How does hypothyroidism affect men differently than women. What are the unique symptoms of Hashimoto’s disease in males. How is hypothyroidism diagnosed and treated in men. Why is thyroid dysfunction less common in men than women. What are the long-term effects of untreated hypothyroidism in men.

The Gender Gap in Hypothyroidism: Why Men Are Less Affected

Hypothyroidism, a condition characterized by an underactive thyroid gland, affects men significantly less than women. Dr. Mario Skugor, an endocrinologist at the Cleveland Clinic, explains that hypothyroidism is about 8 to 10 times less common in men. This substantial difference is primarily due to the autoimmune nature of most hypothyroidism cases.

Approximately 80% of hypothyroidism cases are caused by autoimmune diseases, which are notably more prevalent in women. The most common autoimmune condition leading to hypothyroidism is Hashimoto’s thyroiditis, affecting about 14 million Americans, of which only about 2 million are men.

Why are autoimmune diseases more common in women?

The exact reason for the higher prevalence of autoimmune diseases in women remains a mystery. As Dr. Skugor humorously notes, understanding this phenomenon would be worthy of a Nobel Prize. Researchers speculate that hormonal differences, genetic factors, and environmental influences may all play a role in this gender disparity.

Other causes of hypothyroidism in men

• Damage to the thyroid gland
• Surgical removal of the thyroid due to tumors
• Overtreatment of hyperthyroidism
• Graves’ disease complications

While Hashimoto’s thyroiditis is the primary cause, men can develop hypothyroidism through other means. Thyroid gland damage, surgical interventions, and treatments for hyperthyroidism can all result in an underactive thyroid. Graves’ disease, another autoimmune condition more common in women, can paradoxically lead to hypothyroidism if overtreated.

Recognizing Hypothyroidism Symptoms in Men

The symptoms of hypothyroidism in men are largely similar to those experienced by women. Dr. Skugor emphasizes that hypothyroidism affects the entire metabolism, potentially impacting any organ system in the body. However, some symptoms may manifest differently or be more pronounced in men.

Common symptoms of hypothyroidism in men:

1. Feeling cold
2. Fatigue and tiredness
3. Dry skin and brittle nails
4. Constipation
5. Depression
6. Difficulty concentrating
7. Muscle soreness
8. Weight gain
9. Thyroid gland swelling (goiter)
10. Decreased libido and erectile dysfunction

While most symptoms are shared between genders, men may experience some unique manifestations, particularly in sexual function. A study published in the Urology Journal compared 24 men with hypothyroidism to 66 men without the condition, evaluating erectile dysfunction (ED) using the International Index of Erectile Function Questionnaire. The results showed that men with hypothyroidism scored significantly lower (11.75 on average) compared to those without (20.81 on average), indicating a higher prevalence of ED among hypothyroid men.

Can hypothyroidism cause sexual dysfunction in men?

Yes, hypothyroidism can indeed lead to sexual dysfunction in men. The condition’s impact on overall energy levels and metabolism can result in decreased libido and difficulties with erectile function. Dr. Skugor explains that the fatigue and low energy associated with hypothyroidism can naturally lead to a reduced interest in sexual activity.

Diagnosing Hypothyroidism in Men: Challenges and Considerations

Diagnosing hypothyroidism in men can be challenging, as symptoms often develop gradually and may be mistaken for other conditions or simply attributed to aging. Dr. Skugor notes that symptoms typically don’t appear until thyroid hormone levels are significantly low. This gradual onset can lead to delays in diagnosis, especially if doctors aren’t actively considering hypothyroidism as a possibility in male patients.

Key steps in diagnosing hypothyroidism in men:

• Physical examination to identify signs and symptoms
• Thyroid Stimulating Hormone (TSH) test
• Free T4 and T3 tests if TSH is abnormal
• Thyroid antibody tests to determine if Hashimoto’s is the cause

The most reliable diagnostic tool for hypothyroidism is the Thyroid Stimulating Hormone (TSH) test. This blood test measures the level of TSH, which increases when the thyroid is underactive. If TSH levels are elevated, additional tests for free T4 and T3 hormones may be conducted to confirm the diagnosis and assess the severity of the condition.

Are there any specific diagnostic challenges for men with hypothyroidism?

While the diagnostic process is similar for both genders, men may face unique challenges due to the lower prevalence of the condition in males. Doctors might be less likely to consider hypothyroidism as a potential diagnosis when evaluating male patients with non-specific symptoms like fatigue or weight gain. This bias can lead to delayed diagnosis and treatment, highlighting the importance of increased awareness among both patients and healthcare providers.

Treatment Approaches for Hypothyroidism in Men

The primary treatment for hypothyroidism in men is thyroid hormone replacement therapy. This involves taking synthetic thyroid hormones to restore normal hormone levels and alleviate symptoms. Dr. Skugor emphasizes that thyroid hormone replacement is more akin to a supplement than a medication, as it’s replacing something the body naturally needs but is no longer producing in sufficient quantities.

Key aspects of thyroid hormone replacement therapy for men:

• Dosage based on body weight (men may require higher doses than women)
• Regular monitoring and adjustment of hormone levels
• Potential lifelong treatment
• Importance of consistent medication adherence

Men may require higher doses of thyroid hormone replacement than women due to their generally larger body mass. The exact dosage is carefully calculated based on individual factors and is regularly adjusted through ongoing monitoring of thyroid hormone levels.

How long does it take for thyroid medication to work in men?

The effects of thyroid hormone replacement therapy are not immediate. Most men begin to notice improvements in their symptoms within a few weeks of starting treatment. However, it can take several months for hormone levels to stabilize and for all symptoms to fully resolve. Patience and consistent medication adherence are crucial during this adjustment period.

Living with Hypothyroidism: Lifestyle Considerations for Men

While medication is the cornerstone of hypothyroidism treatment, lifestyle factors play a significant role in managing the condition and optimizing overall health. Men with hypothyroidism can benefit from adopting certain habits and making informed choices to support their thyroid function and general well-being.

Dietary considerations for men with hypothyroidism:

• Ensure adequate iodine intake (but avoid excess)
• Incorporate selenium-rich foods
• Limit goitrogenic foods (e.g., raw cruciferous vegetables)
• Maintain a balanced, nutrient-rich diet
• Consider timing of medication in relation to meals

Nutrition plays a crucial role in thyroid health. Men with hypothyroidism should ensure they’re getting adequate iodine, an essential nutrient for thyroid hormone production. However, excessive iodine intake can be counterproductive, so it’s important to maintain a balance. Selenium-rich foods like Brazil nuts, fish, and eggs can support thyroid function. Some foods, known as goitrogens, can interfere with thyroid hormone production when consumed in large quantities, especially in their raw form. These include cruciferous vegetables like broccoli and cauliflower.

How does exercise impact thyroid function in men with hypothyroidism?

Regular exercise can be beneficial for men with hypothyroidism, helping to boost metabolism, improve energy levels, and manage weight. However, it’s important to start slowly and gradually increase intensity, as hypothyroidism can affect muscle strength and endurance. A combination of cardiovascular exercise and strength training is often recommended. It’s advisable to consult with a healthcare provider before starting a new exercise regimen, especially if experiencing severe symptoms.

The Psychological Impact of Hypothyroidism on Men

The effects of hypothyroidism extend beyond physical symptoms, often impacting mental health and cognitive function. Men with untreated or poorly managed hypothyroidism may experience depression, anxiety, and difficulties with concentration and memory. These psychological aspects of the condition can significantly affect quality of life and should be addressed as part of a comprehensive treatment approach.

Common psychological effects of hypothyroidism in men:

• Depression
• Anxiety
• Cognitive difficulties (“brain fog”)
• Mood swings
• Reduced motivation
• Sleep disturbances

The link between thyroid function and mental health is well-established. Thyroid hormones play a crucial role in brain function, affecting neurotransmitter systems involved in mood regulation and cognitive processes. As such, imbalances in thyroid hormones can lead to various psychological symptoms.

How can men cope with the psychological effects of hypothyroidism?

Managing the psychological impact of hypothyroidism involves a multi-faceted approach. Proper medical treatment to normalize thyroid hormone levels is fundamental. Additionally, men may benefit from:

• Cognitive Behavioral Therapy (CBT) to address depression and anxiety
• Mindfulness and stress reduction techniques
• Regular exercise to boost mood and cognitive function
• Adequate sleep hygiene
• Social support and connection
• Consultation with a mental health professional if symptoms persist

It’s important for men to communicate openly with their healthcare providers about any psychological symptoms they’re experiencing. In some cases, additional interventions such as antidepressant medication may be considered alongside thyroid hormone replacement therapy.

Long-Term Management and Monitoring of Hypothyroidism in Men

Hypothyroidism is typically a lifelong condition that requires ongoing management and monitoring. For men diagnosed with hypothyroidism, establishing a long-term care plan with their healthcare provider is essential to ensure optimal thyroid function and overall health.

Key components of long-term hypothyroidism management:

• Regular thyroid function tests (TSH, free T4)
• Periodic adjustment of medication dosage
• Monitoring for potential complications
• Annual physical examinations
• Attention to cardiovascular health
• Bone density screenings

The frequency of thyroid function tests may vary depending on the individual’s condition and response to treatment. Initially, tests may be conducted every 6-8 weeks until hormone levels stabilize. Once stable, annual testing is typically sufficient, unless symptoms suggest a need for reassessment.

What potential complications should men with hypothyroidism be aware of?

While proper treatment significantly reduces the risk of complications, men with hypothyroidism should be aware of potential long-term health concerns:

• Increased risk of cardiovascular disease
• Potential for osteoporosis, especially with overtreatment
• Fertility issues and decreased libido
• Increased risk of metabolic syndrome
• Potential cognitive decline if left untreated

Regular monitoring and open communication with healthcare providers can help identify and address these potential complications early. Men with hypothyroidism should be proactive in discussing any new symptoms or concerns with their doctors.

Emerging Research and Future Directions in Male Hypothyroidism

The field of thyroid research is continually evolving, with new insights emerging about the unique aspects of hypothyroidism in men. Recent studies have focused on refining diagnostic criteria, exploring genetic factors, and investigating novel treatment approaches that may offer more personalized care for male patients.

Areas of ongoing research in male hypothyroidism:

• Genetic markers for predisposition to autoimmune thyroid disease in men
• Impact of environmental factors on thyroid function in males
• Relationship between thyroid dysfunction and male fertility
• Optimizing treatment protocols for men of different ages and health profiles
• Exploring the potential of regenerative medicine in thyroid disorders

One particularly promising area of research involves the use of advanced imaging techniques to better understand thyroid function and structure in men. These technologies may lead to earlier and more accurate diagnoses, potentially improving outcomes for male patients.

How might future treatments for hypothyroidism differ for men?

As our understanding of gender differences in thyroid function grows, future treatments may become more tailored to the specific needs of male patients. Potential developments could include:

• Personalized dosing algorithms based on genetic profiles
• Novel drug delivery systems for more consistent hormone levels
• Combination therapies addressing both thyroid function and associated conditions
• Targeted interventions for preserving fertility in men with hypothyroidism
• Integrative approaches combining conventional treatment with lifestyle interventions

While these advancements are still on the horizon, they underscore the importance of ongoing research in the field of male thyroid health. Men diagnosed with hypothyroidism today can look forward to potentially more refined and effective treatment options in the future.

In conclusion, while hypothyroidism is less common in men than in women, it remains a significant health concern that requires attention, accurate diagnosis, and proper management. By understanding the unique aspects of hypothyroidism in men, from its causes and symptoms to treatment approaches and long-term considerations, both patients and healthcare providers can work together to ensure optimal thyroid health and overall well-being. As research continues to advance our understanding of this condition, men with hypothyroidism can look forward to increasingly personalized and effective care strategies.

Hypothyroidism in Men – Symptoms, Diagnosis & Treatment

Why Is Hypothyroidism Less Common in Men?

“Hypothyroidism is about eight to 10 times less common in men. That’s because 80 percent of hypothyroidism is caused by autoimmune disease, and autoimmune diseases are more common in women. If I knew why autoimmune diseases are more common in women, I would win the Nobel Prize,” said Mario Skugor, MD, an endocrinologist at the Cleveland Clinic.

An autoimmune disease happens when your body’s defense system, called your immune system, mistakes normal parts of your body for foreign invaders and attacks them. The autoimmune disease that usually causes hypothyroidism in women and men is Hashimoto’s thyroiditis.

In Hashimoto’s, your immune system attacks your thyroid gland. Hashimoto’s thyroiditis affects about 14 million Americans, of which about two million are men.

“Other causes of hypothyroidism in men include damage to the thyroid or removal of the thyroid during surgery for thyroid tumors, and treatments for an overactive thyroid that result in an underactive thyroid.

“Graves’ disease is a cause of hyperthyroidism that may require treatments that leave a person with hypothyroidism. Graves disease is also more common in women,” said Dr. Skugor.

Symptoms of Hypothyroidism in Men

“The symptoms, diagnosis, and treatment of hypothyroidism in men are about the same as in women. Hypothyroidism slows down your whole metabolism, so symptoms can affect any organ system,” Skugor said.

The most common symptoms are:

• Feeling cold
• Tiring easily
• Dry skin and brittle nails
• Constipation
• Depression
• Trouble concentrating
• Sore muscles
• Weight gain
• Swelling of the thyroid gland, called a goiter

Loss of interest in sex and trouble having erections are symptoms that some men may have. “If you are tired and low on energy, it’s not surprising that you will have some loss of interest in sex,” says Skugor.

A recent study published in the Urology Journal compared 24 men with hypothyroidism to 66 men without hypothyroidism.

Erectile dysfunction (ED) was evaluated using the International Index of Erectile Function Questionnaire, which rates ED on a scale from 5 (severe ED) to 25 (no ED).

The men with hypothyroidism had an average score of 11.75 compared to men without hypothyroidism who averaged 20.81.

Getting the Diagnosis and Treatment You Need

“Most symptoms of hypothyroidism do not develop right away. The thyroid hormone level must be overly low,” said Skugor. Men and their doctors need to be aware of the possibility of hypothyroidism in men so that getting a diagnosis isn’t delayed.

Your doctor may suspect hypothyroidism if you have symptoms and signs during a physical examination. The most reliable test for diagnosing hypothyroidism is thyroid stimulating hormone (TSH). This hormone tells your thyroid to make more thyroid hormone if your thyroid is becoming underactive.

“Treatment for hypothyroidism is replacement of thyroid hormone. Some men may not want to take medication, but thyroid hormone is more like a supplement. It is something your body naturally needs. The amount you need to take is based on your weight, so men may need to take higher doses than women,” said Skugor.

If you have symptoms of hypothyroidism, talk to your doctor. Men get hypothyroidism less than women, but you need to get treated just the same. Once you have hypothyroidism, you usually have it for life. With early diagnosis and treatment, thyroid hormone replacement is a safe and effective treatment that can manage your symptoms and prevent complications.

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Hashimoto’s disease – Symptoms & causes

Overview

Hashimoto’s disease is an autoimmune disorder affecting the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the neck just below the Adam’s apple. The thyroid produces hormones that help regulate many functions in the body.

An autoimmune disorder is an illness caused by the immune system attacking healthy tissues. In Hashimoto’s disease, immune-system cells lead to the death of the thyroid’s hormone-producing cells. The disease usually results in a decline in hormone production (hypothyroidism).

Although anyone can develop Hashimoto’s disease, it’s most common among middle-aged women. The primary treatment is thyroid hormone replacement.

Hashimoto’s disease is also known as Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis.

Thyroid gland

The thyroid gland is located at the base of the neck, just below the Adam’s apple.

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Symptoms

Hashimoto’s disease progresses slowly over the years. You may not notice signs or symptoms of the disease. Eventually, the decline in thyroid hormone production can result in any of the following:

• Fatigue and sluggishness
• Increased sensitivity to cold
• Increased sleepiness
• Dry skin
• Constipation
• Muscle weakness
• Muscle aches, tenderness and stiffness
• Joint pain and stiffness
• Irregular or excessive menstrual bleeding
• Depression
• Problems with memory or concentration
• Swelling of the thyroid (goiter)
• A puffy face
• Brittle nails
• Hair loss
• Enlargement of the tongue

When to see a doctor

Signs and symptoms of Hashimoto’s disease vary widely and are not specific to the disorder. Because these symptoms could result from any number of disorders, it’s important to see your health care provider as soon as possible for a timely and accurate diagnosis.

Causes

Hashimoto’s disease is an autoimmune disorder. The immune system creates antibodies that attack thyroid cells as if they were bacteria, viruses or some other foreign body. The immune system wrongly enlists disease-fighting agents that damage cells and lead to cell death.

What causes the immune system to attack thyroid cells is not clear. The onset of disease may be related to:

• Genetic factors
• Environmental triggers, such as infection, stress or radiation exposure
• Interactions between environmental and genetic factors

Risk factors

The following factors are associated with an increased risk of Hashimoto’s disease:

• Sex. Women are much more likely to get Hashimoto’s disease.
• Age. Hashimoto’s disease can occur at any age but more commonly occurs during middle age.
• Other autoimmune disease. Having another autoimmune disease — such as rheumatoid arthritis, type 1 diabetes or lupus — increases your risk of developing Hashimoto’s disease.
• Genetics and family history. You’re at higher risk for Hashimoto’s disease if others in your family have thyroid disorders or other autoimmune diseases.
• Pregnancy. Typical changes in immune function during pregnancy may be a factor in Hashimoto’s disease that begins after pregnancy.
• Excessive iodine intake. Too much iodine in the diet may function as a trigger among people already at risk for Hashimoto’s disease.
• Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto’s disease.

Complications

Thyroid hormones are essential for the healthy function of many body systems. Therefore, when Hashimoto’s disease and hypothyroidism are left untreated, many complications can occur. These include:

• Goiter. A goiter is enlargement of the thyroid. As thyroid hormone production declines due to Hashimoto’s disease, the thyroid receives signals from the pituitary gland to make more. This cycle may result in a goiter. It’s generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing.
• Heart problems. Hypothyroidism can result in poor heart function, an enlarged heart and irregular heartbeats. It can also result in high levels of low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — that is a risk factor for cardiovascular disease and heart failure.
• Mental health issues. Depression or other mental health disorders may occur early in Hashimoto’s disease and may become more severe over time.
• Sexual and reproductive dysfunction. In women, hypothyroidism can result in a reduced sexual desire (libido), an inability to ovulate, and irregular and excessive menstrual bleeding. Men with hypothyroidism may have a reduced libido, erectile dysfunction and a lowered sperm count.
• Poor pregnancy outcomes. Hypothyroidism during pregnancy may increase the risk of a miscarriage or preterm birth. Babies born to women with untreated hypothyroidism are at risk for decreased intellectual abilities, autism, speech delays and other developmental disorders.
• Myxedema (miks-uh-DEE-muh). This rare, life-threatening condition can develop due to long-term, severe, untreated hypothyroidism. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.

Autoimmune thyroiditis (Hashimoto’s thyroiditis) – symptoms, causes, treatment

Thyroid gland and its role in the body

The thyroid gland is a small, butterfly-shaped organ located at the base of the front of the neck.

The gland produces hormones called thyroid hormones. These are TK (triiodothyronine) and T4 (thyroxine). They affect almost all important processes in the body, such as metabolism, maintaining weight, heart rate and body temperature, and the synthesis of certain vitamins.

Thyroid hormones (T3 and T4) have a great influence on all important processes in the body

If the thyroid gland produces an insufficient amount of hormones, this condition is called hypothyroidism , if it is excessive – hyperthyroidism (thyrotoxicosis) .

The thyroid gland is regulated by the pituitary gland, a pea-sized gland located at the base of the brain that synthesizes thyroid-stimulating hormone (TSH).

The interaction of the pituitary gland and the thyroid gland is based on the principle of feedback. So, when the thyroid gland starts producing less T4 than usual, the level of TSH in the blood rises to stimulate the gland to work. And with an increase in the amount of T4, the level of TSH decreases.

Autoimmune thyroiditis

Autoimmune thyroiditis (Hashimoto’s thyroiditis, Hashimoto’s disease, chronic autoimmune thyroiditis, chronic lymphocytic thyroiditis) is a disease in which the immune system destroys healthy thyroid cells, mistaking them for pathogens. At the same time, the organ becomes inflamed and cannot fully function. As a result, less thyroid hormones are synthesized than needed for the needs of the body. This condition is called hypothyroidism.

The pathology was first described by the Japanese surgeon Hakaru Hashimoto in 1912. Therefore, the disease is also called Hashimoto’s thyroiditis, or Hashimoto’s disease / Photo source: Wellcome Library, London

Hashimoto’s thyroiditis is much more common (4-10 times) in women. As a rule, the disease develops when a person reaches the age of 30-50 years.

In the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), autoimmune thyroiditis is coded E06. 3.

Causes of autoimmune thyroiditis. Triggers

The exact causes of the disease are unknown. It is believed that Hashimoto’s thyroiditis develops due to a genetically determined defect in the behavior of lymphocytes – white blood cells that are normally responsible for immune defense against infections. As a result of a failure, lymphocytes begin to mistake thyroid cells for pathogens, attack and destroy them.

Patients with autoimmune thyroiditis often have a haplotype (a piece of DNA that is inherited from one of the parents) HLA-DR5. This fact confirms that the disease develops in people genetically predisposed to it.

At the same time, not all people prone to autoimmune thyroiditis will certainly get sick. In order for pathology to develop, in addition to genetic conditioning, other factors must also influence a person.

Factors provoking the development of autoimmune thyroiditis:

• stress;
• poor environmental conditions, exposure to radiation;
• viral, bacterial and fungal infections;
• long-term use of iodine-containing drugs.

Hashimoto’s disease is also often found in people with other autoimmune diseases.

Autoimmune diseases often associated with Hashimoto’s thyroiditis:

• celiac disease – inflammation of the mucous membrane of the small intestine when eating products containing gluten;
• systemic lupus erythematosus – connective tissue lesion;
• rheumatoid arthritis – inflammation of the joints;
• Sjögren’s syndrome – dryness of the mucous membranes, especially the eyes and mouth;
• type 1 diabetes mellitus – an increase in blood glucose levels due to a lack of insulin in case of destruction of pancreatic beta cells due to autoimmune aggression of the body.

Hashimoto’s thyroiditis is often associated with another autoimmune disease – celiac disease (gluten intolerance)

Classification of autoimmune thyroiditis

The disease can be classified according to several features.

According to the course of the disease and the size of the thyroid gland, the following types of autoimmune thyroiditis are distinguished:

• Latent . The disease practically does not manifest itself in any way (there is no pronounced clinical symptomatology), and only according to the test results, one can notice small deviations in the level of thyroid hormones from the norm. The thyroid gland may be slightly enlarged.
• Hypertrophic . This form of the disease is also called Hashimoto’s goiter because the thyroid gland enlarges. A goiter can be diffuse if the gland is enlarged evenly, nodular with an uneven increase in the gland with the formation of nodes, and diffuse-nodular when there are nodes in the thyroid gland, but the organ is evenly enlarged. In the blood, there can be both an excess (thyrotoxicosis) at the initial stage of the disease, and a lack (hypothyroidism) of hormones, which is always observed in the outcome of the disease.
• Atrophic . In this form of the disease, the thyroid gland, on the contrary, decreases in volume and produces less hormones than it needs (hypothyroidism).

According to the form of the course of the disease, characteristics and functions of the organ, these types of autoimmune thyroiditis of the thyroid gland are distinguished:

• Autoimmune thyroiditis type I . It is divided into two subtypes: Ia – subclinical, Ib – goiter. In the subclinical form of iron, it is normal or slightly increased, elastic; hormone levels are normal. In the goiter form, the gland is slightly enlarged, more dense on palpation than usual; the level of hormones is normal or slightly reduced or increased, which does not significantly affect the patient’s well-being.
• Autoimmune thyroiditis type II . It is divided into two subtypes: IIa – hypertrophic, or classic, form of the disease and IIb – atrophic form of the disease. With a hypertrophic, or classic, form, the thyroid gland is large, dense, with a bumpy surface; the level of hormones is normal (infrequently), reduced (most often) or slightly increased (less often). In the atrophic form, the thyroid gland is normal in size or reduced; hormone levels are reduced.

Stages of autoimmune thyroiditis

There are several stages of autoimmune thyroiditis.

• Euthyroid stage . The asymptomatic stage of the disease, which occurs without changes in the level of thyroid hormones.
• Stage of thyrotoxicosis (hashitoxicosis) . An important sign of this stage is an enlarged thyroid gland (goiter). On palpation, it can be found that the thyroid gland is of a dense heterogeneous structure. At this stage, due to autoimmune inflammation, partial breakdown of thyroid tissue already begins. At the same time, thyroid hormones previously synthesized by the gland are released into the blood in large quantities and their temporary excess occurs – thyrotoxicosis, or hashitoxicosis.
• Subclinical . At this stage, the destruction of the thyroid gland continues. There are fewer normal thyrocytes, which causes the gland to produce less thyroid hormones. However, the pituitary gland takes the blow: it increases the production of thyroid-stimulating hormone (TSH), due to which it stimulates the thyroid gland to work harder. As a result, the body manages to maintain normal levels of thyroid hormones.
• Stage of overt hypothyroidism . As autoimmune inflammation of the thyroid gland continues, it produces less thyroid hormone than the body needs to support physiological processes. Hypothyroidism develops – a lack of thyroid hormones – and the symptoms of the disease are clearly manifested.

It is important to remember that with autoimmune thyroiditis, the patient does not always consistently go through all stages of the disease. It often happens that Hashimoto’s thyroiditis proceeds for a long time with signs of only one of the stages – euthyroidism, thyrotoxicosis, subclinical or overt hypothyroidism.

An important sign of the thyrotoxic stage is enlargement of the thyroid gland (goiter)

Signs and symptoms of autoimmune thyroiditis

Whether symptoms of Hashimoto’s thyroiditis will appear and how much depends on the stage of the disease.

At the euthyroid stage no symptoms.

At the stage of thyrotoxicosis (hashitoxicosis) due to the appearance of goiter, patients may complain of difficulty in swallowing, a feeling of pressure in the neck, hoarseness. Laboratory signs: decrease in TSH level with normal T3 and T4 values ​​(sometimes with elevated T4 levels).

There are no symptoms at the subclinical stage . Laboratory signs: an increase in the level of TSH with a normal T4 value.

Symptoms at the stage of overt hypothyroidism, common for men and women:

• dry skin and hair, brittle nails;
• hair loss;
• sensitivity to cold;
• general and muscle weakness;
• drowsiness;
• decreased concentration;
• memory impairment;
• edema;
• constipation;
• overweight;
• joint pain;
• bradycardia – decreased heart rate;
• sometimes – depression.

In women, signs of autoimmune thyroiditis may include menstrual irregularities, painful and heavy menstruation, and difficulty conceiving. This is due to the close relationship between reproductive function and thyroid function. So, in case of violation of the thyroid gland in women, the process of ovulation and the normal development of pregnancy are disrupted.

In men, problems with potency can be a sign of autoimmune thyroiditis: with an excess or lack of thyroid hormones, testicular production of testosterone, which affects sexual function, also decreases.

Laboratory signs at this stage: an increase in the level of TSH with a decrease in T3 and T4.

It is worth noting that all of the listed symptoms are nonspecific for autoimmune thyroiditis: they are characteristic of hypothyroidism, regardless of the reasons that caused this condition.

Course of illness

Thyrocytes – cells of the thyroid gland – produce thyroglobulin protein and thyroperoxidase enzyme. They are needed for the production of thyroid hormones – T3 (triiodothyronine) and T4 (thyroxine). But with Hashimoto’s thyroiditis, the immune system, due to a malfunction, begins to perceive thyroglobulin and thyroperoxidase as pathogens that need to be destroyed.

To stop the production of these putative pathogens, the immune system attacks the thyrocytes that produce them. For this, autoimmune antibodies to thyroglobulin (AT-TG) and thyroperoxidase (AT-TPO) are first produced. And then lymphocytes, immune blood cells, together with autoimmune antibodies, begin to destroy thyrocytes.

Due to a malfunction in the immune system, lymphocytes begin to attack thyroid cells

The site of destroyed thyroid cells is occupied by scar tissue. But it is non-functional: it cannot produce hormones. This means that as autoimmune inflammation progresses, the number of thyroid cells that work normally decreases. As a result, the level of thyroid hormones decreases and hypothyroidism occurs.

Autoimmune thyroiditis in children

Hashimoto’s thyroiditis is rare in children: the disease is detected in 0.17-2.3% of children. At the same time, if a child or teenager is diagnosed with hypothyroidism or non-toxic goiter (painless enlargement of the thyroid gland without inflammation and changes in hormone levels), autoimmune thyroiditis is almost certainly the cause.

As a rule, children over 4 years old are susceptible to Hashimoto’s disease, and it is most often diagnosed in adolescents. Girls get sick more often than boys.

The following variants of the course of autoimmune thyroiditis in children are possible:

• Appearance of goiter on the background of euthyroidism — normal level of thyroid hormones.
• Transient thyrotoxicosis (hashitoxicosis). It is detected in less than 5% of children. It usually goes away without treatment in 3-5 months.
• Hypothyroidism. It is detected during the first examination in approximately 3-13% of children. Sometimes accompanied by goiter. Hypothyroidism can persist throughout life.

Also, approximately 10-20% of children with euthyroidism due to an enlarged thyroid gland develop persistent hypothyroidism within 5 years after the disease is diagnosed.

Autoimmune thyroiditis and pregnancy

If a patient with autoimmune thyroiditis has a normal concentration of thyroid hormones, and a thyroid-stimulating hormone (TSH) level of up to 2.5 mU/l, the disease will not affect the ability to successfully become pregnant and give birth to a healthy child.

But if a woman has abnormal levels of hormones, then the risks during pregnancy increase significantly.

Possible complications:

• infertility,
• miscarriage,
• miscarriage,
• placental insufficiency,
• late toxicosis,
• preterm birth,
• bleeding after childbirth,
• fetal hypoxia,
• thyrotoxicosis in a newborn.

There is also evidence that mothers with untreated hypothyroidism in Hashimoto’s disease may have children with intellectual disabilities, autism, speech delay and other developmental disabilities.

Prognosis for autoimmune thyroiditis. Possible complications

If autoimmune thyroiditis in a patient remains at the stage of euthyroidism, that is, the normal concentration of T3 and T4 hormones is maintained, then the disease is not dangerous and does not require treatment.

But in the case when the patient has already developed hypothyroidism, it is very important to start therapy in a timely manner. If the normal concentration of thyroid hormones in the blood is not restored, dangerous complications can occur.

Complications of autoimmune thyroiditis accompanied by hypothyroidism:

• reproductive disorders, including infertility;
• pronounced memory loss up to dementia;
• anemia – a decrease in the concentration of hemoglobin in the blood, which disrupts the supply of oxygen to organs and tissues;
• disorders in the work of the cardiovascular system: changes in heart rate; accumulation of fluid in the pericardial cavity – a membrane of connective tissue surrounding the heart; an increase in the level of “bad” cholesterol (LDL), which means an increase in the risk of developing atherosclerosis, heart attack and stroke;
• Myxedematous coma is a condition that can develop due to long-term untreated hypothyroidism. In this case, the patient first feels drowsiness, then lethargy, and finally loses consciousness. Hypothermia, the use of sedatives, infection, and stress can provoke myxedematous coma. A patient in myxedematous coma requires urgent medical attention.

Diagnosis of autoimmune thyroiditis

According to the clinical guidelines of the Russian Association of Endocrinologists, it is possible to confidently say that a patient has autoimmune thyroiditis only if the so-called major diagnostic signs are combined.

Major diagnostic features of autoimmune thyroiditis:

1. Primary overt (with symptoms) or persistent subclinical (without symptoms) hypothyroidism or haschitoxicosis.
2. Detection of antibodies to thyroid tissue.
3. Ultrasound signs of autoimmune pathology.

If at least one of these signs is absent, the diagnosis is “autoimmune thyroiditis”
is probabilistic.

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Thyroid needle biopsy is not required to confirm the diagnosis of autoimmune thyroiditis. This method can only be used for differential diagnosis with oncological diseases of the thyroid gland, if thyroid nodules with a diameter of more than 1 cm are found.

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It also makes no sense to control the change in the level of autoimmune antibodies in autoimmune thyroiditis: this will not help predict how the disease will develop.

Prevention and treatment of autoimmune thyroiditis

It is impossible today to stop the body’s autoimmune aggression against the thyroid gland: there are no such drugs with proven effectiveness. There are also no effective measures to prevent autoimmune thyroiditis.

If a patient has autoimmune antibodies or ultrasound signs of autoimmune thyroiditis, but the thyroid gland continues to function normally (the main indicator is a normal TSH level), it is not advisable to prescribe treatment. Therapy can be recommended only if the thyroid gland is significantly enlarged.

If thyroid dysfunction is detected, hormone replacement therapy is indicated. Such treatment allows you to compensate for the partially lost function of the thyroid gland by taking a hormonal drug.

For hormone replacement therapy in autoimmune thyroiditis, drugs are used, the active ingredient of which is levothyroxine sodium – this is a synthetic form of the hormone thyroxine (T4).

For symptomatic hypothyroidism (increased TSH levels and decreased T4 levels), levothyroxine sodium is usually prescribed at the rate of 1.6-1.8 mcg per 1 kg of the patient’s body weight.

Subclinical hypothyroidism (increased TSH levels with normal T4 levels) is usually not treated immediately. First, a second (after 3-6 months) blood test for hormones is performed. If the results of such an analysis confirm a persistent dysfunction of the thyroid gland (TSH level above 10 mU/l or double detection of TSH level in the range of 5–10 mU/l), then hormone replacement therapy is prescribed. But if patients are over 55
years old and have cardiovascular disease, replacement therapy
prescribed only if the drug is well tolerated.

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If subclinical hypothyroidism is detected in a pregnant woman , full dose replacement therapy is given immediately.

If autoimmune antibodies or ultrasound signs of autoimmune thyroiditis are detected in a woman planning a pregnancy, she will be advised to take a blood test for TSH and free T4 hormones to evaluate thyroid function. Such a study is carried out before conception and in each trimester of pregnancy.

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The treatment is considered effective when, thanks to the drug, it was possible to achieve a stable normal level of TSH in the blood.

Diet and lifestyle in autoimmune thyroiditis

Today there is no confirmed evidence that any diet affects the course of autoimmune thyroiditis. Therefore, the recommendations for patients with this disease are the same as for all people: eat a quality and varied diet, control stress levels, maintain moderate physical activity, get enough sleep.

Autoimmune nutritional protocol (autoimmune diet, autoimmune paleoprotocol) for Hashimoto’s disease

Some experts believe that with Hashimoto’s thyroiditis, it is worth adhering to the so-called autoimmune diet (autoimmune paleoprotocol, autoimmune nutrition protocol). This nutrition system is based on the idea of ​​a “leaky” intestine – damage to the intestinal mucosa and the entry into the bloodstream of substances that normally remain in the intestine. Then the immune system reacts to them and produces antibodies to them that attack the structures of the thyroid gland.

The purpose of the autoimmune diet is to patch up the gut and reduce autoimmune inflammation through proper nutrition

Permitted under this diet: meat, fish and seafood, vegetables (except nightshade: potatoes, eggplant, tomatoes, bell peppers), fruits, fermented foods, bone broths and herbs. Milk and soy, eggs, legumes, nuts and seeds, refined foods, sugar and sweeteners, canned food, coffee and alcohol are not recommended.

Such a diet can indeed optimize intestinal motility, however, due to the large number of restrictions, it can cause a deficiency of certain vitamins and minerals, such as calcium. And there are currently no convincing studies on the role of an autoimmune diet in the treatment of autoimmune thyroiditis.

Also, patients with autoimmune thyroiditis need to be careful when taking drugs with iodine. If iodine in some drugs is contained in a dose exceeding 1 mg per day, this can lead to the manifestation of hypothyroidism, that is, a decrease in the level of thyroid hormones. With this treatment, it is necessary to control the function of the thyroid gland.

Which doctor to contact for autoimmune thyroiditis

An endocrinologist deals with the diagnosis and treatment of autoimmune thyroiditis.

This doctor specializes in the treatment of diseases of the endocrine system. It includes endocrine glands that produce and secrete hormones into the blood – biologically active substances that regulate the functioning of internal organs and important processes in the body (metabolism, maintaining a stable body temperature, and others). The thyroid gland is one of the endocrine glands.

During the initial appointment, the endocrinologist may suspect autoimmune thyroiditis when collecting complaints, anamnesis and palpation of the thyroid gland. To confirm the diagnosis, the doctor may prescribe additional studies: ultrasound of the thyroid gland and blood tests for hormones.

Hashimoto’s Disease and Reproduction

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9 decembris 2021 | 3.5 minutes of reading

Hashimoto’s disease is an autoimmune thyroid disorder that causes progressive hypothyroidism (hormone deficiency). It usually develops gradually and the symptoms are often associated with other diseases, so Hashimoto’s disease can go undiagnosed for a long time. The treatment of Hashimoto’s disease mainly consists of proper drug therapy, supplemented by a healthy diet.

Causes of Hashimoto’s disease

Hashimoto’s disease is caused by a malfunction of the immune system, which instead of protecting the body from infection and disease produces antibodies that attack the thyroid gland. Unfortunately, the cause of this condition is not fully known. Hashimoto’s disease is thought to be caused by both genetic and hormonal factors. The disease can also develop with the use of certain drugs. Environmental factors, malnutrition, excessive and chronic stress are also important.

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Diagnosis of Hashimoto’s disease

Several tests are needed to diagnose this disease:

• Test for thyroid stimulating hormone (TSH) – an elevated level of this hormone may indicate a lack of thyroid hormones;
• The level of thyroxine and triiodothyronine – the decrease is associated with a violation of the secretion of thyroid hormones;
• Thyroid ultrasound;
• Thyroid peroxidase antibody (anti-TPO) test – persistently elevated blood levels may indicate illness even if there are no other symptoms.

Symptoms of thyroid dysfunction

The most common symptoms that may indicate thyroid dysfunction are: dry skin,

Hashimoto’s disease and infertility

Thyroid disorders cause fertility problems in both women and men, who can also develop Hashimoto’s disease, although much less frequently than women.

Hashimoto’s disease in women mainly affects the course of the menstrual cycle, often thyroid dysfunction can cause anovulation. This is due, among other things, to a decrease in the production of estradiol, which plays an important role during ovulation and pregnancy. For this reason, it is difficult not only to get pregnant, but also to maintain a pregnancy. Hormonal imbalances can lead to preterm birth, abortion, fetal death, and preeclampsia.

Thyroid hormones are also very important for men – they affect the level of androgenic hormones, which determine the quantity and quality of sperm. Poor sperm quality makes it difficult to conceive.

However, the disease does not preclude the possibility of pregnancy – stimulation and a healthy diet can increase the chances of pregnancy. It is worth remembering that it is also necessary to monitor your health during pregnancy, as neglected hypothyroidism can contribute to the development of fetal abnormalities. That is why early diagnosis and appropriate treatment in the early stages of the disease is so important.

How to deal with Hashimoto’s disease?

Treatment is mainly based on regulating the levels of hormones that are not produced naturally and preventing the symptoms of the disease.

Patients are usually given oral hormonal preparations containing levothyroxine. It should be remembered that drug therapy cannot be stopped and must be used under the strict supervision of an endocrinologist throughout life.