Hashimoto’s disease, also known as Hashimoto’s thyroiditis or autoimmune thyroiditis, is a very common and widespread ailment, nowadays. My Hashimoto’s disease was diagnosed in 1983, when I was only 12 years old. Ever since, I have always struggled with the consequent discomfort caused by this illness. With this article, I wanted to share my experience and a bulk of helpful information to better cope with this troublesome autoimmune disease.
Overview
Hashimoto’s disease is an autoimmune condition in which the immune system produces antibodies that attack the thyroid gland. Placed in the front of the neck, the thyroid is an important endocrine organ that produces hormones regulating our metabolism.
The disease is also called Chronic Autoimmune Thyroiditis (AIT) or Chronic Lymphocytic Thyroiditis. This medical term depends on the fact that, in this disease, the tissue of thyroid presents a massive infiltration of lymphocytes, known as lymphomatous struma.
Lymphocytes are the cells our immune system uses to protect us from infections and tumors. In the case of Hashimoto’s disease, lymphocytes attack the thyroid as if it is an external virus, tumor, or bacteria. In short: these cells don’t recognize that the gland is an important piece of our body! In Hashimoto’s disease, the thyroid is recognized as a foreign body or an enemy to destroy.
The process is gradual and impairs many thyroid functions and our same wellness. The destruction of thyroid, in fact, is the final stage of Hashimoto’s disease. Indeed, when I undergo an ultrasound examination, doctors say that my thyroid is severely damaged, but not destroyed, yet and with a normal level of hormones.
Unfortunately, the problems caused by Hashimoto’s Thyroiditis are in other areas of our body. They often represent the intermediate stages of the disease with all their destabilizing consequences, such as food sensitivities, hair loss, and mental disorders, only to mention a few of them.
These disorders are often regarded as secondary problems and go overlooked, sometimes. With Hashimoto’s disease, patients may feel bad, but most doctors will tell them to have imaginary symptoms.
This shallow approach has turned this disease into a silent killer which does not kill us physically, but strikes us in every moment of our life. However, before deepening the further implications of Hashimoto’s disease, I would like to dive into its origins, because even though it seems to be a disease of our complicated epoch, it is much more ancient than you think.
Origins of the Disease
Hashimoto’s disease was diagnosed for the first time in 1912 by Japanese doctor Hakaru Hashimoto. He was born on May 5, 1881 in the small village of Midai, a few kms away from Iga Ueno, the seat of the school for Ninjas. Hashimoto entered the medicine faculty in 1900 at the subsidiary seat of the university of Kyoto, in Fukuoka, and was the first student who graduated in 1907.
Between 1905 and 1909, the young Japanese doctor studied four patients who had undergone a partial thyroidectomy due to goiter, but after further examinations, he noticed that the goiter was full of lymphoid cells. The histological test showed that the tissue was like Graves’ disease, but with different lymphocytes triggered by an unidentified factor.
While Graves’ disease, indeed, was and is an autoimmune illness characterized by hyperthyroidism (with more thyroid hormone production), the new disease discovered by Hashimoto was characterized by hypothyroidism (low thyroid hormone).
The discovery was published in 1912 by the same Hashimoto in a German journal. However, in Germany, the discovery was not considered as a new disease, but only as a variant of Riedel thyroiditis.
Only in 1931, a British surgeon at the Cleveland Clinic, Graham, confirmed that the lymphomatous struma (the type of lymphocytic infiltration in thyroid) described by Hashimoto was a different disease. Germany included Hashimoto’s disease in its own scientific literature in 1935, a year after the death of the Japanese doctor.
The term Hashimoto’s thyroiditis was, then, worldwide recognized in 1939. However, in the following years, the disease was still rare. In 1956, two immunologists from Buffalo, Witebsky and Rose, injected rabbit thyroglobulin, along with an adjuvant, to trigger antibodies production and a lymphocytic infiltration like the one of Hashimoto’s Thyroiditis. Ever since, Hashimoto’s disease has been affecting lots of people all over the world. Why?
Causes
Even though Hashimoto’s thyroiditis is still considered an unexplainable disease, people who struggle with thyroid problems are millions. According to the research by Dana L. Mincer and Ishwarlal Jialal, published on the website of The National Center for Biotechnology Information, Hashimoto’s thyroiditis” incidence is estimated to be 0.8 per 1000 per year in men and 3.5 per 1000 per year in women.”
An interesting article by Italian endocrinologist Serena Missori reveals that the increase of this type of autoimmune disease might be related to the environmental causes, such as plastic pollution. Plastic, in fact, is considered an “endocrine disruptor”. Even the European Union affirmed that plastic is dangerous for our health, because it contains two toxic compounds: phthalates and bisphenol.
These two toxic substances bind to hormonal receptors, altering our metabolism. They also can alter the cells of our thyroid. In addition to that, we also live in a very stressful age and this condition increases a hormone that reduces thyroid metabolism: it is the so-called Reverse 3. The Italian endocrinologist also affirms that Hashimoto’s Thyroiditis could be caused by intestinal disorders, because many autoimmune diseases start from the intestine, first.
Official medical research, instead, affirms that the main cause of Hashimoto’s disease is genetic, even though environmental influences are likewise considered in addition to sex hormones. The above-mentioned research, indeed, reads that “79% of predisposition is due to genetic factors, allotting 21% for environmental and sex hormone influences.”
As regards sex hormones, this data is referred to female sex hormones, above all, estrogens. These may increase the Reverse 3 hormone that influences our thyroid. That is why women are more affected by Hashimoto’s disease than men.
This latter category of patients may develop the disease for genetic and environmental factors. Anyway, hereditary factors play a crucial role for the transmission of Hashimoto’s disease.
The illness is not contagious, obviously, no autoimmune disease is, unless it is caused by external factors, such the immunodeficiency caused by HIV. Chronic autoimmune thyroiditis is often passed down from mother to son. In my case, the disease has been transmitted from my mother: she has Hashimoto’s disease, too.
Diagnosis
Sometimes, autoimmune thyroiditis occurs with a large goiter. This may be the first sign leading to the diagnosis. Usually, doctors treat the goiter with synthetic thyroid hormone (levothyroxine). That is the treatment I have had when I was a teenager. I was treated with levothyroxine for 8 years (from 12 to 20 years of age).
Another evidence of Hashimoto’s disease is represented by antithyroid peroxidase (anti-TPO) antibodies. These are another sign that leads to the diagnosis of Hashimoto’s disease. These antibodies, sometimes, along with the antithyroglobulin ones, are thought to cause lymphocyte infiltration and fibrosis that destroy the thyroid cells, called thyrocytes.
These cells are responsible for producing the thyroid hormones thyroxine (T4) and triiodothyronine (T3) under the stimulation of TSH (thyroid stimulating hormone). Hence, to diagnose the disease, you need a blood test that measures the presence and the level of thyroid antibodies!
However, according to the medical research mentioned above, “There is a small subset of the population, no more than 10-15% with evident disease, who are serum antibody-negative.” In this case, to diagnose Hashimoto’s disease and verify lymphocytic infiltration in the tissue of the thyroid, it is necessary to perform an ultrasound.
Symptoms
In most cases, this autoimmune disease has no clear symptoms. However, Hashimoto’s thyroiditis can also lead to annoying and sometimes severe symptoms in other areas of our body, because thyroid is the center of our metabolism and regulates other functions and organs, such as intestine, brain, heart, fertility, hair, skin, muscles, and bones.
Another evident symptom of Hashimoto’s disease is the inflammation of thyroid. Inflammation is the process triggered by small proteins called cytokines. These proteins serve to fight diseases, they are a weapon of our immune system. Cytokines bring a stream of blood to the organ affected by the illness, causing swelling and reddening (fibrosis in the case of thyroid).
That is a reaction that should help us get rid of the inflammation. Unfortunately, with Hashimoto’s disease, the thyroid inflammation is persistent. To soothe it, our body releases another hormone: cortisol. If the latter is high, inflammation worsens.
Chronic autoimmune thyroiditis is, hence, a sort of vicious circle, where we can feel strange and subtle symptoms over our life without ever knowing if they are caused by the disease, cytokines, or cortisol.
The current approach of doctors is to prevent hypothyroidism, but Hashimoto’s disease can go across different stages. For this reason, it is also called intermittent disease. During adolescence, we can have goiter, and high antibodies.
They can reduce over time and in adulthood, but other conditions, such as stress, pregnancy, menopause and the like, can trigger other symptoms. Many patients with Hashimoto’s disease report symptoms such as:
-
- dairy and gluten sensitivities
- fatigue
- irritability
- anxiety
- depression
- mood swings
- hair loss
- intestinal irregularity
- miscarriage
- early menopause
- tachycardia
- nausea
- anemia
Many of the mentioned symptoms are considered signs of subclinical hypothyroidism, namely normal T3 and T4 hormones and high TSH. However, they also occur in patient with normal T3, T4 and normal TSH. The explanation or hypothesis relates to periodical hormonal fluctuations that cause the passage from hyper to hypothyroidism.
That is why patients can lose or gain weight in different stages of their life. Irritability and anxiety may mark hyperthyroidism stages, while hair loss, depression and intestinal irregularity may mark hypothyroidism stages.
As regards the symptoms of anxiety and depression, recent studies have investigated the correlation among psychiatric disorders and Chronic Autoimmune Thyroiditis.
One of these studies has been published on the website of the American Medical Association and reveals that “inflammatory processes have been described to be related with symptoms of major depressive disorder, especially by increasing levels of circulating pro-inflammatory cytokines”. “Importantly- the research says – thyroid metabolism has been shown to modulate the brain serotonin system by reducing the sensitivity of 5-HT1A autoreceptors in the Raphé area, and by increasing 5-HT2 receptor sensitivity. Concerning anxiety, it is likely that the thyroid-catecholamine system interaction (via noradrenaline and T3) and its influence on sympathetic nervous system activity affect symptoms such as high blood pressure or sensible nightly tachycardia.”
In short: thyroid metabolism is associated with the brain serotonin system that regulates our mood. Severe depression often occurs with hypothyroidism, but thyroid inflammation can also alter thyroid metabolism, influencing the secretion of serotonin, the hormone that regulates the nervous system.
Medical research, however, has not yet confirmed the close correlation between Hashimoto’s disease and depression, but only the potential vulnerability of this type of patients. Many of them, in fact, report remarkable irritability, anxiety, and low stress tolerance.
To tolerate stress, we need a good level of serotonin, if this hormone is influenced by the inflammatory processes of Hashimoto’s disease, patients may develop severe mental disorders with a negative impact on the quality of life.
Diet
Hashimoto’s disease is often characterized by intestinal permeability that causes food allergies and intolerances. The most troublesome are dairy and gluten sensitivities.
Proteins in milk and gluten, in fact, imitate the same structure of thyroid, triggering the autoimmune reaction and a long chain of annoying symptoms, such as headache, nausea, dry skin, irritable bowel syndrome, insufficient absorption of vitamins, especially B and D, that play a crucial role to keep a good emotional and intestinal balance.
The shortage of D vitamin, for example, may lead to osteoporosis, bone and muscle aches and depression, while the shortage of B vitamin, besides the nervous system, may damage hair and skin. A healthy diet for Hashimoto’s disease must aim to avoid food intolerances, foster the good functioning of thyroid and replenish the missing vitamins.
Yes to:
- Eggs
- Fish
- White meat
- Fruit and Vegetables
- Organic cereals.
No to things that cause inflammation, such as refined sugar and processed food.
Treatment
International guidelines say that Hashimoto’s thyroiditis with normal hormones does not need treatment. The latter is necessary in case of hypothyroidism.
However, even with normal levels of thyroid hormones, Hashimoto’s disease can mimic hypothyroidism, namely the same symptoms of those who have unbalanced thyroid hormones.
These symptoms can’t be left untreated, because they cause severe discomfort, such as hair loss, fatigue, anxiety, food intolerance, frequent inflammations, and gastric reflux.
Fortunately, an Italian study, published in the Journal of Translational Endocrinology, paved the way to defeat the symptoms of subclinical hypothyroidism triggered by Hashimoto’s disease.
During this study, patients who suffer from Hashimoto’s, and who don’t take any thyroid hormone, have been administered orally with aloe juice for three months. After the treatment, the serum level of thyroid peroxidase autoantibodies (TPOAb) showed a significant decrease, with improvement of the symptoms of subclinical hypothyroidism.
To treat this condition, in fact, endocrinologists usually prescribe titrated levothyroxine sodium. The medication must be taken orally, in the morning and on an empty stomach. In case of shortage of Vitamin D, doctors can prescribe vitamin D supplements.
Annually, patients must do blood tests and ultrasound examinations to check the level of hormones, antibodies, and the condition of the gland. To soothe the thyroid inflammation and lower antithyroid antibodies, doctors can prescribe Selenium and Zinc supplements. These minerals, along with Vitamin B6, balance the immune system.
Moreover, Zinc prevents thyroid nodules. A balanced intake of minerals and vitamins can make Hashimoto’s disease more curable.
Disease Progression
Chronic Autoimmune Thyroiditis evolves gradually. Symptoms and repercussions vary from person to person. Many patients may remain euthyroid for their lifetime, others may go into hypothyroidism, others may develop thyroid cancer, or nodules, others may have hyperthyroidism. Others may have only depression and intestinal problems.
I don’t know people who died from Hashimoto’s thyroiditis. Maybe, someone died from other secondary conditions due to this disease, such as other more severe autoimmune illnesses or coronary disease due to hypothyroidism.
Women with Hashimoto’s thyroiditis may have an intense menstrual flow with consequent anemia. The final stage of hypothyroidism (when it occurs) leads to an increase in weight and cholesterol.
Wrapping Up
Hashimoto’s disease is also my disease. I have many of the symptoms I described here. As usual, I used medical sources to write this post, even though many details come from my same experience and condition. An autoimmune disease is always a critical condition, especially if it lasts for the entire life. Its symptoms are still today underestimated, as if it was an invisible illness.
But an unbalanced immune system is a burden that forces us to struggle with ongoing ups and downs! For the rest of life! I would like this disease to become curable and definitively defeated! If you recognized your autoimmune thyroiditis in this article, I am sure that we’ll both feel less alone!
By Rosalba Mancuso
References & Bibliography
- Dr. Giuseppe Papa – Tiroidite di Hashimoto (tiroidite cronica autoimmune)
- Dr. Vincenzo Piazza – Biografia di Hashimoto – PDF file
- Dana L. Mincer; Ishwarlal Jialal – Hashimoto Thyroiditis – August 10, 2020
- Dr. Serena Missori –Tiroidite di Hashimoto e intestino: che relazione c’è e cosa è importante sapere
- Eva-Maria Siegmann, Helge H. O. Müller, Caroline Luecke – Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis A Systematic Review and Meta-analysis – May 2, 2018
- Dr. Cristina Tomasi – Quali minerali influenzano la tiroide? – April 17, 2017
ABOUT THE AUTHOR
Rosalba Mancuso is a Sicily-based freelance journalist with 31 years of experience as a contributor to national newspapers and magazines. International medical reporter and professional member of the AHCJ, American Association of Health Care Journalists, she covers stories and news on mental health, autoimmunity and neurological diseases. Website: https://rosalbamancuso.com.
