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(Hashimoto's thyroiditis) Hashimoto’s disease – Symptoms, Causes and Complications

Pace Hospitals

Hashimoto's disease is an autoimmune disorder (the immune system makes antibodies that turn against the body's own tissues), which can cause hypothyroidism or an underactive thyroid. It is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis or autoimmune thyroiditis.


The thyroid is a little gland at the front of the neck that resembles a butterfly shape. When Hashimoto's disease is present, the immune system's mediated antibodies attack the thyroid gland, leading to the accumulation of excessive quantities of white blood cells (part of the immune system) that harm the thyroid gland. As a result, the thyroid is not able to produce adequate thyroid hormones, resulting in hypothyroidism.


Around the globe, the annual incidence of Hashimoto disease was reported at 0.3-1.5 cases per 1000 persons (estimated). The symptoms of Hashimoto disease are similar to those of hypothyroidism, as Hashimoto disease causes hypothyroidism. Medication such as hormone replacement therapy is used to treat hypothyroidism in the majority of patients who have Hashimoto disease. If the patient has mild hypothyroidism, they may not require any treatment. However, the physician might suggest a routine thyroid-stimulating hormone test to keep an eye on thyroid hormone levels.

(Hashimoto's disease) Hashimoto’s Thyroiditis Causes

The exact cause of Hashimoto disease (autoimmune thyroiditis) is still under research, and the following might be the possible contributors:

  • Genes: The presence of Hashimoto disease or other autoimmune diseases in the family history may increase the likelihood of disease occurrence.
  • Viral infections: According to research, viral infections such as hepatitis C (which attacks the liver and causes inflammation) have autoimmune phenomena, which include rheumatoid arthritis, thyroid disease, cryoglobulinaemia, immune thrombocytopenic purpura, systemic lupus erythematous, and Sjogren syndrome. 
  • Usage of certain medications: Medications that are used to treat bipolar disorder, other mental health problems, and abnormal heart rhythms have the potential to cause Hashimoto disease.
  • Exposure to environmental toxins, such as nuclear radiation.

(Hashimoto’s Thyroiditis) Hashimoto’s Disease Symptoms

Many patients remain asymptomatic. Nevertheless, the Hashimoto's disease (autoimmune thyroiditis) symptoms can be early ones, which may include:

  • Difficulty in passing stools
  • Fatigue
  • Dry skin
  • Increased in weight
  • As the disease progresses, the patient might encounter a few symptoms of hypothyroidism.
  • Intolerance to cold
  • Peripheral neuropathy
  • Decreased energy
  • Depression
  • Loss of memory
  • Joint and muscle pain
  • Hair loss
  • Apnea (difficulty in breathing)
  • Menorrhagia (abnormally heavy bleeding during menstruation)
  • Voice hoarseness due to goiter enlargement


In extremely rare cases, hyperthyroidism symptoms can manifest themselves early in the course of the disease due to the release of excessive amounts of thyroid hormone into the blood due to thyroid damage.

Physical findings of Hashimoto's Disease (Hashimoto's thyroiditis) include: 

  • Ataxia (difficulty in co-ordination, balance and speech)
  • Bradycardia (decreased heart rate)
  • Brittle nails
  • Dry skin
  • Increase in blood pressure
  • Macroglossia (enlarged tongue)
  • Periorbital facial oedema and nonpitting oedema in the hands and feet
  • Slurred speech
  • Delayed in relaxation phase of tendon reflexes

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(Hashimoto's Disease) Hashimoto's Thyroiditis Risk Factors

The risk factors of Hashimoto disease are as follows:

  • Women are more susceptible (4 to 10 times) compared to men. This illness can strike at any time in a woman's life, but it typically manifests insidiously between the ages of 30 and 50.
  • Patients with any other autoimmune disorders are prone to having Hashimoto disease, which includes: 
  • Celiac disease
  • Lupus 
  • Rheumatoid arthritis 
  • Sjogren’s syndrome
  • Type 1 diabetes
  • Family history of having Hashimoto or thyroid disease.
  • Patients who are exposed to high environmental radiation levels.

(Hashimoto's Disease) Hashimoto's Thyroiditis Complications

Many people with Hashimoto disease can develop hypothyroidism. If unmanaged, hypothyroidism can lead to several health problems, including:

  • Heart problems like low heart rate, hypertension, and heart failure.
  • Occurrence of Goitre (an enlargement of the thyroid gland that manifests as a bump on the front of the neck).
  • Myxoedema a rare, fatal and extreme complication of hypothyroidism characterised by profound cognitive and behavioural changes as well as multiple organ abnormalities.
  • Increase in low-density lipoprotein (bad cholesterol).

(Hashimoto Thyroid Disease) Hashimoto's thyroiditis diagnosis 

(Hashimoto's disease) Hashimoto's thyroiditis symptoms may be triggered by a variety of health issues. To diagnose the autoimmune thyroiditis condition, the physician may consider the following factors.


Patient’s medical and family history: 

  • Presence of Hashimoto disease in the patient’s family
  • Environmental radiation exposure
  • Usage of medications which can cause autoimmune diseases
  • Presence of any previous viral infections


Physical exam: 

The physician will look for enlargement of the thyroid gland and physical findings


Blood tests: After collecting a family and medical history followed by a physical examination, the physician might ask for one or all of the below-mentioned blood tests in order to assess the presence of hypothyroidism.

  • Thyroid-stimulating hormone (TSH) test
  • Test for Total T4, T3 and Free T4
  • Thyroid antibody test (for Hashimoto disease)

(Hashimoto's disease) Hashimoto's thyroiditis treatment

(Hashimoto's disease) Hashimoto's thyroiditis treatment consists of pharmacotherapy management with hormone replacement therapy. This therapy cannot reverse Hashimoto disease, and it can help normalise hormone levels and metabolism.


Thyroid hormone replacement therapy is an effective treatment for Hashimoto disease. Synthetic thyroxine is the most commonly used thyroid hormone replacement. Once the patient's treatment has begun, the doctor may ask for a TSH test on a regular basis (6-10 weeks) to monitor thyroid function and determine the appropriate dose.


Hormone replacement therapy agents are available in various dosages. The patient’s dose will be determined based on -

  • Age
  • Weight
  • Severity of hypothyroidism
  • Other health problems

(Hashimoto's disease) Hashimoto's thyroiditis prevention

Hashimoto's disease is an autoimmune disorder caused by an immune system malfunction. There is no known way to prevent hashimoto's disease or hashimoto's thyroiditis, but a few precautions can be recommended, such as:

  • Consistent exercise
  • Self-medication should be avoided
  • Low environmental radiation exposure
  • Having a healthy diet
  • Trying to avoid smoking

Hashimoto's disease vs Hypothyroidism | Difference between Hashimoto's disease and Hypothyroidism

Elements Hashimoto's Disease Hypothyroidism
Definition It is a form of autoimmune disease in which the body's immune system malfunctions and attacks the thyroid gland. Also known as underactive thyroid, producing an insufficient amount of thyroid hormones.
Symptom Hypothyroidism is one of the symptoms of Hashimoto disease. Hashimoto disease is one of the causative factors for hypothyroidism.
Diagnostic parameters The presence of TPO antibodies in the blood signifies the presence of Hashimoto disease along with high TSH, and low T4 blood levels. A high TSH level and a low T4 level in the blood could indicate an underactive thyroid condition.

FAQs

  • Is Hashimoto disease dangerous?

    Yes, it is mainly caused by hypothyroidism. If it is not treated promptly and effectively, it can lead to some serious complications such as goiter, cardiovascular disease, mental health issues, and myxoedema.

  • Who treats Hashimoto disease?

    The general physician might not be helpful in these cases. A hormone disorder specialist, also known as an endocrinologist, will be treating Hashimoto's disease.

  • What not to eat with Hashimoto disease?

    As perthe paleo autoimmune protocol (AIP) diet, which has been promising in relieving a wide range of Hashimoto symptoms. It states that all grains, legumes, nightshades (such as eggplant and peppers), dairy, eggs, coffee, alcohol, sugar, oil, and food additives should be avoided.

  • What are the ways for hashimoto disease treatment?

    When TSH and free T4 levels are normal, treatment is unnecessary for patients with elevated TPO antibodies. Treatment for Hashimoto's disease can be accomplished with the help of thyroid hormone replacement therapy. Synthetic thyroxine taken at the right dose effectively restores normal thyroid hormone levels and alleviates the symptoms of hypothyroidism. When starting a new patient on treatment, the physician may want to check thyroid hormone levels regularly to ensure they're at the right level, based on which the doses will be adjusted.

  • How to test Hashimoto disease?

    The physician will likely order blood tests to rule out hypothyroidism as a possible cause of the patient’s symptoms.


    TSH test: High levels of stimulating thyroid hormone (TSH) in the blood indicate low thyroid hormone production because the pituitary gland sends TSH to the thyroid to increase thyroid hormone production when T4 levels fall.


    T-4 tests: If the patient’sT4 level is low with a high TSH level, it indicates a problem with the thyroid gland.


    Antibody tests: The presence of TPO antibodies (anti-TPO) in a patient’s blood indicates the presence of Hashimotodisease, asthis disease is characterised by the production of an antibody against thyroid peroxidase (TPO), a protein crucial to the synthesis of thyroid hormones.

  • What is Hashimoto-Pritzker disease?

    It is a rare disease known as congenital self-healing reticulo-histiocytosis, characterised by single or multiple disseminated skin lesions suchas red-purple or brown papules and nodules present at birth or soon thereafter.

  • How Hashimoto disease cause underactive thyroid?

    Hashimoto disease is characterised by the production of antibodies by theimmune system that targets the thyroid gland.

    • The white blood cells of the patient’s immune system accumulate in the thyroid, causing inflammation and damage to the thyroid cells and a reduction in the gland's ability to produce the necessary hormones.
    • This can lead to hypothyroidism, a condition in which the thyroid does not make enough hormones for the body's needs.

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