gland becomes enlarged (a condition called a goiter). A goiter is a common first sign of Hashimoto’s disease. A goiter is painless, but can create a feeling of fullness in the throat, and can make the front of your neck look swollen.

Other symptoms of Hashimoto’s disease that develop over time include:

Tiredness (fatigue).
Weight gain.
Feeling cold.
Joint stiffness and muscle pain.
Constipation (trouble having a bowel movement).
Depression.
Puffy eyes/face.
Dry skin.
Thinning hair/hair loss.
Heavy or irregular periods.
Difficulty becoming pregnant.
Memory problems/difficulty thinking or concentrating.
Slow heartbeat.

Diagnosis and Tests

How is Hashimoto’s disease diagnosed?

First, your healthcare provider will take your medical history and perform a physical exam. He or she will feel your thyroid gland to determine if it is enlarged. Blood tests are also ordered. These include:

Thyroid stimulating hormone (TSH) test: A high TSH level most commonly means the thyroid gland is not producing enough T4 hormone. This lab is usually most consistent with a diagnosis of hypothyroidism or subclinical hypothyroidism.
Free T4 test: A low T4 level suggests that the person has hypothyroidism.
Antithyroid antibody test: Presence of antibodies indicates a higher risk of developing Hashimoto’s hypothyroidism.

The most common imaging test that may be ordered is an ultrasound of your thyroid gland. The ultrasound shows the size and appearance of the thyroid and if there are any nodules or growths in your neck area.

Management and Treatment

Does Hashimoto’s disease always need treatment?

Not everyone with Hashimoto’s disease develops hypothyroidism. Because having antibody levels that are consistent with Hashimoto’s incur a higher risk of developing hypothyroidism, healthcare providers generally choose to monitor your condition and watch for any changes in your thyroid health.

How is Hashimoto’s disease treated?

If Hashimoto’s disease does progress to hypothyroidism, usual treatment is a synthetic (man-made) form of thyroid hormone called levothyroxine (Synthroid®, Tirosint®, Levoxyl®, Levothroid®, Unithroid®).

This drug restores the normal function of the thyroid. You’ll need to take it every day for the rest of your life. Your providers and you will figure out how to adjust your dose to make sure that your hypothyroidism is kept under control.

Will I need to have my thyroid removed for Hashimoto’s disease and hypothyroidism?

No. Because hypothyroidism and Hashimoto’s disease are managed by medications, surgery is not necessary.

Is there a special diet for people with Hashimoto’s disease?

There is no special diet for Hashimoto’s disease, but some foods, medicines or supplements may affect your ability to absorb levothyroxine, your thyroid medication. These include iron and calcium supplements, the ulcer medicine sucralfate, cholestyramine and aluminum hydroxide (found in some antacids). Taking these four hours before or after the levothyroxine may solve this problem.

Talk to your doctor about any dietary questions you have.

Eating well and a healthy lifestyle – exercising, sleeping well and controlling stress – can help your immune system. No matter what, you’ll need to keep taking your medications if you are diagnosed with hypothyroidism.

Outlook / Prognosis

Is Hashimoto’s disease dangerous or fatal?

If left untreated, hypothyroidism can lead to some serious complications and, in rare cases, death. These include:

Heart problems, such as enlarged heart or heart failure.
Mental health issues, including depression.
Myxedema coma, which needs immediate emergency care. Myxedema is a rare, life-threatening condition that can lead to heart failure, seizures, coma and death.

What happens if I have hypothyroidism during pregnancy?

For pregnant women, there is a different thyroid stimulating hormone (TSH) goal. If your TSH level is not at goal, your provider will likely offer you treatment with synthetic thyroid hormone to protect the safety of your pregnancy and your baby.

Untreated hypothyroidism during pregnancy can increase the risk of miscarriage, premature birth and stillbirth. Or it may cause a dangerous rise in blood pressure in late pregnancy (called preeclampsia). Untreated hypothyroidism can also affect your baby’s growth and brain development. Your providers will work with you to make sure your hypothyroidism is under control during your pregnancy.

Hypothyroidism during pregnancy is not common. But sometimes symptoms of hypothyroidism can be overlooked during pregnancy, with its fatigue and weight gain. Let your providers know right away if you notice any hypothyroidism symptoms, or feel like you’re developing a goiter.

A note from Cleveland Clinic

In most cases, hypothyroidism can remain well controlled as long as you take your daily medication and get blood tests to adjust the dosage as instructed by your healthcare provider. Eating healthy and getting enough exercise can help you live a long, healthy life with the condition. Your healthcare providers can tell you what steps to take to feel better along the way.

Causes, Symptoms, Diagnosis & Treatments

Overview

What is Hashimoto’s disease?

Hashimoto’s disease is common and affects about five people in 100 in the United States.

What is hypothyroidism?

Hashimoto’s hypothyroidism happens when the thyroid gland doesn’t make enough thyroid hormones to meet the body’s needs because its immune system has damaged it.

Thyroid hormones regulate metabolism, which is how you turn food into energy. Without enough energy, your body cannot operate normally and its functions begin to slow down.

How does hypothyroidism affect your body?

Hypothyroidism can affect you in ways that can be hard emotionally and physically. For example:

When your metabolism slows due to hypothyroidism, you eventually gain weight, feel tired more often and have little energy.
You can experience fuzzy thinking and memory problems (hypothyroidism is often misdiagnosed as depression).
Women can develop menstrual irregularity and change in flow, and find it harder to become pregnant.
You may be increasingly constipated (trouble having a bowel movement), have heartburn and other digestive problems.
Hypothyroidism can also lead to sexual dysfunction in both men and women.

A slow metabolism can affect almost every part of your body, with effects mild to severe.

Who is most likely to develop Hashimoto’s disease?

Hashimoto’s disease:

Is more common in women than men.
Commonly appears between the ages of 30 and 50.
Tends to run in families (hereditary).
Is more likely to develop in people who have other autoimmune diseases, like certain liver conditions, B12 deficiency, gluten sensitivity, rheumatoid arthritis, type 1 diabetes, lupus and Addison’s disease (an adrenal gland condition).

Symptoms and Causes

What causes Hashimoto’s disease?

What are the symptoms of Hashimoto’s disease?

Other symptoms of Hashimoto’s disease that develop over time include:

Tiredness (fatigue).
Weight gain.
Feeling cold.
Joint stiffness and muscle pain.
Constipation (trouble having a bowel movement).
Depression.
Puffy eyes/face.
Dry skin.
Thinning hair/hair loss.
Heavy or irregular periods.
Difficulty becoming pregnant.
Memory problems/difficulty thinking or concentrating.
Slow heartbeat.

Diagnosis and Tests

How is Hashimoto’s disease diagnosed?

Thyroid stimulating hormone (TSH) test: A high TSH level most commonly means the thyroid gland is not producing enough T4 hormone. This lab is usually most consistent with a diagnosis of hypothyroidism or subclinical hypothyroidism.
Free T4 test: A low T4 level suggests that the person has hypothyroidism.
Antithyroid antibody test: Presence of antibodies indicates a higher risk of developing Hashimoto’s hypothyroidism.

Management and Treatment

Does Hashimoto’s disease always need treatment?

How is Hashimoto’s disease treated?

Will I need to have my thyroid removed for Hashimoto’s disease and hypothyroidism?

No. Because hypothyroidism and Hashimoto’s disease are managed by medications, surgery is not necessary.

Is there a special diet for people with Hashimoto’s disease?

Talk to your doctor about any dietary questions you have.

Outlook / Prognosis

Is Hashimoto’s disease dangerous or fatal?

If left untreated, hypothyroidism can lead to some serious complications and, in rare cases, death. These include:

Heart problems, such as enlarged heart or heart failure.
Mental health issues, including depression.
Myxedema coma, which needs immediate emergency care. Myxedema is a rare, life-threatening condition that can lead to heart failure, seizures, coma and death.

What happens if I have hypothyroidism during pregnancy?

A note from Cleveland Clinic

Hashimoto’s Disease | NIDDK

On this page:

What is Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid.

The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease

the immune system makes antibodies that attack the thyroid gland
large numbers of white blood cells, which are part of the immune system, build up in the thyroid
the thyroid becomes damaged and can’t make enough thyroid hormones

Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats.

The thyroid is a small gland in your neck that makes thyroid hormones.

Does Hashimoto’s disease have another name?

Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis.

How common is Hashimoto’s disease?

The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.¹

Who is more likely to have Hashimoto’s disease?

Hashimoto’s disease is 4 to 10 times more common in women than men.² Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.³ Your chance of developing Hashimoto’s disease increases if other family members have the disease.

You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including⁴

What are the complications of Hashimoto’s disease?

Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including⁵

Left untreated, hypothyroidism can also cause problems during pregnancy.

What are the symptoms of Hashimoto’s disease?

Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism.

Some common symptoms of hypothyroidism include

fatigue
weight gain
trouble tolerating cold
joint and muscle pain
constipation
dry skin or dry, thinning hair
heavy or irregular menstrual periods or fertility problems
slowed heart rate

Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.³

Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear.

An enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful.

What causes Hashimoto’s disease?

Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including²

Hypothyroidism can also be caused by

some medicines used to treat bipolar disorder or other mental health problems
iodine-containing medicines used to treat abnormal heart rhythm
exposure to toxins, such as nuclear radiation

How do doctors diagnose Hashimoto’s disease?

Doctors diagnose Hashimoto’s disease based on

medical history and physical exam. Your doctor will start by taking a medical history and performing a physical exam. In addition to asking about symptoms, the doctor will check your neck for a goiter, which some people with Hashimoto’s disease can develop.
blood tests. Your doctor will order one or more blood tests to check for hypothyroidism and its causes. Examples include tests for
- the thyroid hormones T4 (thyroxine) and T3 (triiodothyronine)
- thyroid-stimulating hormone, or TSH
- thyroid peroxidase antibodies (TPO), a type of thyroid antibody that is present in most people with Hashimoto’s disease

You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland.

How do doctors treat Hashimoto’s disease?

How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly.

The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.² These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed.

Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.^1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal.

You will take levothyroxine to replace the hormone your thyroid no longer makes.

Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year.

Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.⁵

Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests.

How does eating, diet, and nutrition affect Hashimoto’s disease?

The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect.

Talk with members of your health care team about

what foods and beverages to limit or avoid
whether you take iodine supplements
any cough syrups you take that may contain iodine

However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need.

Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.² However, no specific guidance is currently available.³

Clinical Trials for Hashimoto’s Disease

The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for Hashimoto’s disease?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future.

Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical studies for Hashimoto’s disease are looking for participants?

You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

[1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL

[2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos’ thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367

[3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/

[4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto’s thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737

[5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1

[6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214

Hashimoto’s Disease: Signs, Symptoms, and Complications

When discussing the symptoms of Hashimoto’s disease (Hashimoto’s thyroiditis), most are usually referring to the clinical symptoms of low thyroid function—fatigue, sensitivity to cold, hair loss, constipation, and others. Though Hashimoto’s impairs the thyroid gland’s ability to produce hormones that the body needs to maintain normal metabolism (the conversion of oxygen and calories into energy), it isn’t until the associated inflammation of the thyroid gland—known as chronic lymphocytic thyroiditis—causes hypothyroidism that symptoms are usually detected.

Illustration by Emily Roberts, Verywell

Frequent Symptoms

Though most people with Hashimoto’s have no obvious symptoms at the early stages of the disease, some may experience mild swelling at the front of the throat (goiter) caused by the direct inflammation of the gland.

Hashimoto’s disease typically worsens slowly over many years and causes progressive damage to the thyroid gland, leading to an associative decline in thyroid hormone output.

While some people use the terms Hashimoto’s disease and hypothyroidism synonymously, Hashimoto’s is more aptly characterized as the most common of the disorder that can produce hypothyroidism.

Hashimoto’s and hypothyroidism symptoms are the same.

The most common include:

Fatigue
Increased sensitivity to cold
Constipation
Pale and dry skin
A puffy face
Brittle nails
Hair loss (alopecia)
Enlargement of the tongue
Unexplained weight gain despite no change in your diet
Muscle aches (myalgia)
Joint pain (arthralgia)
Muscle weakness
Heavy menstrual bleeding (menorrhagia)
Irregular menstruation (oligomenorrhea)
Depression
Lapses in memory (“brain fog”)
Low sex drive
Growth delay in children

Complications

As Hashimoto’s disease progresses, it can cause permanent damage to the thyroid gland. In an effort to produce more thyroid hormone, the gland itself will start to enlarge, leading to the development of a goiter.

There are different types of goiter:

Diffuse, characterized by smooth and generalized swelling
Nodular, characterized by a lump
Multinodular (multiple lumps)
Retrosternal (extending backward toward the windpipe)

While smaller goiters may not require treatment, radioactive iodine (RAI) may be needed to reduce the size of larger ones. Retrosternal goiters occasionally require surgical removal if they interfere with breathing or swallowing.

The progressive dysregulation of metabolism and growing imbalances in hormonal output can begin to affect multiple organ systems, leading to a cascade of complications that extend well beyond the thyroid gland itself.

Infertility

If thyroid hormone levels are too low, they can affect the hormonal mechanisms that regulate the menstrual cycle and trigger ovulation. This can lead to infertility, which can affect up to 50% of women with Hashimoto’s, according to research published in the International Journal of Endocrinology.

Even with the proper treatment of hypothyroidism, there is no guarantee that fertility can be fully restored in women severely affected by Hashimoto’s.

Heart Disorders

Even mild hypothyroidism can have a profound effect on heart health. The dysregulation of thyroid hormones can instigate increases in “bad” LDL (low-density lipoprotein) cholesterol, leading to the hardening of arteries (atherosclerosis) and increasing the risk of heart attacks and stroke.

Pericardial effusion, the buildup of fluid around the heart, can affect up to 30% percent of people who have hypothyroidism.

While most cases are mild, severe hypothyroidism can lead to a pericardial tamponade, a condition in which the heart is less able to pump blood. In some cases, it can lead to a potentially fatal drop in blood pressure.

Pregnancy Complications

Because maternal thyroid hormone is vital to fetal development, untreated hypothyroidism during pregnancy can lead to potentially serious complications for both the mother and baby.

According to research, untreated hypothyroidism nearly doubles the risk of premature birth and significantly increases the risk of low birth weight, premature rupture of membranes, fetal heartbeat irregularities, and fetal respiratory distress.

Even with subclinical hypothyroidism (in which there are no observable symptoms), pregnant women are at greater risk of preeclampsia, gestational diabetes, post-delivery hemorrhage, and postpartum depression than women without thyroid disease.

Hashimoto’s Encephalopathy

Hashimoto’s encephalopathy is a rare complication in which the swelling of the brain can cause profound and debilitating neurological symptoms. The condition only affects around two of every 100,000 people each year and usually between the ages of 41 and 44. Women are four times more affected than men.

Hashimoto’s encephalopathy typically manifests in one of two ways:

A steady decline in cognitive function leading to tremors, sleepiness, confusion, hallucinations, dementia, and, in rare cases, coma
Seizures or sudden stroke-like attacks

Hashimoto’s encephalopathy is usually treated with intravenous corticosteroid drugs like prednisone to quickly bring down the inflammation and swelling of the brain.

Myxedema

Myxedema is a severe form of hypothyroidism in which metabolism slows to a point where you can fall into a coma and potentially die. It is associated with untreated disease and can be recognized by characteristic changes in the skin and other organs, including:

Swollen and puffy skin
Drooping eyelids
Severe intolerance to cold
A drop in body temperature leading to hypothermia
Slowed breathing
Extreme exhaustion
Slowed movement
Confusion
Psychosis
Shock

Myxedema is considered a medical emergency requiring immediate medical assistance.

When to See a Doctor

As a largely “invisible” disease in the early stages, Hashimoto’s is often first discovered during a routine exam when thyroid hormone levels are found to be abnormally low.

As Hashimoto’s disease tends to run in families, it’s a good idea to get tested if someone in your family has the disease.

Talk to your doctor if you begin to experience the classic signs of hypothyroidism, including persistent tiredness, facial puffiness, dry skin, hair loss, abnormal periods, and unexplained weight gain. Early diagnosis and treatment will improve your outcome.

Frequently Asked Questions

What does it feel like when you have a Hashimoto attack?
Your hypothyroid symptoms will flare up, so you may feel tired and begin gaining weight or have other common symptoms of an underactive thyroid such as cognitive problems, sensitivity to cold, dry skin, constipation, and hair loss.
What are signs that you may be suffering from complications of Hashimoto disease?
The most common signs include goiter, heart disease, depression, peripheral nerve disease, and infertility. Rarely, “brain fog,” increased sleepiness, or sudden seizures could be a sign of Hashimoto encephalopathy in which the brain swells and causes neurological problems. Chest pain and shortness of breath, meanwhile, could be a sign of cardiac tamponade, a rare and life-threatening heart condition caused by hypothyroidism.

Hashimoto thyroiditis: MedlinePlus Genetics

Hashimoto thyroiditis is thought to result from a combination of genetic and environmental factors. Some of these factors have been identified, but many remain unknown.

Hashimoto thyroiditis is classified as an autoimmune disorder, one of a large group of conditions that occur when the immune system attacks the body’s own tissues and organs. In people with Hashimoto thyroiditis, white blood cells called lymphocytes accumulate abnormally in the thyroid, which can damage it. The lymphocytes make immune system proteins called antibodies that attack and destroy thyroid cells. When too many thyroid cells become damaged or die, the thyroid can no longer make enough hormones to regulate body functions. This shortage of thyroid hormones underlies the signs and symptoms of Hashimoto thyroiditis. However, some people with thyroid antibodies never develop hypothyroidism or experience any related signs or symptoms.

People with Hashimoto thyroiditis have an increased risk of developing other autoimmune disorders, including vitiligo, rheumatoid arthritis, Addison disease, type 1 diabetes, multiple sclerosis, and pernicious anemia.

Variations in several genes have been studied as possible risk factors for Hashimoto thyroiditis. Some of these genes are part of a family called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body’s own proteins from proteins made by foreign invaders (such as viruses and bacteria). Other genes that have been associated with Hashimoto thyroiditis help regulate the immune system or are involved in normal thyroid function. Most of the genetic variations that have been discovered are thought to have a small impact on a person’s overall risk of developing this condition.

Other, nongenetic factors also play a role in Hashimoto thyroiditis. These factors may trigger the condition in people who are at risk, although the mechanism is unclear. Potential triggers include changes in sex hormones (particularly in women), viral infections, certain medications, exposure to ionizing radiation, eating large amounts of foods that contain animal proteins, and excess consumption of iodine (a substance involved in thyroid hormone production).

Which stage of Hashimoto’s are you in? — BOOST Thyroid: Hashimoto’s and Hypothyroid App

There are 7 stages of an underactive thyroid condition

Hashimoto’s is a lifelong and progressive autoimmune disease. It starts subtly—usually long before you were or will be diagnosed—and develops slowly.

1. Initiation

This is the start of Hashimoto’s.

Your immune system starts making molecules that mistakenly recognize part of the thyroid gland as a foreign body and starts destroying it.

This occurs on a small scale, so you generally won’t feel any symptoms related to an underactive thyroid. You might experience problems with digestion because your gut is where most of immune cells are made.

At this stage, your thyroid is still close to fully functional. That means TSH blood tests won’t be sensitive enough to reveal Hashimoto’s. If you’re tested positive for thyroid antibodies (TPO or TG), you should get a thyroid ultrasound or have a biopsy as your doctor might diagnose you with Hashimoto’s at this point.

This stage can last several years—it’s the best stage for receiving a diagnosis, because you can follow a healthy lifestyle and prevent Hashimoto’s from reaching stage 2.

2. Expansion

Immune cells start increasing in number and efficiency, working faster to destroy bigger portions of your thyroid gland.

You might begin to feel a few early symptoms, such as fatigue, hair loss, or sensitivity to cold.

Some people experience goiter (swelling of the neck) during flare-ups and feel more symptoms—or symptoms at a higher intensity—after stress, colds, or certain foods.

At this point your TSH levels will most likely still be in a normal range, while your fT4 levels may be slightly lower.

This stage might last a few months or years, but in certain cases it might only last a few weeks.

If you’re diagnosed at this stage, you have a great chance to keep your thyroid gland sufficiently functional and avoid taking medications by following a healthy lifestyle.

3. Full-blown disease

This stage is usually the tipping point for your thyroid health.

You will likely start feeling increasingly tired and you might start experiencing many other symptoms with an increasing frequency and intensity.

A thyroid hormone blood test will show that your TSH is elevated. Depending on the country or lab where the test was done, your doctor might prescribe therapy with thyroid hormone replacement—the most common is T4 (Levothyroxine).

If your values are only slightly shifted, your doctor might prescribe expectant management. This means you will be regularly monitored for any changes in thyroid hormone levels and be prescribed medication once your thyroid blood values are clearly out of the “normal” zone.

If you’re diagnosed at this stage, you still have a very good chance to keep your thyroid gland highly functional with minimal medication or avoid taking medication by implementing and following a healthy lifestyle.

Certain symptoms might remain and you potentially need to work harder to get your hormones in balance again.

4. Medicated Hashimoto’s

Most Hashimoto’s diagnoses occur during this stage. At this point, the thyroid can’t produce enough daily T4 and T3 necessary for optimal health.

To compensate for the loss of thyroid function, your doctor will increase your dose of synthetic thyroid hormones. Most people usually start with the lowest dose of T4—as you age, this dose increases.

It’s crucial to have enough thyroid hormones in the body to complete for some basic bodily functions, such as metabolism, brain function, and body temperature regulation.

This is why it’s important to take thyroid medication if your own thyroid can’t produce enough.

At the same time, balancing thyroid hormones won’t do much to prevent the immune system from further destroying the thyroid gland—this can be managed by maintaining a healthy lifestyle.

5. Medicated and lifestyle managed Hashimoto’s

At this stage, you’ll need to adjust your lifestyle in order to manage your weight and flare-ups. This helps to keep Hashimoto’s at bay.

Maintaining a healthy weight will help prevent heart and bone problems, as well as some other health issues.

6. Putting the brakes on the disease

By following a healthy diet and exercise routine, you can further halt disease progression. This is what many people refer to as “reversion.”

It’s important to know that the autoimmune condition can be blocked, but it won’t go away. This means the moment you stop following a healthy lifestyle, the condition will be triggered again.

An underactive thyroid can be fixed to a certain extent. The thyroid gland has some regenerative potential, but it’s notoriously slow at regenerating (1, 2). It might take months or years, especially if large portions of your thyroid have already been destroyed.

7. Preventively managing Hashimoto’s

This stage is for life.

You need to avoid all triggers that work against your thyroid. Yet the immune system is a bit tricky—sometimes foods that previously weren’t problematic for you can start causing flare-ups.

The good news is that at this stage you will know your body so well that you will be able to recognize warning signs early on.

Hashimoto’s risks and flare-ups

Everybody is different, so triggers of flare-ups vary individually. However, there are some common triggers that might help you on your path to health.

According to BOOST Thyroid’s internal research, common food triggers include:

And you’re at a higher risk of developing Hashimoto’s if you:

Have low vitamin D levels before diagnosis (5 in 10 people)
Have at least one family member diagnosed with Hashimoto’s (5 in 10 people)
Have at least one family member diagnosed with any other autoimmune disease (6 in 10 people)
Were born in a spring month (6 in 10 people)

Track your symptoms, medication, supplements, lab tests, and more in BOOST Thyroid.

Hypothyroidism and Hashimoto’s Thyroiditis (for Parents)

What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.

It’s brownish red, with left and right halves (called lobes) that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many things, such as get energy from food, grow, and go through sexual development. In younger children, it is also important for brain development.

What Is Hypothyroidism?

Hypothyroidism (or underactive thyroid) is when the thyroid gland doesn’t make enough of some important hormones. This makes the body use up energy more slowly, and chemical activity (metabolism) in the cells slows down.

Hypothyroidism is a common condition, especially in adult women. But kids can have it too. Some children are born with it — this is called congenital hypothyroidism. Others develop it later, usually late in childhood or as teens. The most common cause of hypothyroidism in kids and teens is the

autoimmunedisease Hashimoto’s thyroiditis.

What Are the Signs & Symptoms of Hypothyroidism?

A person with mild hypothyroidism may feel just fine. In fact, it might cause no symptoms at all.

But if thyroid hormone levels get too low, symptoms can become more obvious. These include:

sluggishness
depression
dry skin or hair loss
feeling cold
muscle weakness
poor memory or trouble concentrating
constipation
facial puffiness
weight gain (even when not eating more or exercising less)
slowed growth
slow sexual development
irregular menstrual periods in girls

What Is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis (hah-she-MOE-toes thy-roy-DYE-tiss) is an autoimmune disease. It causes most cases of hypothyroidism in kids and teens. Hashimoto’s thyroiditis is also called
chronic lymphocytic thyroiditis.

What Happens in Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis is an ongoing condition in which the immune system attacks the thyroid. Some people continue to have normal thyroid function. But often, over time the thyroid isn’t making enough thyroid hormone, causing hypothyroidism. The body responds by sending a message to the thyroid to work harder to make enough hormone.

This, and the swelling the immune system causes as it attacks the gland, can make the thyroid get bigger, leading to a goiter. The thyroid can keep changing size over months or years.

How Are Hypothyroidism and Hashimoto’s Thyroiditis Diagnosed?

To diagnose hypothyroidism and Hashimoto’s thyroiditis, doctors ask about a person’s symptoms, do an exam, and order blood tests. The tests measure:

Thyroid hormone levels, particularly thyroxine (T4) and thyroid-stimulating hormone (TSH). T4 is the thyroid hormone made in the thyroid that works throughout the body. TSH is a hormone made in the pituitary gland
(a pea-sized gland just beneath the brain). More TSH is released into the blood when the brain and pituitary sense that the levels of thyroid hormone in the blood are too low. TSH stimulates the thyroid to work harder to make more thyroid hormone.
Some antibodies (proteins made by the immune system). High levels of these antibodies in the blood are a sign that the gland is being attack by the immune system in Hashimoto’s. The two antibodies commonly measured are thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPO).

How Are Hypothyroidism and Hashimoto’s Thyroiditis Treated?

Doctors treat an underactive thyroid with daily thyroid hormone replacement pills. The medicine is the same T4 that the body is no longer making. These will bring the body’s levels of thyroid hormone back to normal.

This treatment is fairly simple, but a person will have doctor visits several times a year for an exam, blood tests, and medicine changes as needed.

Inflammation of the thyroid gland (Hashimoto’s disease)

Treatment for Hashimoto’s disease may include testing and medication. If there is no evidence of a lack of thyroid hormones and the thyroid gland is functioning normally, your doctor may advise you to take a wait-and-see attitude. If you need medication, you may have to take it your whole life.

Synthetic hormones
If Hashimoto’s disease has caused an underactive thyroid, you may need thyroid hormone replacement therapy.This usually means taking the synthetic thyroid hormone levothyroxine daily.

Synthetic levothyroxine is identical to thyroxine, a hormone synthesized by the thyroid gland. Ingestion of this medication restores normal thyroid hormone levels and relieves symptoms of hypothyroidism.

Soon after starting treatment, you will notice that you will feel a reduction in fatigue. The medication will also gradually reduce cholesterol levels caused by the illness and may normalize weight.

Treatment with levothyroxine is usually lifelong. However, since the required dosage may change, your doctor will check your thyrotropin levels every six months or a year.

Dose Adjustment
To determine the correct initial dose, your doctor will usually check your thyrotropin levels a few weeks after starting treatment. Elevated thyroid-stimulating hormone levels can accelerate bone loss, leading to worsening or onset of osteoporosis.An overdose of levothyroxine can also lead to arrhythmias (heart rhythm disturbances).

If you have coronary atherosclerosis or severe hypothyroidism, your doctor may start treatment with a small dose of the medication and gradually increase it. The gradual replacement with synthetic hormone will allow your heart to adapt to the accelerated metabolism.

Levothyroxine is relatively cheap and has practically no side effects if the dose is chosen correctly.If you change the manufacturer of levothyroxine, tell your doctor so that he can check the correct dose. Also, do not skip your medication or stop taking it. If you do this, the symptoms will gradually return.

Effects of Other Substances
Certain medications, dietary supplements and foods affect your ability to metabolize levothyroxine. However, this problem can be solved by taking levothyroxine at least four hours before or after other medications. Check with your doctor if you are eating a lot of soy products, a lot of fiber, or if you are taking any of these:

Iron supplements, including multivitamins with iron
Cholestyramine – a medicine to lower blood cholesterol
Aluminum hydroxide (found in some antacids – drugs that reduce stomach acidity)
Sodium polystyrene sulfonate, used to lower blood potassium
Sucralfate (antiulcer drug)
Food supplements containing calcium

Autoimmune thyroid glands

Many believe that the cause of rapid fatigue and chronic fatigue syndrome is in “problems” with the thyroid gland.Namely – in chronic inflammation of the thyroid tissue (autoimmune thyroiditis). But is it?

Autoimmune thyroiditis accounts for 20-30% of all thyroid diseases. It occurs in women 10-20 times more often than in men. What you need to know about this disease – signs of autoimmune thyroiditis and possible consequences?

Symptoms of autoimmune thyroiditis

1. What are the signs of autoimmune thyroiditis? Is it true that at the first stage, the disease proceeds without symptoms?

In fact, autoimmune thyroiditis is not one but several diseases that are united by inflammation in the thyroid gland.The classic variant is chronic autoimmune thyroiditis, or Hashimoto’s thyroiditis. It can lead to a permanent decrease in thyroid function – hypothyroidism. I emphasize – it can. But not always.

And autoimmune thyroiditis itself has no clinical signs. Manifestations can only be in case of dysfunction of the thyroid gland. And then not immediately. As a rule, chronic thyroiditis leads to hypothyroidism years later, often even decades later.

Diagnosis of chronic fatigue syndrome

2.It is believed that autoimmune thyroiditis is the cause of rapid fatigue, weakness, and chronic fatigue syndrome. Is it so?

Since autoimmune thyroiditis with intact thyroid function does not manifest itself in any way, let’s immediately talk about its possible consequence – hypothyroidism. Hypothyroidism can indeed be accompanied by symptoms similar to asthenia. Symptoms such as menstrual irregularities, constipation, anemia, increased cholesterol levels may worsen … However, similar manifestations occur in many diseases.This is the problem of diagnosing hypothyroidism, since even at advanced stages it has no specific signs.

Fatigue, weakness and drowsiness in some cases may be associated with a decrease in thyroid function. But it can be a train of other chronic diseases. As for the chronic fatigue syndrome, this is a beautiful, but not quite definite concept.

3. What tests should I take to confirm (or exclude) autoimmune thyroiditis?

Searching for autoimmune thyroiditis, in most cases, does not make much sense.A person can live their entire life with signs of autoimmune thyroiditis and die from another disease. But hypothyroidism really cannot be ignored, since thyroid hormones (thyroxine and triiodothyronine) regulate the flow of oxygen into the cells. With a deficiency of thyroid hormones, all cells, without exception, function in an energy-saving mode. They seem to run out of batteries. They cannot adequately carry out their functions.

An accurate and simple test for the diagnosis of hypothyroidism – determination of the level of TSH (thyroid stimulating hormone) in the blood.With a decrease in thyroid function, it increases.

4. Why does autoimmune thyroiditis develop? I read that there are many provoking factors. For example, pregnancy, lack of iodine in food …

A question for the Nobel Prize – no less! We do not know for sure the root causes of autoimmune diseases. Even when it comes to the most common autoimmune disease – autoimmune thyroiditis. For some reason, the normal functioning of the immune system is disrupted in susceptible individuals, and it attacks its own cells.In this case, the cells of the thyroid gland. Any autoimmune disease is generally much more common in women than in men. Sometimes – 10-20 times.

Pregnancy can really be a provoking factor. Or rather, the period. The fact is that during pregnancy, the activity of the immune system is suppressed (this is necessary in order to endure an immunologically foreign fetus), and after childbirth it is activated. Sometimes – excessively, causing autoimmune processes.

Food iodine deficiency does not lead to autoimmune thyroiditis.In general, thyroid disease should not be associated with iodine deficiency alone. Several dozen diseases of the thyroid gland have been described – completely different for reasons, course and prognosis – and only some of them are directly or indirectly related to iodine deficiency.

Treatment of autoimmune thyroiditis

5. Is it true that hypothyroidism is the only indication for the treatment of autoimmune thyroiditis, and in other cases no treatment is required?

If we are talking about chronic autoimmune thyroiditis, this is absolutely correct.Alas, modern medicine does not know how to specifically influence the autoimmune process. Moreover, autoimmune thyroiditis, as already noted, does not always have an adverse effect on the body. Its only significant consequence is a decrease in thyroid function.

And hypothyroidism is fairly easy to control. Replacement therapy for hypothyroidism involves the daily intake of levothyroxine tablets. The dose can be precisely controlled when determining the TSH level.As a rule, compensated hypothyroid patients do not experience any limitations.

Thyroiditis and its types

Inflammation (including in the thyroid gland) occurs for various reasons and can proceed in different ways.Based on these factors according to the International Classification of Diseases (ICD-10), the following main types of thyroiditis are distinguished:

Hashimoto’s autoimmune or chronic thyroiditis (in honor of the Japanese scientist who studied and described the disease in 1912).
Acute – an infectious lesion with focal or diffuse (complete) inflammation in the gland.
Subacute – has three forms: granulomatous, lymphocytic and pneumocystis.
Chronic – inflammation of the fibrous type.

There are also such types of thyroiditis as postpartum and drug. The first can develop in pregnant women, appear after childbirth, and the second appears as a side effect of medications. Such a pathology is not treated separately – everything will return to normal on its own after a while.

The general symptoms of thyroiditis of the thyroid gland include general weakness and malaise, pain in the neck, which increases with pressure on the area where the thyroid gland is located. Later, puffiness, bradycardia are added, memory and performance deteriorate, and body temperature decreases.

Any sign of malfunctioning of the thyroid gland is a good reason for an urgent visit to the doctor.

Do not self-medicate or suppress symptoms with medications. This will not help, but will only make the situation worse. You still have to treat the disease, but it will be much more difficult.

Any disease is easier to treat in the early stages.

Here you will receive full-fledged qualified medical care. We do not apply standard approaches to all patients.For each patient, an individual treatment is selected after a thorough examination. Make an appointment at the Kutuzov Medical and Diagnostic Center. We are as attentive as possible to the problems of each patient and are always ready to help you.

Each of the forms of inflammation has its own characteristic features of the course and treatment.

Hashimoto’s autoimmune thyroiditis

Develops if a person has a congenital predisposition to pathologies of the immune system at the genetic level.Hashimoto’s thyroiditis is characterized by mutations that affect antibody production. The immune system begins to perceive thyroid cells as foreign and dangerous to the body. It produces special proteins – antibodies that act on the thyroid gland and disrupt its work. This form of pathology is characterized by a protracted, chronic course and can be a lifelong condition.

Causes of thyroid thyroiditis of the chronic autoimmune type:

Excess iodine in the body (mainly due to the diet).
Herpes.
Deficiency of vitamins and minerals, primarily selenium.

If we are not talking about a diffuse goiter, when the whole organ is enlarged, then the localization classification is applied:

Unilateral – neoplasms on one side.
Double-sided – on both sides.

In women, Hashimoto’s thyroiditis occurs up to 10-20 times more often. The average age of patients is from 40 to 50 years, however, more and more young people began to get sick.

Symptoms of chronic thyroiditis of the thyroid gland Hashimoto appear due to a decrease in the activity of the organ (hypothyroidism). Among the main ones:

Loss of energy, constant sleepiness.
Unreasonable weight gain.
Bad mood.
Chilliness of the body.
Hair loss, up to baldness.
Stool disorders.
Growth of the gland in size, but without pain.
An increase in the interval between menstruation, up to their termination, is a characteristic symptom of chronic thyroiditis of the thyroid gland in women.

Help to diagnose:

Laboratory tests – a symptom of Hashimoto’s thyroiditis is an increase in the level of TK and T4, when the inflammation has just begun, and later their production decreases, but the amount of TSH in the blood increases.
The appearance in the blood of specific antibodies to thyroid cells.
ultrasound.
Scintigraphy (if necessary, as an additional examination).

Treatment of a chronic inflammatory process of an autoimmune type is aimed at normalizing the functioning of the gland and treating hypothyroidism.For this, hormone therapy is used. The dosage is individual in each case. Competent selection of drugs restores the normal quality of life of patients or significantly slows down the rate of development of the disease.

Acute thyroiditis

Develops against the background of damage by bacteria or viruses. It is often a complication from ENT infections: sinusitis, tonsillitis and others. Any infectious bacteria can become the causative agent of purulent inflammation, but basically these are such common microorganisms as streptococci, Klebsiella, enterobacteria.

Acute inflammation of a non-purulent nature may appear after bruises of the neck in the thyroid gland after radiation therapy.

Symptoms of acute thyroiditis of the thyroid gland:

Swelling of the neck.
Fever up to fever.
Sore throat that gets worse when swallowing or moving the neck.
Voice change – hoarseness, wheezing due to compression of the vocal cords appear.
General weakened state when fatigue appears even after little physical exertion.Active movements are accompanied by a rapid heartbeat, weakness.
Tissue abscess in a neglected form.

A characteristic feature of this type of thyroiditis is the rapid increase in the intensity of symptoms.

Help to confirm the diagnosis:

Analyzes – assessment of the amount of thyroid hormones (in an acute course, their production will be normal), ESR, leukocytes in the blood.
Ultrasound of the thyroid gland – used as an additional examination in a number of cases.
Puncture from the affected area is needed if an abscess has developed or a course of antibiotics has not helped. The analysis will show the type of pathogens and their sensitivity to a particular group of antibiotics.

Treatment of acute inflammation is carried out with antibiotics. If there is an abscess, then the affected part must be removed surgically so as not to face complications.

Subacute thyroiditis

The causes of this type of thyroiditis are a specific reaction to infections: measles, mumps, influenza and ARVI.From the virus, the follicles of the gland are destroyed, the integrity of their membranes is disrupted, and hormones that have entered the blood lead to the appearance of specific symptoms. Usually, it takes several weeks (or even months) from the moment of recovery to the appearance of noticeable signs of thyroid problems.

The disease often occurs under the names de Quervain’s thyroiditis or giant cell, granulomatous thyroiditis.

In women, the symptoms of thyroiditis and the disease itself occur 5-6 times more often. The disease may begin with symptoms that resemble hyperthyroidism with elevated thyroid hormone levels:

Rapid heartbeat.
Body tremors (more often than hands).
Nervousness, irritability.
Increased sweating.
Weight loss without changes in diet and physical activity.
Digestive and stool disorders.
Pressure increase.
Weakness and soreness of the muscles, pain in the joints.
Loss of appetite.
Sleep disorders.
Headache attacks.

There are also typical external manifestations associated with an enlargement of the gland:

Increased goiter on the neck, swelling, redness of the skin.
Sharp pain in the thyroid gland when pressing on it or bending the neck.
Feeling of a “lump” in the throat, difficulty swallowing.

The acute stage lasts 1-2 months.

The following applies for the diagnosis:

Blood test – characteristic results: the level of TK and T4 hormones is higher than normal, and TSH is lower. Significantly higher than the ESR norm.
Ultrasound – to identify the number of affected areas, assess blood circulation in them.
Scintigraphy – assessment of the absorption of iodine radioisotopes by the gland and biopsy.

In many cases, the inflammation goes away on its own. This is based on the fact that an excess of hormones reduces the activity of the hypothalamus and the production of its hormone thyrotropin. It is a hormone regulating the functioning of the thyroid gland, which means that its decrease in the body leads to a decrease in the activity of the thyroid gland. This self-regulation process will take about two months (although relapses are possible), and therapy during this time is aimed at reducing pain and discomfort in the patient.Non-steroidal anti-inflammatory drugs will help, in severe cases – corticosteroid drugs or beta-blockers. The doctor may also prescribe hormone replacement therapy. Prescriptions, dosage, frequency and duration of administration are individual.

Chronic thyroiditis

Another name for this form of inflammation is Riedel’s thyroiditis. This is the least studied type of disease.

Among its main causes are systemic immune failures that increase the activity of plasma cells.This leads to the fact that the cells of the gland die, leaving fibrous areas. People with Graves’ disease or endemic goiter are more likely to get sick (even in the past).

Symptoms of chronic thyroiditis of the thyroid gland will rarely be noticeable at the very beginning of the disease. Because of this, time is lost when conservative therapy is effective. As the disease progresses, the patient experiences symptoms that resemble cancer. They are caused by the rapid growth of the organ:

“Lump” in the throat.
Shortness of breath, choking.
Long cough, hoarse voice.

No pain when pressing on the gland.

For the diagnosis of Riedel’s thyroiditis are used:

A blood test – for which indicators are characteristic: there are anti-TPO antibodies, the level of TSH is increased in 30% of cases, and in the remaining 70% the hormonal background is normal.
Cytological examination of tissue from a puncture. It helps distinguish cancer from fibrotic inflammation without malignant tumor.

Such examinations as ultrasound diagnostics and even MRI with Riedel’s thyroiditis are not very informative.

Therapy is aimed at preventing complications. If the tumor is too large and squeezes adjacent organs, it is partially (or completely) removed by surgery. After the operation, hormone replacement therapy, drugs that suppress fibrosis in the tissues, and drugs for autoimmune processes are performed. At the initial stage, such conservative therapy often does not help – the tumor grows too quickly, so it is difficult to avoid surgery.

Prevention of thyroiditis

A healthy lifestyle helps reduce the risk of inflammation with:

Adequate intake of vitamins and minerals.
Treatment of acute respiratory viral infections and infections, especially in the nasopharynx, other ENT organs and the oral cavity.

Prevention, diagnosis and treatment of these diseases is carried out by an endocrinologist, in some cases with the help of an immunologist.

It is possible to pass high-quality examinations in express format at the Kutuzovsky Medical Center.Pre-registration is possible online or by calling the clinic.

In the Kutuzov diagnostic and treatment center, you can undergo a full examination using high-precision equipment and determine the cause of the pathology. Modern methods of treatment and unique proprietary developments allow our specialists to achieve excellent results. We value your time and offer appointments with your doctor. Come to our center to undergo a thorough examination and receive an individual treatment regimen for the revealed pathology in a comfortable environment and at a convenient time.In addition, the doctor will give full recommendations on preventive measures that will help avoid the development of pathology in the future.

Prices

Name	Price
Appointment (examination, consultation) at an endocrinologist, primary	2 200 ₽
Appointment (examination, consultation) of an endocrinologist repeated	1 900 ₽

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90,000 COVID on the neck: the new coronavirus provokes thyroid disease | Articles

Doctors warned that coronavirus infection can cause the development of thyroid diseases, both inflammatory and autoimmune.Damage to this organ is not uncommon after other infections: influenza, rubella, adenoviruses, etc. However, with COVID-19, has its own characteristics – the absence of neck pain, the presence of mild thyroid dysfunction, and a higher incidence of pathology among men. At the same time, , some domestic experts are sure that it is impossible to unequivocally associate coronavirus with thyroid diseases, since this may be in ordinary statistics, because this pathology is one of the most common.

Endocrine drama

Coronavirus can cause inflammation of the thyroid gland. This is evidenced by a review published by specialists from the Department of Endocrinology and Metabolic Diseases of the CHU-Larrey Hospital (Toulouse, France). As stated in the article, extrapulmonary manifestations of COVID-19 can include endocrine forms, including diseases of the pancreas, pituitary gland, gonads, and finally the thyroid gland. In particular, the scientific literature reports a very significant frequency of subacute or chronic thyroiditis (inflammatory lesions of the thyroid gland of a different nature), Hashimoto’s disease (chronic inflammatory disease of the thyroid gland of autoimmune genesis) and other endocrine pathologies in such patients.

The most common of these is subacute thyroiditis, characterized by pain in the neck, which is usually preceded by an upper respiratory tract infection. As stated in the article, 90,137 the number of postcoid clinical cases is comparable to thyroiditis observed during or after other infections caused by cytomegalovirus, rubella, Epstein-Barr virus, enterovirus, adenovirus, measles, influenza and other viruses.

Photo: Depositphotos

However, the pathogenesis of the development of endocrine pathologies in coronavirus differs from what happens during other infections. In particular, a report was presented at the ENDO 2021 Annual International Meeting of the Endocrinological Society, which stated that some patients with moderate to severe COVID-19 disease have abnormal inflammation of the thyroid gland. Its signs are the absence of neck pain, the presence of mild dysfunction, a higher incidence of pathology among men and a connection with a severe course of COVID-19.

Own goal

In the case of COVID-19, thyroid pathologies can often be of an autoimmune nature. Patients who have contracted a new coronavirus infection at any age often develop autoimmune reactions , Irina Shestakova, professor, chief infectious disease specialist at Medsi Group, told Izvestia. Therefore, even if a person has been ill easily, the consequences of the postponed coronavirus infection can be serious and affect both the thyroid gland and many other organs and systems of the body.

– Absolutely all researchers agree that factors associated with both the pathogen itself and human immunity play a key role in the development and outcome of the coronavirus.It is clear that there is a direct cytopathic effect of the virus, which lies in its ability to enter cells through the ACE-2 receptor. And this enzyme is present on almost all epithelial and endothelial cells of the body. At the same time, pathologies of both the lungs and the thyroid gland, and other tissues and organs are caused not only by the direct damaging effect of the virus, but also by an autoimmune reaction, – said Irina Shestakova.

Photo: Izvestia / Alexander Polegenko

The thyroid gland is just one of the organs that are affected by autoantibodies (antibodies to their own tissues).In addition, a person may have a hereditary predisposition to autoimmune thyroid pathologies, which he might not have suspected before COVID-19, and the infection launched this process. To avoid such consequences, it is necessary to be vaccinated, the expert emphasized.

However, there is still insufficient scientific evidence to link the development of inflammatory diseases of the thyroid gland with the new coronavirus infection, says the director of the endocrinology clinic of the I.M.THEM. Sechenov, Corresponding Member of the Russian Academy of Sciences Valentin Fadeev. And the described cases can be explained by statistics.

– There is no solid evidence of such a connection. For example, antibodies to the thyroid gland, that is, signs of inflammation of one degree or another, are determined in 10% of women. These are the most common autoimmune diseases, – said the endocrinologist.

Photo: Depositphotos

Be that as it may, the relationship between coronavirus infection and thyroid disease needs to be studied more deeply.

Search and neutralize

There are two main types of thyroid dysfunction: hypothyroidism, when the gland produces little hormones, and hyperthyroidism, when the situation is reversed , Marina Savkina, a leading expert at the CMD Center for Molecular Diagnostics of the Central Research Institute of Epidemiology of Rospotrebnadzor, told Izvestia.

Diseases of this organ can arise, according to her, not only due to iodine deficiency, but also due to autoimmune processes, but also against the background of taking certain medications in the first months after childbirth, etc.And after viral infections, subacute thyroiditis with thyroid dysfunction does develop. And it is very important to identify the pathology in time.

– Since the “sphere of influence” of the thyroid gland is huge, the signs of its malfunction can be varied. The most common symptoms are: weight change (both gain and loss), irritability, anxiety, memory and concentration loss, joint and muscle pain, weakness, trouble sleeping, heart palpitations.As well as menstrual irregularities, dry, brittle hair and nails, dry skin , – said the specialist.

Photo: Izvestia / Sergey Konkov

If we talk about the patient’s physical sensations, then with inflammation of the thyroid tissue, pain appears in the neck region, radiating to the jaw and ear, pain on palpation, turning the head, swallowing, and the temperature may rise up to 40 ° C. Most often, the symptoms of disorders develop slowly, and patients sometimes do not notice the changes taking place in the body, said the Center for Molecular Diagnostics of Rospotrebnadzor.

The authors of the scientific article themselves are confident that the prevalence of inflammatory thyroiditis and other thyroid pathologies justifies the assessment of the function of this organ in patients hospitalized in intensive care units in order to avoid serious endocrine disruptions.

Autoimmune thyroiditis (HAIT): what is it, HAIT diseases, changes on ultrasound

In the practice of an endocrinologist, there are 2 horror stories: hormones and chronic autoimmune thyroiditis (HAIT).And if the hormones are different, among them there may be those who should be feared, then the danger of KHAIT is clearly overestimated.

What is HAIT? This is the production of antibodies by the body against its thyroid gland. Antibodies attack an innocent organ for a long time and very often can destroy it completely. Fearfully.

The first nightmare faced by patients is an increase in antibodies to thyroid peroxidase (TPO). Moreover, the normal values of antibodies are very low (usually up to 6 units), against this background, even 30 units seem to be a nightmare.Meanwhile, an isolated increase in antibodies to TPO (i.e., if the levels of hormones TSH, free T4 and free T3 are within the normal range) is not yet a reason for treatment.

According to statistics, after detecting an increase in antibodies, the likelihood of developing real chronic autoimmune thyroiditis in the next 20 years of life is 30%.

The situation with antibodies to thyroglobulin (TG) is even more interesting: they have no relation to KHAIT by themselves, they can rise up “for the company.”An isolated increase in antibodies to thyroglobulin (when antibodies to TPO are not increased) is diagnostically significant only when the thyroid gland is completely removed. In other situations, this is an accidental find, let’s say “a personal matter of the organism itself, not related to the endocrinologist.”

The second “nightmare” of KHAIT: changes in ultrasound. They are usually very colorfully described by doctors, evoking different associations in patients. In fact, doctors are simply describing a typical situation that happens to the thyroid gland when it is in trouble.

It is impossible to make a diagnosis of KHAIT only by ultrasound.

What threaten a person with changes in the thyroid gland with HAIT? Nothing. This condition will not develop into cancer, it is not necessary to operate on it, it will not spread to other organs.

When do antibodies to TPO really matter?

When there are more than 500 (several years) or 1000 (detected for the first time) with a normal level of TSH, T4 and T3 free. In this case, a person needs to check the function of the thyroid gland annually (the above 4 indicators are better in winter, i.e.because the likelihood of a malfunction of the thyroid gland in winter is higher). 20 years is a long time, 30% is not enough, but it is better to play it safe.
If the above situation is noted during pregnancy or during a planned pregnancy, then the woman will be monitored much more closely. Pregnancy is a burden for the thyroid gland, who knows how it will cope with it.
If, with a high level of antibodies, there is a violation of the level of TSH, and free T4 and T3 are normal. This is called subclinical hypothyroidism.It is highly likely that the antibodies did reach the thyroid gland. In such a situation, hormone replacement therapy can be prescribed. And you can not appoint. And you can assign and then cancel. Here it is up to the doctor to decide in each specific case, for this he was trained for so many years.
If disrupted TSH is combined with disrupted free T4 + high antibodies. This is already a real HAIT. In this situation, treatment is necessary.

And now we smoothly come to the third nightmare of KHAIT: lifelong hormone replacement therapy (HRT).Sounds awful, but it actually means just one pill in the morning. In principle, there are no restrictions and contraindications.

It is possible to become pregnant and give birth on HRT, the drug does not pass through the placenta, and the child synthesizes hormones for himself from the 8th – 10th week on his own.
The sun, sea, sauna, massage will not fundamentally change the state, so there is no point in avoiding them, depriving yourself of pleasure.
Alcohol, parties – no question, live as before.
Missing one tablet – yes, at least 3, the drug accumulates and the body will last for some time without much loss. Skipping longer is already fraught.

The fourth nightmare of HAIT is weight gain on HRT. It will not be. You are simply replacing a natural hormone with an artificial one. Fortunately, it was produced very well, so the body does not feel the difference and lives on.

It should be noted that HAIT was first described by the Japanese Hashimoto (therefore, the disease is sometimes called Hashimoto’s thyroiditis) in 1912, patients have been receiving HRT for at least 30 years.During this time, extensive material has been accumulated on the preparations, confirming that they do not affect either life expectancy or its quality.

The only proven adverse effect is worsening of osteoporosis. In this regard, X-ray densitometry is recommended for persons who have been taking 100 or more mcg of the drug for more than 10 years to assess the amount of calcium in the bones.

It is imperative to be monitored with KHAIT, but the frequency of examinations must be determined by the doctor individually.It depends on several reasons: age, initial TSH level, and the prescribed dose of the drug. Let’s say right away that the annual ultrasound scan will definitely not be included in this list.

Author: Endocrinologist, Candidate of Medical Sciences Tanygina Natalya Ivanovna.

Evgeny Zhilyaev: “All systemic diseases, if not treated, shorten life” | Brandvoice

About the profession of a rheumatologist

By definition, a rheumatologist deals with all diseases of the musculoskeletal system that do not require surgery.The range of diseases we work with are diseases of the periarticular soft tissues, acute and chronic arthritis, systemic vasculitis, systemic connective tissue diseases, and bone diseases. Another task of a rheumatologist is to search for the cause of an incomprehensible systemic disease, for example, a fever of unknown origin. We usually do this too.

The spectrum of diseases that we treat is very wide – about 700 diseases. Among them there are rare and very rare. Therefore, often, when other doctors do not understand what the patient is sick with, they refer him to us.The complexity is associated with the variety of diseases and, accordingly, with the variety of approaches to treatment. For example, what do systemic lupus erythematosus and osteoporosis have in common? Almost nothing. Nevertheless, a rheumatologist treats both. Our profession is difficult, but interesting. Our success primarily depends on the head and hands. And from the laboratory and instrumental base. At EMC we have both.

About the specifics of diseases

Systemic inflammatory diseases are conventionally divided into auto-inflammatory and autoimmune.In autoimmune diseases, the immune system purposefully attacks the body’s own systems. In autoinflammatory diseases, inflammation occurs that cannot stop by itself. Inflammation is like fire, it is a self-sustaining process. Our body has specific mechanisms for its automatic extinguishing. If these mechanisms are violated, then the inflammatory process can take on a systemic nature, in which it can self-ignite, but not extinguish. In this case, a group of diseases arises, which are called autoinflammatory.These diseases are very diverse, most of them manifest in childhood. They are treatable, but not always easy.

About common diseases

Most often, a rheumatologist has to deal with osteoarthritis and osteoporosis. In terms of their prevalence, they can be compared with hypertension. Osteoarthritis is a low-inflammatory, chronic joint disease. It appears for a number of reasons: these are microorganisms that penetrate the joints, and anatomical damage to the joints, and any severe inflammatory process in the joint.All adverse processes in the joint lead to osteoarthritis. Osteoporosis is usually not seen by a doctor. As with hypertension, doctors themselves have to find it. Hypertension is not treated because it torments people, but to avoid serious complications. The situation is the same with osteoporosis. This disease must be actively identified and treated in order to prevent fractures.

Evgeny Zhilyaev, chief physician of EMC, chief rheumatologist of Moscow, professor, doctor of medical sciences, doctor of the highest category

On the specifics of treatment

Unfortunately, many rheumatological diseases are treated for life.But we have made significant progress in their treatment. For example, 15 years ago, with the most severe form of arthritis, rheumatoid arthritis, we set ourselves the goal of slowing the onset of disability. This disease leads to rapid destruction of the joints. Now our goal is to increase the number of remissions, if possible, drug-free. That is, such patients remain at risk of recurrence of the disease, but we completely remove the symptoms of arthritis, and the person lives without drugs. The key to success in treatment is early diagnosis and, accordingly, early therapy.But the most important part of rheumatoid arthritis treatment is strategy. Rapidly escalating therapy under tight medical supervision allows us to achieve remission more and more often. For example, a disease such as systemic lupus erythematosus, 10-15 years ago, sharply reduced a person’s life expectancy. Now the situation has improved significantly. We have achieved the possibility of a long-term, almost lifelong remission of this disease.

About working with other specialists

We work closely with neurologists, orthopedists, gastroenterologists, dermatologists, hematologists, oncologists.For example, systemic inflammatory diseases often arise as a reaction to a tumor. We have had cases when patients came to us with systemic inflammatory diseases, and at the same time we detected their oncological diseases. This happens especially often with hematological pathologies: lymphomas, myeloproliferative diseases. These are the most difficult patients because they usually have an atypical picture of systemic inflammatory disease. In such cases, we, together with oncologists, develop tactics for treating the tumor and associated systemic inflammatory diseases.

Once a patient came to us with fever and joint pain. This is the so-called fever of unknown origin. We did a CT scan of the chest and abdomen. We found a suspicious lymph node near the bronchi. Then a bronchoscopy was performed with a biopsy of this lymph node and lymphoma was confirmed. Since this disease was detected at an early stage, we quickly achieved remission.

About complex diseases

One of the most difficult clinical situations is a fever of unknown origin.The most common causes of this disease are infections, malignant tumors and systemic inflammatory diseases. Usually, if a patient with fever does not have an obvious infection or suspected tumor, then they are referred to us. Another complex group of diseases is vasculitis (vascular inflammation). They can be difficult to diagnose, especially some of their types. At the same time, a person may not have any pain, the disease is manifested by fever and weakness, nothing else. Problems associated with infection of prostheses can be difficult.It is not such a rare disease, but it is difficult to identify it. The fact is that the prosthesis interferes with MRI or computed tomography, which greatly complicates the diagnosis.

About difficult cases

We received a woman with suspected stroke. MRI confirmed the diagnosis, but the neurologist drew attention to changes in laboratory tests and fever in the patient. All this suggested that the stroke did not happen by itself. We hypothesized that it is giant cell arteritis, an inflammatory arterial disease.This disease occurs predominantly in the elderly. Our patient was over 80 years old. We made her a biopsy of the temporal artery, after which the diagnosis was confirmed. With this disease, the risk of stroke is 7-10 times higher than the average. Giant cell arteritis is a difficult disease that is difficult to treat, but we have managed to achieve a drug-free remission. The patient, in her almost 90 years, continues to lead an active lifestyle. From difficult cases, I can also recall a patient who had impaired urine flow from both kidneys and the fever did not pass.Urologists stent the ureters and during the examination revealed bladder cancer, treated. Despite the fact that the outflow from the kidneys returned to normal, kidney function continued to deteriorate. After another computed tomography, a formation around the aorta was found. The patient was referred to us. We diagnosed IgG4-associated disease. Treatment was promptly prescribed, after which the patient’s temperature returned to normal, kidney function stabilized and ureteral patency was restored.But when we reduced the dose of the drug, strange changes appeared in the lungs. We did a biopsy – it turned out that there was a manifestation of the same disease in the lungs, which happens very rarely in this disease. The leading pulmonologists of Russia took part in the fate of this patient, because the history of the lungs was not easy. For two years we have brought the patient into remission. Interestingly, there is a poorly understood relationship with cancer in IgG4-associated disease. And often with the transferred in the past. Apparently, there are some common immune defects.With this disease, removal of the tumor does not affect the course of the disease.

On the danger of systemic diseases

There is a huge block of diseases – primary systemic vasculitis, in which the source of inflammation is associated with the vessels. The most dangerous group is ANCA-associated vasculitis. These are fatal diseases. If left untreated, they kill a person faster than almost any tumor. The average life span is 5–7 months. If you turn to a specialist in time, intensive drug therapy saves a person’s life.All systemic autoimmune diseases are dangerous. As well as autoinflammatory. Even diseases that are not fatal by themselves can pose serious problems. For example, it is not rheumatoid arthritis itself that is dangerous to life, but its complications. Even 10 years ago, patients with this disease lived 10 years less. They died from cardiovascular complications or infections, which occur much more often than people without this disease. The same systemic lupus erythematosus shortened life on average by 20 years.In some systemic vasculitis, not long ago, patients lived for several months. All untreated systemic inflammatory diseases, to one degree or another, shorten a person’s life. Therefore, it is so important to see a doctor in time.

Acute, subacute, chronic autoimmune thyroiditis

Chronic autoimmune thyroiditis or lymphomatous thyroiditis is an inflammatory disease of the thyroid gland of an autoimmune nature, when antibodies and lymphocytes are formed in the human body that damage its own cells of the thyroid gland.Most often, autoimmune thyroiditis occurs in patients from 40 to 50 years old, and in women it is ten times more often than in men. It is the most common inflammatory disease of the thyroid gland. However, recently, an increasing number of young patients and children suffer from autoimmune thyroiditis.

It is believed that autoimmune lymphomatous thyroiditis is hereditary in nature. Relatives of patients with thyroiditis Hashimoto or Hashimoto often have diabetes mellitus, various diseases of the thyroid gland.But for the realization of hereditary predisposition, additional unfavorable external factors are needed. These are respiratory viral diseases, chronic foci of infection of the extra-palatine tonsils, sinuses, teeth affected by caries.

Contribute to the development of autoimmune thyroiditis long-term uncontrolled intake of iodine-containing drugs, the effect of radiation. Under the influence of a provoking factor, clones of lymphocytes are activated in the body, which trigger the formation of antibodies to its own cells.The result of this process is damage to thyroid cells (thyrocytes). From the damaged cells of the thyroid gland, the contents of the follicles enter the blood: hormones, destroyed parts of the internal organelles of the cell, which in turn contribute to the further formation of antibodies to the cells of the thyroid gland. The process becomes cyclical.

Chronic autoimmune thyroiditis very often takes a long time without any clinical manifestations. Early signs include discomfort in the thyroid gland, a lump in the throat when swallowing, a feeling of pressure in the throat, and discomfort when swallowing.Sometimes there are mild pains in the thyroid gland, mainly when palpating the thyroid gland. Some patients may complain of slight weakness, joint pain.

Depending on the clinical picture and size of the thyroid gland Hashimoto’s chronic autoimmune thyroiditis is divided into the following forms:

· atrophic form of autoimmune thyroiditis . With an atrophic form of an enlargement of the thyroid gland, it does not occur. Usually, this form is clinically accompanied by a decrease in thyroid function (hypothyroidism).

hypertrophic form The hypertrophic form of autoimmune thyroiditis is always accompanied by an enlargement of the thyroid gland. The thyroid gland can be evenly enlarged throughout the entire volume (diffuse hypertrophic form), or the presence of nodes (nodular form) is noted. A combination of diffuse and nodal forms is possible. The hypertrophic form of autoimmune thyroiditis can be accompanied by thyrotoxicosis at the onset of the disease, but more often the function of the thyroid gland is normal or reduced.

Diagnosis of autoimmune thyroiditis is established on the basis of a history of the disease, a characteristic clinical picture, data from additional research methods – ultrasound of the thyroid gland and hormonal levels.

Treatment for autoimmune thyroiditis : There is no specific therapy for autoimmune thyroiditis. In the conditions of the department of endocrine surgery of the OKBM, patients have the opportunity to receive treatment in full: complex anti-inflammatory therapy, immunomodulatory therapy, symptomatic therapy, physiotherapy, as well as the know-how of the department are prescribed – intraorgan, subfascial injections of diprospan, directly into the thyroid gland, under the control of the thyroid gland.