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Hashimoto's: What you should know about the disease!

Hashimoto's thyroiditis (Hashimoto's for short) is a chronic inflammation of the thyroid gland. It is named after the Japanese doctor Hakaru Hashimoto, who first described the disease in 1912. Hashimoto's is caused by the body's own immune system and is therefore one of the autoimmune diseases. The defence system produces antibodies against the body's own thyroid cells (thyrocytes) and destroys the tissue. As a result, not enough thyroid hormones are produced, leading to underactive thyroid (hypothyroidism). As the process is gradual, Hashimoto's often goes unnoticed for years. The disease is not considered curable, but can be treated well. Once the diagnosis has been made, those affected usually have to take thyroid hormones to replace the body's own hormone production that is lacking.

Experts suspect that there is a genetic predisposition to the disease. Other triggers for the development of Hashimoto's thyroiditis include leaky gut syndrome, viral diseases (e.g. glandular fever), gluten intolerance or nutrient deficiency (e.g. vitamin D deficiency). Certain foods such as soya or cabbage are also under discussion. These contain active ingredients that have a goitrogenic effect and can therefore trigger an enlargement of the thyroid gland. However, those who do not consume excessive amounts of cabbage or soya every day need not worry about this. The role of iodine in the development of thyroid disorders is a major topic of controversy. The question of whether too little or too much iodine is more harmful remains unanswered. In the case of Hashimoto's thyroiditis, however, most experts agree and do not recommend that patients take additional iodine tablets.

Underactive thyroid: are you affected?

The butterfly-shaped thyroid gland is located in the neck area, below the larynx and in front of the windpipe. Its main function is to store iodine and produce the two iodine-containing hormones triiodothyronine (T3) and tetraiodothyronine (T4, tyroxine) as well as the hormone calcitonin. The latter regulates the calcium balance and inhibits, for example, the release of calcium and phosphate from the bones. T3 and T4 play a central role in energy metabolism and growth processes. In the case of hypothyroidism, the thyroid gland produces too few hormones and the metabolism slows down. A typical symptom is therefore unexplained weight gain and a drop in performance. The consequences are particularly serious when a lack of hormones occurs in children and adolescents. This can lead to physical and mental developmental delays (cretinism).

Typical symptoms of hypothyroidism

  • Weight gain
  • Constantly feeling cold
  • Fatigue and listlessness
  • Hair loss
  • Dry skin
  • Muscle weakness
  • Concentration disorders
  • Depressive mood
  • Chronic constipation
  • Cycle, libido and erectile dysfunction

Hashimoto's is not always the cause of hypothyroidism. An extreme iodine or selenium deficiency, interactions with medication or a malfunction of the pituitary gland (hypophysis) can also cause hypothyroidism.

In addition, it should be noted that Hashimoto's thyroiditis can initially lead to hyperthyroidism. This manifests itself in exactly the opposite symptoms, e.g. weight loss, sleep disorders or nervousness.

How do you recognise Hashimoto's thyroiditis?

A blood test provides information on whether the thyroid gland is underactive or overactive. Firstly, the hormone TSH (thyroid-stimulating hormone) is determined. It is secreted by the pituitary gland and stimulates the thyroid gland to produce hormones. Normally, an increased release of TSH therefore leads to increased production of T3 and T4. If the TSH value is within the normal range, everything is fine. If TSH values are too high, the two thyroid hormones triiodothyronine and thyroxine are also analysed in their free form (fT3 and fT4), as only they are biologically active. The majority of the hormones released into the blood are bound to proteins and are inactive.

In Hashimoto's, the blood levels of thyroid hormones are low, but the TSH level is high. The onset of hypothyroidism is indicated when TSH levels are elevated despite normal hormone levels. However, a blood count test is not always sufficient. In addition, an ultrasound examination of the thyroid gland (sonography) is therefore often carried out. The antibodies produced by the body can also be detected in the blood. However, the values fluctuate considerably over the course of the disease and do not allow any direct conclusions to be drawn about thyroid function.

Diagnosis of Hashimoto's: what you need to be aware of

An autoimmune disease rarely comes alone. Hashimoto's is no exception and can be associated with numerous other diseases. Typical examples include the skin disease vitiligo (white spot disease), coeliac disease (gluten intolerance) and type 1 diabetes mellitus. vitamin B12 deficiency and, as a result, a reduction in red blood cells (pernicious anaemia). This is caused by chronic inflammation of the gastric mucosa and the formation of antibodies against a protein (intrinsic factor), which is formed in the stomach and required for the absorption of vitamin B12.

Selenium is another micronutrient that is important in Hashimoto's thyroiditis. The trace element is involved in the conversion of thyroid hormones. A deficiency can therefore exacerbate the symptoms. Vegetarians and vegans in particular often consume too little selenium in their diet and should have their blood levels checked regularly.

A study published in 2017 also showed that an underactive thyroid doubles the risk of cardiovascular disease. Those affected should therefore have their thyroid levels checked regularly.