Hashimoto's disease is achronic disease of the thyroid gland. Experts also refer to it as thyroiditis, autoimmune thyroiditis or Hashimoto's thyroiditis, which describes the autoimmune, inflammatory pathology of the disease.
An immune system disorder in which autoantibodies are directed against the thyroid tissue leads to inflammation.
Those affected hardly notice Hashimoto's thyroiditis in the early stages. The progressive, subclinical inflammation leads to the destruction of thyroid tissue over time.
Thyroid hormones are no longer produced in sufficient quantities, which is why symptoms of an underactive thyroid (hypothyroidism) occur. A severe flare-up of inflammation can lead to a short-term overproduction of hormones and an overactive thyroid (hyperthyroidism).
If the thyroid gland atrophies due to chronic inflammation, the body lacks important hormones @ Dr_Microbe /AdobeStock
As the exact cause of Hashimoto's disease is not known, there is no causal therapy.
The goals of Hashimoto's treatment are:
- Inhibition of inflammation to slow down the destruction of the organ and
- Replacement of thyroid hormones (hormone therapy) in the event of reduced hormone production and symptoms of hypothyroidism.
The doctor prescribes drug therapy for both.
When functioning normally, the thyroid gland produces the hormone thyroxine (T4), which the body converts to thyronine (T3). Those affected take synthetic levothyroxine (L-thyroxine) in tablet form. The synthetic substance is very similar to the T4 produced by the thyroid gland.
In order to regulate the hormone system permanently, daily intake of the tablets is often necessary for life. Correct adjustment is important, so the doctor must check the values regularly.
Normally, the doctor will adjust the TSH (thyroid stimulating hormone) value. In the case of hypothyroidism, the T4 is usually too low and the TSH value too high. During therapy, the ratio should be reversed so that the T4 value increases to the reference range and the TSH decreases. Avoid too high a dose of levothyroxine, as this can lead to bone loss and cardiac arrhythmia.
Thyroid diagnostics are used to classify the symptoms and assess the thyroid condition.
This includes
Examination of the thyroid gland using ultrasound @ Kalim /AdobeStock
In most cases, it is possible to control symptoms and regulate hormones and metabolism with levothyroxine therapy. If there is no improvement, the doctor may consider a combination therapy of levothyroxine and triiodothyronine (T4 and T3).
Although inflammation relief and hormone adjustment are possible, it is difficult to stop Hashimoto's. Alternative medicine methods work with additional selenium supplementation to regulate the immune processes.
The first treatment check is usually carried out two to six weeks after the start of therapy. Depending on the blood values (TSH, free T4, free T3), the doctor may adjust the dosage. After successful adjustment, further check-ups during Hashimoto's treatment consist of blood value measurements and ultrasound examinations. These are carried out at intervals of six or twelve months. In the blood tests, the doctor looks at the hormones and thyroid antibodies (TPO-AK, Tg-AK).
An increase in autoantibodies can mean a flare-up of the inflammation. The doctor uses thyroid ultrasound to check the structure and size of the thyroid gland. Changes in echogenicity can also indicate inflammation.
Enlargement may be indicated by hyperfunction. The thyroid gland can shrink if the disease progresses, if tissue is destroyed or if it is underactive.
During Hashimoto's treatment with L-thyroxine, it is important to ensure that there are no interactions with other medications, food supplements or foods.
Certain preparations and some foods inhibit the absorption of the hormone. Patients must therefore take them every four hours. Normally, the doctor recommends taking levothyroxine on an empty stomach about half an hour before breakfast.
Preparations and foods that interfere with absorption:
- Soy products and high-fiber diets
- Iron, calcium or multivitamin supplements
- Acid blockers and sucrabest
- Cholesterol-lowering medication
You should alsoavoid excessive iodine intake so as not to increase the inflammatory reaction. The iodine that
ingested with food has hardly any influence. Supplementation in the form of tablets, on the other hand, is harmful.
During Hashimoto's treatment, also pay attention to the symptoms of an underactive or overactive thyroid . These are signs that the doctor needs to readjust the L-thyroxine dose. As this is an immune system disorder, it is possible that other organs may also be damaged. You should therefore have yourself tested for other autoimmune diseases if you have symptoms so that treatment can be initiated at an early stage.
Levothyroxine therapy has hardly any side effects. Sometimes hypersensitivity reactions to the excipients in the preparations occur. The doctor then prescribes L-thyroxine from another manufacturer. Symptoms of hyperthyroidism can occur as a complication of treatment if the dose is too high.
Hormone supplementation and a balanced diet, which have a positive effect on inflammatory processes, slow down the progression of the disease. However, even if the thyroid gland loses its function completely, hormone supplementation makes a normal quality of life possible.
The aim of Hashimoto's treatment is to reduce inflammation in the thyroid gland and to replace thyroid hormones in cases of hypothyroidism. Selenium supplementation also alleviates the autoimmune process that causes tissue destruction.
The endocrinologist or internist usually prescribes levothyroxine as a hormone replacement preparation, which allows hormone levels to be well adjusted. Anti-inflammatory medication is used for severe inflammatory reactions. A healthy diet helps to regulate the inflammatory processes.
