What is Hashimoto’s thyroiditis?

Hashimoto’s Thyroiditis (Lymphocytic Goitre)

Also known as chronic thyroiditis or lymphocytic goitre, Hashimoto’s thyroiditis (or disease) is a common auto-immune disorder that is named after the Japanese doctor who first described the condition. Auto-immune disorders are when the body’s immune system, which is designed to attack anything “foreign” (such as bacteria and viruses), goes wrong and attacks your own tissue. In the case of Hashimoto disease, the immune system attacks the thyroid gland over the course of many years, eventually resulting in thyroid deficiency (hypothyroidism).

Who is at risk of developing Hashimoto’s thyroiditis?
Hashimoto disease is most common in adults, especially women in late middle age, but can also affect female children and teenagers. Auto-immune diseases, such as Hashimoto’s disease, often run in families, and so if there is a history of another auto-immune disease (such as Addison’s disease) or thyroid problem (such as Grave’s disease) in your close family you are likely to be at increased risk of developing Hashimoto’s disease.

What are the symptoms?
Hashimoto’s disease usually develops very slowly over many years, and so there may be no symptoms for most of the time you have the disease. Indeed, most people are not aware that anything’s wrong until they develop thyroid deficiency (hypothyroidism) late on in the course of the disease. The thyroid gland lies at the front of the neck and controls the metabolism (the speed at which everything happens in your body), so early possible symptoms may include:

* Small goitre – you may develop a small goitre (lump) at the front of your neck, often during your childhood, teenage years, or early adulthood. The goitre is likely to be soft and fleshy, unlike in Grave’s disease, when the goitre is usually hard and lumpy. It will probably be tender when touched, but is unlikely to be painful. You are likely to feel perfectly well, although some people develop thyroid overactivity (hyperthyroidism) at this stage, as described below.

* Hyperthyroidism – a few people will experience hyperthyroidism in the early stages of the disease. Symptoms usually only last for a few months at most, but may include a rapid heart rate and palpitations, looseness of the bowels, loss of weight, and starey eyes. You may feel unwell, overheat very easily and be very intolerant of hot rooms or weather. You may be (mis)diagnosed as having Grave’s disease.

* Slight discomfort when swallowing – some people notice slight discomfort when swallowing, or simply have an awareness of their necks. This usually only lasts for a month or so.

Later on in the course of the disease, as your thyroid functions increasingly slowly, hypothyroidism often slowly develops. Symptoms may include:

* Increasing tiredness and lack of energy – you may feel persistently run down and sluggish.

* You are likely to feel the cold more – and find it difficult to get or keep warm.

* Weight gain – although usually not more than 4 kg (10 lb) in a year.

* Skin may become drier and you may develop white patches on it (known as vitiligo).

* Hair may become sparser – body and pubic hair may become very scanty and your head hair may fall out much more than it used to.

* You may be constipated and feel bloated.

* Your periods may change – they may become heavier and last longer or they may stop altogether. You may think you are, or be diagnosed as, starting the menopause. If your periods have become heavier you may become anaemic, which will increase your feelings of tiredness.

* Aches and cramps in your muscles – a common symptom, especially first thing in the morning. You may also feel clumsy and less steady on your feet.

* Pins and needles in your hands – known as carpal tunnel syndrome, and is caused by a nerve in your wrist becoming trapped.

* You may find that you can’t remember things as quickly as you once could – and your speech may become slower.

How is Hashimoto’s thyroiditis diagnosed?
As can be seen, Hashimoto’s disease can easily mimic other problems and so may be misdiagnosed at any stage in its development. Consequently, your doctor is likely to take a very careful history and may refer you to a specialist for further investigations. In addition, your doctor is likely to want you to have a blood test to find out if you have thyroid antibodies in your blood. The levels of these often increase as the disease progresses.

What can be done about it?
Unfortunately there is no cure for auto-immune diseases, including Hashimoto’s thyroiditis, at present, but there are effective drug treatments (such as thyroxine) available to control the symptoms of the disease. Surgery may be considered in some cases.

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