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Immunosuppressants are a class of drugs that help to treat some autoimmune conditions and to prevent rejection of transplanted tissues and organs. As the name implies, these immunosuppressant drugs suppress the body's immune response. 

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The primary function of the immune system is to protect the body from foreign microorganisms like viruses or bacteria. A healthy immune system offers immunity by producing antibodies and lymphocytes (types of white blood cells). These lymphocytes trigger antibodies to attach to the foreign microorganisms, which signal to T cells where to find the infection to be destroyed.

Sometimes, immune cells make a mistake and attack the local cells that they are supposed to protect. This overactivity of the immune system is called autoimmunity.

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Autoimmune conditions

Immunosuppressant drugs treat some autoimmune diseases. Autoimmunity is when the immune system attacks the body's own tissues and organs, confusing local cells with foreign cells. Immunosuppressants suppress this immune reaction, helping to reduce the impact of an autoimmune condition on the body. 

Autoimmune diseases treated with immunosuppressant drugs include:

• psoriasis
• lupus
• rheumatoid arthritis
• Crohn's disease
• multiple sclerosis
• alopecia areata
  

A person may have more than one autoimmune disorder at the same time, called polyautoimmunity. So, if you have Hashimoto's thyroiditis, you may be at higher risk of developing another autoimmune disease that requires immunosuppressant therapy.

Typically, thyroid hormone replacement medications treat hypothyroidism caused by Hashimoto's. These medications are not in the same class as harsh drugs or immunosuppressants used to treat other autoimmune conditions. Thyroid medications supplement or replace the thyroid hormone that your body does not naturally produce.

Organ transplant

Immunosuppressive drugs effectively reduce organ rejection after transplantation. The immune system processes, and attacks, a transplanted organ as if it were a foreign object. Immunosuppressants decrease the body's immune reaction to the foreign object, allowing the transplanted organ to stay healthy.

The type of immunosuppressant drug(s) prescribed depends on whether the patient has an organ transplant, an autoimmune disorder, or another condition.

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Corticosteroids

• prednisone (Deltasone, Orasone)
• budesonide (Entocort EC)
• prednisolone (Millipred)

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Janus kinase inhibitors

• tofacitinib (Xeljanz)

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Calcineurin inhibitors

• cyclosporine (Neoral, Sandimmune, SangCya)
• tacrolimus (Astagraf XL, Envarsus XR, Prograf)

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mTOR inhibitors

• sirolimus (Rapamune)
• everolimus (Afinitor, Zortress)

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IMDH inhibitors

• azathioprine (Azasan, Imuran)
• leflunomide (Arava)
• mycophenolate (CellCept, Myfortic)

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Biologics

• abatacept (Orencia)
• adalimumab (Humira)
• anakinra (Kineret)
• certolizumab (Cimzia)
• etanercept (Enbrel)
• golimumab (Simponi)
• infliximab (Remicade)
• ixekizumab (Taltz)
• natalizumab (Tysabri)
• rituximab (Rituxan)
• secukinumab (Cosentyx)
• tocilizumab (Actemra)
• ustekinumab (Stelara)
• vedolizumab (Entyvio)

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Monoclonal antibodies

• basiliximab (Simulect)
• daclizumab (Zinbryta)

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Side effects vary significantly for each of the different immunosuppressant drugs available. If you take immunosuppressants as prescribed by your doctor, ask your doctor or pharmacist about the side effects of your particular medication. 

Immunosuppressants may be associated with an increased risk of infection. The immunosuppressant weakens your immune system, making your body less resistant to infection. 

For example, rheumatoid arthritis patients have an increased risk of tuberculosis. Immunosuppressant drugs give relief to patients with rheumatoid arthritis, but, in some cases, may promote the re-emergence of tuberculosis.

Call your doctor immediately if you have any of these symptoms of infection while taking immunosuppressants:

• fever or chills
• pain in the side of your lower back
• trouble urinating
• pain while urinating
• frequent urination
• unusual tiredness or weakness

While helpful for certain autoimmune conditions or organ transplants, immunosuppressant drugs may not be necessary to treat Hashimoto's or hypothyroidism. Generally, it's believed that the side effects and complications of using immunosuppressive drugs outweigh any potential benefits for Hashimoto's. 

Exceptions

There is a very rare condition called Hashimoto encephalopathy that affects the brain, contributing to issues like seizures, confusion, or dementia. Research suggests that it may be associated with Hashimoto's thyroiditis, but the exact connection is still unclear. Most people with Hashimoto encephalopathy respond well to corticosteroid or other immunosuppressive medications.

Tangentially, thyroid eye disease (TED) is a condition associated with thyroid autoimmunity that causes the eyes to inflame (or "bulge"). Most commonly related to Graves' disease, TED may respond to immunosuppressant therapies, but research shows modest results. 

Each of us is unique with individual sensitivities. There is no one-size-fits-all thyroid treatment. Instead, we recommend that you work with your thyroid doctor to determine the right treatment plan for you.

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