Swollen thyroid gland (goiter)
• What Is Hashimoto's Disease?
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|What Is Hashimoto's Disease?
Hashimoto's disease is an autoimmune disorder. It results in antibodies being produced by the body which can attack the thyroid and interfere with its ability to produce thyroid hormones. Hashimoto's is the most common cause of an underactive thyroid (hypothyroidism) in the United States. When a thyroid is underactive, the whole body slows down. Your heart rate slows down, as well as your brain function and the rate at which you burn calories (so you gain weight). Doctors can tell the difference between hypothyroid patients with Hashimoto's disease from other forms of hypothyroidism because their blood tests reveal the presence of specific antibodies. It is closely related to Graves disease, another autoimmune disease which has the opposite effect causing an overactive thyroid, or hyperthyroidism. Hashimoto's is also called autoimmune thyroid disease and Hashimoto's thyroiditis.
To begin with, many patients with Hashimoto's display no symptoms and may be undiagnosed. The first sign of the disease, which sends people to the doctor, is usually a swollen thyroid gland called a goiter (picture). Goiters come in different shapes and sizes but they all tend to make the neck area look swollen. Although a goiter rarely causes pain, it can make swallowing or breathing difficult if it becomes large enough. Eventually, most people with Hashimoto's go on to develop hypothyroidism. To begin with the symptoms of thyroid disease might be nonexistent or mild, but they tend to worsen over time. Signs include:
Hashimoto's disease is an autoimmune disorder. This means the body's own immune system creates antibodies which end up attacking and destroying the thyroid cells. Scientists are not sure what causes the immune system to attack the body in this way, but possible theories include:
Gender: Hashimoto's is 7 times more common in women than it is in men.
In the past doctors were not able to diagnose Hashimoto's until symptoms were more advanced. Now, due to the advent of more sensitive blood tests, it is possible to diagnose the condition earlier. Initially your doctor will perform a physical examination, looking for signs of neck swelling, dry skin and hair loss. He will ask you about your energy levels, if there have been any changes in your bowel movement and if you have been experiencing a hoarse voice. Laboratory blood tests will be necessary to make a clinical diagnosis (these are discussed in more detail in our article thyroid tests):
If you test positive for Hashimoto antibodies, but your thyroid is still functioning normally, doctors may recommend a wait-and-see approach. If your thyroid is affected, you will need to start taking thyroid hormone replacement drugs, probably for the rest of your life. This is not as bad as it seems, it usually only involves taking one oral pill daily - usually levothyroxine (brand names Levoxyl, Levothroid and Synthroid). When you start treatment you should feel less exhausted quite quickly. The medication also helps to lower cholesterol levels and may help reverse weight gain. As your dosage requirements can change over time, you will need to have a blood test every 6 to 12 months check your TSH hormone levels. The dose may also need to be changed if you become pregnant, develop heart disease or start taking estrogen replacement therapy for treating menopause symptoms.
If you do not treat Hashimoto’s it can lead to problems such as:
You should plan your pregnancy carefully if you have been pre-diagnosed with the condition. You will need to consult with both your OB/Gyn and endocrinologist. Levothyroxine is safe to continue taking during pregnancy but you may need to take a higher dose. You will have to be carefully monitored during your pregnancy trimesters and your thyroid function should be checked every 6 to 8 weeks. You can normally return to your pre-pregnancy dosage after delivery. Levothyroxine is not likely to pose problems to your baby if you breastfeed (although it does pass into breast milk).
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