Thyroiditis is an inflammation – not an infection – of the thyroid gland. Hashimoto’s thyroiditis, also called autoimmune or chronic lymphocyctic thyroiditis, is the most common type of thyroiditis and manifests itself as a painless, diffuse enlargement of the thyroid gland occurring predominantly in middle-aged women. Thyroid function is often normal, but hypothyroidism may develop, and rarely, hyperthyroidism. Often, autoantibodies (antibodies your body makes against itself) are present.
Hashimoto’s thyroiditis occurs when autoantibodies attack the thyroid tissue, confusing it with a foreign substance. Theories about why this occurs emphasize a basic abnormality in the immune system, which in many patients somehow allows autoimmunity to develop against thyroid tissues as well as other tissues, including those of the stomach, adrenal glands and ovaries. Other autoimmune diseases are frequently seen in these patients, such as rheumatoid arthritis, SLE (lupus), and Sjogren’s syndrome.
Some researchers believe that Hashimoto’s thyroiditis, primary myxedema and Graves’ disease (hyperthyroidism) are different expressions of a basically similar autoimmune process, and that the clinical appearance reflects the immune response in that particular patient.
Thyroiditis is more common than Graves’ disease when mild cases are included, and the prevalence among women is at least 2%. The gland affected by thyroiditis tends to lose its ability to store iodine and is inefficient in making thyroid hormone.
Diagnosis
Diagnosis is made by the finding of a painless, smooth, firm goiter in a young woman, with positive levels of anti-thyroid hormones and a euthyroid (normal thyroid) or hypothyroid metabolic status. Since progression of symptoms may be subtle, thyroiditis is difficult to diagnose at times.
A patient with a small goiter and euthyroidism does not require therapy unless the TSH level is elevated. The presence of a large gland, progressive growth of the goiter, or hypothyroidism indicates the need for replacement thyroid hormone. Surgery is rarely indicated. Development of a lymphoma, though very unusual, must be considered if there is growth or pain in the involved gland.
Postpartum Thyroiditis
Postpartum thyroiditis is the most common thyroid disease to occur after delivery and results in temporary hyperthyroidism or hypothyroidism. Five to seven per cent of women worldwide develop the disease after giving birth, according to the American Thyroid Association.
When the thyroid becomes inflamed, it will first emit larger quantities of thyroid hormone into the bloodstream (hyperthyroidism). During this phase, most women are unaware of any symptoms, which are often mild and short-lived. Once this initial phase passes, a woman either recovers completely or has sustained damage to her thyroid. If the thyroid gland was damaged, this damage – together with a depleted reservoir of thyroid hormones – can lead to hypothyroidism. This condition also may clear up or result in further damage and complications. Postpartum thyroiditis symptoms usually do not appear until three to eight months after childbirth. Symptoms are also often mistaken for normal signs of recovery from childbirth.
Conditions that suggest Chronic Thyroiditis
Gluten Sensitivity / Celiac Disease
In one study, 83 patients with autoimmune thyroid disorder were screened for celiac disease. Three patients with asymptomatic celiac disease were found along with one who had previously been diagnosed, giving an overall frequency of 4.8%. By contrast, only one of 249 age- and sex-matched blood donors was found to have celiac disease.
Anemia, Megaloblastic
Pernicious anemia is more common in people who have other autoimmune diseases such as thyroiditis.
Hypothyroidism
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the United States. The condition was named after Dr. Hakaru Hashimoto, the doctor who described it in 1912.
Hyperprolactinemia
Women with thyrotoxicosis can also develop idiopathic galactorrhea.
Panic Attacks
Hashimoto’s autoimmune thyroiditis has been associated with a range of anxiety symptoms including panic attack.
Rheumatoid Arthritis
A study of 91 patients with rheumatoid arthritis found 29 patients had evidence of thyroid dysfunction compared to 10 of the
93 controls. The excess thyroid dysfunction was due to either hypothyroidism or Hashimoto’s thyroiditis. In this study, thyroid dysfunction is seen at least 3 times more often in women with rheumatoid arthritis than in women with similar demographic features with non-inflammatory rheumatoid diseases such as osteoarthritis and fibromyalgia. [Annals of Rheumatic Diseases, 1993;52 pp.454-456]
Hives
In patients with chronic hives and either treated hypothyroidism or a normally functioning thyroid gland, it is reasonable to test for anti-thyroid antibodies. In a study of 10 patients with chronic hives, thyroxine (T4) was administered for a minimum of 12 weeks. Of 7 patients with elevated anti-thyroid antibodies at baseline, all 7 had complete resolution of hives or marked improvement within 4 weeks. Two patients required an increase in the thyroxine before complete resolution was seen. In 2 others, already on thyroxine therapy for hypothyroidism, an increase in the dose also resulted in resolution of the hives.
The initial dose was on average 100mcg per day, which was increased if the initial dose failed to produce clinical improvement. The highest dose used was 250mcg per day. The 3 patients without elevated anti-thyroid antibodies did not respond to thyroxine therapy. There was a recurrence of hives after treatment was stopped which resolved again after treatment was restarted. There was no consistent correlation between improvement in symptoms and reduction in thyroid antibody levels. [J Allergy Clin Immunol 1995;96: pp.901-905]
Risk factors for Chronic Thyroiditis
Sjogren's Syndrome
Antithyroid antibodies are created when antibodies migrate out of the salivary glands into the thyroid gland. Antithyroid antibodies cause thyroiditis, a common problem in people with Sjögren’s.
Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
Approximately 10% of lupus patients have thyroid antibodies, and autoimmune thyroiditis occasionally coexists with SLE.
Autoimmune Tendency
Hashimoto’s disease may rarely be associated with other endocrine disorders caused by the immune system. When Hashimoto’s disease occurs with adrenal insufficiency and type 1 diabetes mellitus, the condition is called type 2 polyglandular autoimmune syndrome (PGA II).
Less commonly, Hashimoto’s disease occurs with hypoparathyroidism, adrenal insufficiency, and fungal infections of the mouth and nails in a condition called type 1 polyglandular autoimmune syndrome (PGA I).
Cigarette Smoke Damage
A study of 132 pairs of twins (264 subjects) showed that smoking can have negative effects on the endocrine system, causing a 3- to 5-fold increase in the risk of all types of thyroid disease. The association was most pronounced in autoimmune disorders (Graves’ disease and autoimmune thyroiditis), although there was still a strong association for non-autoimmune thyroid disorders.
Dysbiosis, Bacterial
There is a correlation between abnormally high levels of certain bacteria (Yersinia enterocolitica and Borrelia burgdorferi) in the digestive system and autoimmune hypothyroidism. [Thyroid. November 1, 2004, 14(11): pp. 964-966]
History of chronic thyroiditis
Chronic Thyroiditis suggests the following may be present
Autoimmune Tendency
Hashimoto’s disease may rarely be associated with other endocrine disorders caused by the immune system. When Hashimoto’s disease occurs with adrenal insufficiency and type 1 diabetes mellitus, the condition is called type 2 polyglandular autoimmune syndrome (PGA II).
Less commonly, Hashimoto’s disease occurs with hypoparathyroidism, adrenal insufficiency, and fungal infections of the mouth and nails in a condition called type 1 polyglandular autoimmune syndrome (PGA I).
Sjogren's Syndrome
Antithyroid antibodies are created when antibodies migrate out of the salivary glands into the thyroid gland. Antithyroid antibodies cause thyroiditis, a common problem in people with Sjögren’s.
Cigarette Smoke Damage
A study of 132 pairs of twins (264 subjects) showed that smoking can have negative effects on the endocrine system, causing a 3- to 5-fold increase in the risk of all types of thyroid disease. The association was most pronounced in autoimmune disorders (Graves’ disease and autoimmune thyroiditis), although there was still a strong association for non-autoimmune thyroid disorders.
Dysbiosis, Bacterial
There is a correlation between abnormally high levels of certain bacteria (Yersinia enterocolitica and Borrelia burgdorferi) in the digestive system and autoimmune hypothyroidism. [Thyroid. November 1, 2004, 14(11): pp. 964-966]
Vitamin D Requirement
As vitamin D deficiency is common in Hashimoto’s and many other forms of autoimmune diseases, patient status should be should be determined. A simple blood test can help determine whether or not you are deficient in Vitamin D.
Recommendations for Chronic Thyroiditis
Glandular / Live Cell Therapy
There are glandular preparations which may help reduce thyroid antibodies over time. High doses of a product such as Thyrostim or Thytrophin PMG could help. These are a neonatal bovine glandular formulas designed to support optimal thyroid function. They may contain supplemental factors such as vitamin A, selected minerals, amino acids, iodine, SOD and catalase, which help support and maintain normal functioning of the thyroid gland.
Gluten-free Diet
Some doctors recommend the complete avoidance of gluten/gliadin and dairy products when this allergy is suspected in cases of thyroiditis or other autoimmune disease.
Thyroid Medications
Due to the profound effect of thyroid hormones, their use in a hypothyroid and hyperthyroid conditions is well justified. That is, thyroid replacement in hypothyroidism and thyroid medications to reduce thyroid activity in hyperthyroidism.
DHEA
Some doctors report finding that a high percentage of patients with autoimmune disorders, such as thyroiditis, are also deficient in DHEA, and should be tested for this hormone.
Hydrochloric Acid (Trial)
Some doctors report that 50% of patients with autoimmune disease are also hypochlorhydric (have low stomach acid).
Test Thyroid Function
If antithyroid antibody testing has not yet taken place, and chronic thyroiditis is suspected, your concern should be expressed at your next clinic / doctor visit.
Antimicrosomal (anti-M) and antithyroglobulin (anti-Tg) antibodies are commonly measured together to detect Hashimoto’s thyroiditis. Since this nearly doubles the cost of testing for one antibody, we wished to determine whether significant diagnostic loss would occur if the two tests were replaced by anti-M alone. Both tests were performed in 2030 consecutive patients referred by general internists and endocrinologists.
With a positive result defined as either test being positive at a 1:100 dilution, anti-M was much more sensitive than anti-Tg. Anti-M was positive in 99% (823/831) of all patients with positive tests, while anti-Tg was positive in 36% (302/831). Anti-M was the only positive test in 64% of all patients with positive tests, while anti-Tg was the only positive test in 1%. With a cutoff point of 1:400 dilution, the results were similar.
CONCLUSIONS: Anti-M alone appears sufficient to detect autoimmune thyroid disease at about one half the cost of routinely performing both anti-M and anti-Tg studies. The widespread practice of performing both tests increases the cost without an offsetting diagnostic gain. [The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto’s thyroiditis, Nordyke RA, Gilbert FI Jr, Miyamoto LA, Fleury KA. Straub Clinic and Hospital, Honolulu, Hawaii.]
Selenium
Three months of supplementation with 200mcg selenium daily reduced thyroid peroxidase antibodies (TPOAb) but had no effect on Tg antibodies (TgAb) in a well-controlled study of 70 women with autoimmune thyroiditis. TPOAb and/or TgAb levels were above 350 IU/ml. [ J Clin Endocrinol Metab 2002;87(4): pp.1687-1691]
Iodine
Iodine is important for normal thyroid hormone production but in Hashimoto’s thyroiditis, supplemental iodine can enhance the immune system attack and thus could make the thyroid problem worse.
Vitamin D
Vitamin D is an important vitamin for calming the immune system. Vitamin D stimulates the T-regulatory cells of the immune system.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| May do some good |
| Likely to help |
| Highly recommended |
| Reasonably likely to cause problems |
Glossary
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Hyperthyroidism
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Immune System
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Myxedema
A condition arising from diminished thyroid function, characterized by hard swelling of subcutaneous tissue, hair loss, lower temperature, muscle debility, hoarseness and the slow return of a muscle to neutral position after a tendon jerk. Resulting thyroid cell destruction eventually progresses to thyroid failure.
Iodine
A essential mineral that is an integral part of the thyroid hormones, thyroxin and triiodothyronine which have important metabolic roles and govern basal metabolism. The best known iodine deficiency symptom is goiter. Other iodine deficiency problems are reduced vitality, hypothyroidism, inability to think clearly, low resistance to infection, loss of control of the muscles of the mouth resulting in mouth contortion and drooling, defective teeth, tendency to obesity and cretinism which is a congenital abnormal condition marked by physical stunting and mental deficiency.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Goiter
A chronic enlargement of the thyroid gland produced by the body in an attempt to increase hormone production from limited amount of iodine. It is not due to cancerous growth.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Lymphoma
Any tumor of the lymphatic tissues.
Postpartum
After childbirth.
Celiac Disease
(Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Asymptomatic
Not showing symptoms.
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.
Thyrotoxicosis
Also known as Graves' disease, is a disorder of excess thyroid hormone production. It is usually linked to an enlarged thyroid gland and bulging eyes (exophthalmos).
Idiopathic
Arising spontaneously or from an obscure or unknown cause.
Galactorrhea
Galactorrhea is inappropriate lactation in the woman who is not pregnant or has not recently given birth. It can be unilateral or bilateral.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Panic Attack
A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.
Rheumatism
General term applied to conditions of pain, or inability to articulate, various elements of the musculoskeletal system.
Fibromyalgia
(FMS): Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Urticaria
Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergies to foods or medications as well as viral illness are frequent causes of acute urticaria which usually lasts only a few hours but may last up to 6 weeks. Chronic urticaria (lasting more than 6 weeks) is more complex, given the vast number of potential triggers. Symptoms include sudden onset; initial itching; then swelling of the surface of the skin into red or skin-colored welts (wheals) with clearly defined edges; welts turn white on touching; new welts develop when the skin is scratched; usually disappear within minutes or hours. Welts enlarge, change shape, spread or join together to form large flat raised areas.
T4
Thyroxin, thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.
Microgram
(mcg): 1/1,000 of a milligram in weight.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Adrenal Insufficiency
Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Vitamin D
A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.