Hashimoto’s thyroiditis

The Hashimoto ‘s thyroiditis is an autoimmune disease.

In general, the word thyroiditis is used to describe thyroid diseases characterized by an inflammation of the gland. In this case, the inflammatory process is chronic.

It occurs most frequently in middle-aged women and is the most common cause of sporadic goiter in children.

Causes of Hashimoto’s thyroiditis

The causes of this disease are unknown, although autoimmunity is believed to play an important role in its development.

In favor of the autoimmune process:

• Infiltration of the thyroid gland by lymphocytes.
• The presence of antibodies and immunoglobulins against different components of the thyroid tissue. These antibodies are probably a consequence of the destruction of the thyroid, which occurs in this disease, and not the direct cause of the disease.

Symptoms of Hashimoto’s thyroiditis

The main clinical manifestation of this disease is goiter. The increase in size may be minimal or maximum, but compressive symptoms are rare.

At first the levels of hormones are fine, but, as the gland is damaged, these levels decrease and hypothyroidism develops that initially does not give any symptoms but later ends with the characteristic symptoms (fatigue, constipation , dry skin and rough, cold intolerance, loss of appetite and weight gain…). We have to know that this thyroiditis is the most common cause of hypothyroidism in the West.

In some cases, Hashimoto’s thyroiditis appears with other diseases with autoimmune characteristics such as pernicious anemia, Sjögren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, or Graves’ disease.

Some patients have symptoms of hyperthyroidism associated with a very hard consistency of the thyroid gland and very high levels of thyroid antibodies. This combination probably suggests the combination of Graves’ disease with Hashimoto’s thyroiditis (also called Hashitoxicosis).

How is it diagnosed?

There are several methods that we can use to diagnose Hashimoto’s thyroiditis, although sometimes it is not necessary to do all of them:

• Clinical examination: palpation of the thyroid will show us an asymmetrically enlarged gland with an elastic consistency.
• Hemogram: no abnormalities are observed.
• Thyroid autoantibodies: the elevation of two types of antibodies, antiperoxidase and antithyroglobulin antibodies, is observed above all.
• Thyroid function studies: as we have already mentioned, thyroid hormones initially have normal values, but as the disease progresses, the levels decrease.
• Imaging tests: thyroid scan. Areas of low iodine uptake are demonstrated .
• FNAB: although all the mentioned tests are sufficient for the diagnosis, with the puncture it can be confirmed. An infiltrate of lymphocytes and the presence of cells that are characteristic of Hashimoto’s thyroiditis and are called Askanazy cells will be observed.

Hashimoto’s thyroiditis treatment

In cases where Hashimoto’s thyroiditis and Graves ‘disease are associated, the hyperthyroidism will be treated with the same drugs that are used for Graves’ disease.

How can I avoid it?

Being a disease with autoimmune components we cannot advise anything to prevent it, since it is due to genetic and specific characteristics of the individuals themselves.

We must go to the doctor as soon as we notice the inflammation of the thyroid gland or the symptoms of hypothyroidism that we have already mentioned (lethargy, intolerance to cold, constipation, dry and rough skin …).