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Hashimoto’s thyroiditis, an autoimmune disorder where your immune system attacks your thyroid gland, is one of the most common causes of hypothyroidism in the United States and developed countries. Despite its prevalence, Hashimoto’s often goes undiagnosed or misdiagnosed for years, leaving millions of people struggling unnecessarily with unexplained symptoms. This “silent epidemic” affects a significant number of people, particularly women, yet it remains under-recognized in both the medical community and public awareness. In this article, we’ll explore why Hashimoto’s is so challenging to identify and what you can do to advocate for your health.
Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis, was first described by Japanese physician Hakaru Hashimoto in 1912. The condition occurs when the immune system mistakenly attacks the thyroid gland, leading to inflammation and, over time, the gradual destruction of thyroid tissue.
The thyroid, a small butterfly-shaped gland in your neck, regulates various bodily functions. It produces hormones that control metabolism, heart rate, body temperature, and more.
When the thyroid becomes damaged, as in Hashimoto’s, it loses its ability to produce sufficient hormones, leading to hypothyroidism. When you are hypothyroid, your body’s metabolism slows down due to a lack of thyroid hormones.
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in developed countries, affecting approximately 1 to 2% of the population. However, this figure might underestimate the actual number, as many cases go undiagnosed. As with most autoimmune diseases, women are significantly more likely to develop Hashimoto’s than men. Estimates suggest that women are affected by Hashimoto’s at a ratio of up to 10:1 compared to men, with most women being diagnosed between 30 and 50 years of age. Hashimoto’s can, however, be diagnosed at any age, including in children and adolescents.
While the exact cause remains unknown, several factors may increase the risk of developing Hashimoto’s:
- Genetic factors and predisposition
- Environmental triggers
- Hormonal changes
- Excessive iodine intake
- Certain medications
- Stress
One of the most challenging aspects of diagnosing Hashimoto’s thyroiditis is its wide range of symptoms, which can mimic many other conditions. The thyroid gland plays a critical role in regulating metabolism. When it is underactive, symptoms can affect almost every part of the body.
Common symptoms of Hashimoto’s (and the resulting hypothyroidism) include:
- Fatigue: Persistent tiredness and a feeling of being run down.
- Weight gain: Unexplained weight gain despite no change in diet or exercise habits.
- Cold intolerance: Sensitivity to cold temperatures.
- Depression: Feelings of sadness or hopelessness, often dismissed as unrelated.
- Memory problems: Difficulty concentrating or remembering things, often termed “brain fog.”
- Hair loss: Thinning or loss of hair, including from the eyebrows.
- Dry skin: Rough, dry, and flaky skin.
- Joint pain and muscle weakness: Aches and stiffness in the joints and weakness in the muscles.
- Menstrual irregularities: Changes in menstrual periods, including heavier, lighter, or skipped periods.
- Leaky gut and digestive issues: Constipation or other gastrointestinal problems.
- Slowed heart rate: A decrease in heart rate, often lower than 60 beats per minute.
- Neck pain, enlargement (goiter): Tenderness or pain in the neck, enlargement of the thyroid gland known as goiter.
Because these symptoms can develop gradually over years, are so varied, and can be associated with many other health conditions, Hashimoto’s is often overlooked or misdiagnosed as something else.
There are several reasons why Hashimoto’s thyroiditis is often misdiagnosed or not diagnosed at all despite being a common cause of hypothyroidism.
Non-specific symptoms
As mentioned earlier, the symptoms of Hashimoto’s are non-specific and can overlap with those of other conditions. For example, fatigue and weight gain are common complaints that could be attributed to age, lifestyle factors, depression, or other hormonal states, including postpartum, perimenopause, and menopause. Because the symptoms are so general, they may not immediately suggest a thyroid problem to patients or healthcare providers.
Slow onset of symptoms
Hashimoto’s thyroiditis is a progressive condition, meaning symptoms often develop slowly over time. In the early stages, a person might experience only mild symptoms or none at all. This gradual onset can make it difficult for patients and doctors to recognize that something is wrong until the condition has significantly progressed.
Lack of sufficient awareness among healthcare providers
While hypothyroidism is well-known among healthcare providers, Hashimoto’s thyroiditis as an autoimmune thyroid disease is sometimes overlooked. Some doctors may not be aware of the importance of testing for thyroid antibodies, which can indicate an autoimmune attack on the thyroid even when thyroid hormone levels appear normal. This oversight can lead to a missed diagnosis or delayed treatment.
Fluctuating thyroid function
One of the most confusing aspects of Hashimoto’s is that thyroid function can fluctuate over time. In the early stages, patients may experience periods of hyperthyroidism (overactive thyroid) as the damaged gland releases excess hormones. This can then alternate with hypothyroidism (underactive thyroid) as the gland becomes less functional. These fluctuations can lead to inconsistent test results and symptoms, further complicating diagnosis.
Inadequate testing
Many doctors rely solely on TSH (thyroid-stimulating hormone) levels to assess thyroid function. While elevated TSH can indicate hypothyroidism, it doesn’t tell the whole story. Patients with Hashimoto’s may have normal TSH levels, especially in the early stages of the disease. As a result, many patients with the condition may be told that their thyroid function is normal when, in fact, they are experiencing symptoms related to Hashimoto’s.
Comprehensive thyroid testing that includes TSH, free thyroxine (Free T4), free triiodothyronine (Free T3), and thyroid peroxidase antibodies (TPOAb) is crucial for an accurate diagnosis.
Overlap with other conditions
Hashimoto’s thyroiditis shares symptoms with several other health conditions, including chronic fatigue syndrome, fibromyalgia, depression, and even menopause. This overlap can lead to misdiagnosis, with patients being treated for other conditions while the underlying thyroid issue remains unaddressed.
Gender bias in healthcare
Women are more likely to be affected by Hashimoto’s thyroiditis, yet research has shown that women’s health concerns are sometimes dismissed or not taken as seriously by healthcare providers. Symptoms such as fatigue, weight gain, and depression are sometimes attributed to stress, emotional factors, and lifestyle rather than being investigated as potential signs of a thyroid disorder.
Understanding Hashimoto's Thyroiditis
This guide will teach you about Hashimoto's Thyroiditis, its anatomy, how to diagnose it, and treatment options.
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Identifying Hashimoto’s thyroiditis as early as possible is crucial for several reasons:
- Preventing further thyroid damage: Early intervention can help slow the progression of thyroid destruction and preserve thyroid function.
- Addressing symptoms: Proper treatment can alleviate the often debilitating symptoms associated with thyroid dysfunction.
- Preventing cardiovascular issues: Untreated hypothyroidism can lead to high cholesterol levels, increasing the risk of heart disease and stroke.
- Reducing the risk of infertility and pregnancy complications: Thyroid hormones are crucial for reproductive health. Women with untreated Hashimoto’s may experience difficulties conceiving, increased risk of miscarriage, and complications during pregnancy.
- Identifying related conditions: Hashimoto’s is often associated with other autoimmune diseases, such as celiac disease and type 1 diabetes. Early diagnosis can prompt screening for these associated conditions.
- Improving mental health conditions: The psychological effects of untreated Hashimoto’s can be profound, causing or contributing to anxiety, depression, and cognitive impairment.
Given the challenges in diagnosing an autoimmune thyroid disorder, patients must be proactive about their health. If you suspect that you may have a thyroid problem, consider the following steps:
1. Track your symptoms
Keep a detailed record of your symptoms, including when they started and how they have changed over time. This information can be valuable in helping your healthcare provider put together a detailed medical history and understanding of your condition. (Paloma’s free Thyroid app, available for IOS and Android) has a helpful symptom tracker that makes this easy.)
2. Get comprehensive thyroid testing
If you have risk factors for Hashimoto’s autoimmune thyroiditis, ask your doctor to perform comprehensive thyroid testing.
Here are the critical tests typically needed:
- Thyroid-stimulating hormone (TSH): Measures the level of TSH, which regulates thyroid hormone production. High TSH levels typically indicate hypothyroidism, while low levels may suggest hyperthyroidism or overtreatment with thyroid hormone.
- Free T4 (Thyroxine): Assesses the level of free T4, the primary hormone produced by the thyroid gland. This test helps determine if the thyroid is producing adequate hormones.
- Free T3 (Triiodothyronine): Measures the level of free T3, the active form of thyroid hormone. While T4 is more commonly measured, T3 levels can provide additional insight into thyroid function, especially if symptoms persist despite normal T4 levels.
- Thyroid Peroxidase (TPO) antibodies (also known as anti-TPO antibodies and thyroid peroxidase autoantibodies): High levels suggest an autoimmune thyroid attack, common in Hashimoto’s. These antibodies can also be monitored to evaluate the success of efforts to reduce inflammation and modulate autoimmune thyroid activity.
- Reverse T3 (RT3): This test measures an inactive form of T3. It’s sometimes used to periodically assess whether T4 is being adequately converted to the active T3, especially in complex cases.
- Vitamin D levels: Vitamin D deficiency is common in patients with autoimmune conditions like Hashimoto’s, and optimal D levels can support hormonal and immune health.
These tests should be performed regularly, with the frequency depending on the stage of treatment and the patient’s symptoms. Initially, blood tests may be needed every 6 to 8 weeks until thyroid hormone levels stabilize. Once stabilized, testing may be reduced to every 6-12 months. (Note: Paloma’s home thyroid test kit measures TSH, Free T4, Free T3, and TPO antibodies, with the option of adding on Reverse T3 and Vitamin D levels. The kit makes thyroid testing easy, convenient, and affordable.)
3. Seek a second opinion
If you feel your symptoms are not being taken seriously or your condition is being misdiagnosed, don’t hesitate to seek a second opinion. Another healthcare provider may have a different perspective and be more thorough in their approach to diagnosis. (Remember that you can always schedule a virtual consultation with one of Paloma’s expert thyroid providers for a second opinion.)
4. Consider seeing a specialty practice
You may want to see a physician or practice like Paloma specializing in the diagnosis and treatment of thyroid and hormonal imbalances. These healthcare providers are often better equipped to diagnose and treat your Hashimoto’s thyroiditis.
While being diagnosed with Hashimoto’s thyroiditis can be daunting, it is important to remember that the condition is manageable with proper treatment. Most people with Hashimoto’s can lead healthy, active lives once they receive the appropriate care.
Medication
The primary treatment for Hashimoto’s thyroiditis is thyroid hormone replacement medications. These medications help to restore normal thyroid hormone levels, alleviate symptoms, and prevent further complications.
Diet and lifestyle changes
While medication is essential, some people with Hashimoto’s find that certain dietary and lifestyle changes can help manage their symptoms. This might include following an autoimmune protocol AIP diet, reducing stress, and exercising regularly.
Regular monitoring/testing
Because Hashimoto’s thyroiditis is a chronic condition, it requires ongoing monitoring. Regular blood tests are necessary to ensure that thyroid hormone levels are within the desired range, and adjustments to medication may be needed over time.
Support networks
Living with a chronic condition can be challenging, both physically and emotionally. Finding support from others who understand what you’re going through can be incredibly helpful. Online forums like Paloma Health’s patient community, support groups, and counseling can provide valuable resources and a sense of shared experience and greater community.
Raising awareness
One of the most significant challenges in combating the “silent epidemic” of Hashimoto’s thyroiditis is raising awareness. By sharing information about the condition with others, advocating for better testing and diagnosis, and supporting those who are affected, we can all help to reduce the number of people who suffer unnecessarily due to misdiagnosis or lack of treatment.
The future of Hashimoto’s thyroiditis diagnosis and treatment looks promising, with several emerging approaches and areas of research.
Improved diagnostic methods
Advances in diagnostic techniques may allow for earlier and more accurate detection of Hashimoto’s:
- Genetic profiling could help identify individuals at higher risk of developing the condition.
- More sensitive antibody tests may detect the disease at earlier stages.
- Advanced imaging techniques like ultrasound elastography may improve the assessment of thyroid damage.
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Novel treatment approaches
Several new treatment strategies are being explored:
- Rituximab, etanercept, and tocilizumab are being studied to suppress the overactive immune response. These may help reduce thyroid damage and antibody levels in some patients.
- Tiratricol, a thyroid hormone analog similar to T3 and T4, may help compensate for hormone deficiency and potentially normalize the autoimmune response.
- Thyroid peroxidase inhibitors, compounds that aim to limit the autoimmune attack by inhibiting a key enzyme in thyroid hormone synthesis.
- Natural desiccated thyroid or combination levothyroxine/liothyronine (T4/T3) therapy may provide better symptom relief for some patients compared to standard levothyroxine alone.
- Metformin: this type 2 diabetes drug shows potential benefits in Hashimoto’s treatment, though more research is needed.
The future of Hashimoto’s management is likely to involve more individualized approaches, with treatment tailored to a patient’s genetic profile, antibody levels, and specific symptoms. Regular monitoring and adjustment of these personalized treatment plans will also be crucial to optimizing outcomes. (Note: Paloma’s integrative approach to hypothyroidism care currently provides personalized treatment plans for your hypothyroidism.)
Addressing comorbidities
Research is focusing on managing Hashimoto’s alongside common comorbidities, including improving strategies for treating Hashimoto’s in conjunction with conditions like papillary thyroid cancer and type 1 and type 2 diabetes.
Exploring gut microbiota and nutrition
Emerging research is investigating the roles of gut microbiota in the development and progression of Hashimoto’s, as well as nutritional factors that may influence the disease course.
While thyroid hormone replacement drugs remain the standard treatment, these advancements offer hope for more effective and personalized management of Hashimoto’s thyroiditis. Ongoing clinical trials will be crucial in validating and bringing new approaches into mainstream clinical practice.
Hashimoto’s thyroiditis may be a “silent epidemic,” but it doesn’t have to remain that way. The key to overcoming this silent epidemic lies in education, awareness, and being proactive in seeking appropriate care. By understanding the symptoms, seeking comprehensive testing, and advocating for oneself, those affected by Hashimoto’s can receive the treatment they need to live full, healthy lives.
If you suspect you may have Hashimoto’s, don’t hesitate to advocate for yourself and seek the answers you need. With proper diagnosis and treatment, it’s possible to manage this condition effectively and improve your quality of life.
As specialists in treating Hashimoto’s and hypothyroidism from a holistic perspective, Paloma Health can work with you to get correctly diagnosed and optimally treated for your Hashimoto’s, including convenient at-home thyroid tests, consultation with knowledgeable health care providers, optimal thyroid treatment, nutritional and health coaching geared to Hashimoto’s and hypothyroid patients, ongoing information via our articles, webinars, videos, and podcasts, and an active support community of fellow thyroid patients.
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