Hashimoto's Thyroid

The term thyroiditis means inflammation of the thyroid gland. There are many possible causes of thyroiditis.

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism overall. It is an autoimmune disorder in which antibodies against the thyroid gland cause chronic inflammation. Autoimmune diseases are disorders in which the immune system perceives the body's own tissue as foreign and attacks it. In Hashimoto's thyroiditis, these antibodies attack our own thyroid tissue.

What are the symptoms of Hashimoto's Thyroiditis?

In Hashimoto's thyroiditis, due to the attack on the thyroid tissue of the patients in the early stages, the thyroid cells begin to break down and the thyroid hormone passing into the blood begins to increase. Depending on the amount of this attack and destruction, symptoms of hyperthyroidism (palpitations, weakness, irritability, weight loss) vary from person to person and often go unnoticed. Over time, due to damaged thyroid tissue, thyroid hormone synthesis decreases and people become hypothyroid; (weakness, lethargy, intolerance to cold, intestinal laziness, pale and dry skin, facial swelling, nail brittleness, hair loss, tongue enlargement, unexplained weight gain, muscle pain, tenderness, stiffness, joint pain and stiffness, muscle weakness, excessive and prolonged It comes with complaints such as menstrual bleeding or other menstrual irregularity, depression, memory problems, decreased exercise tolerance.

What are the Causes of Hashimoto's Thyroiditis?

Hashimoto's thyroiditis is an autoimmune disease in which the immune system develops antibodies that damage the thyroid gland. It is still not known exactly what triggers this process. Some research suggests that a virus or bacteria may trigger this response. Genetic predisposition also plays a role. However, the main factors behind the increase in Hashimoto's disease today are the increase in the toxic load of our body due to GMO and additive-containing nutrition and environmental factors.

What are the Risk Factors of Hashimoto's Thyroiditis?

Risk factors that trigger the development of Hashimoto's thyroiditis can be listed as follows:

• Gender: Hashimoto's thyroiditis is more common in women.
• Age: Although it is seen at all ages, it is more common in middle age.
• Genetics: People with family members who have thyroid or other autoimmune diseases are more likely to develop Hashimoto's thyroiditis.
• Other autoimmune disease: Having another autoimmune disease such as Vitiligo, Celiac, Rheumatoid arthritis, Ankylosing Spondylitis, Psoriasis, type 1 diabetes or lupus increases the risk of Hashimoto's thyroiditis.
• Radiation exposure: Excessive exposure to environmental radiation increases the risk of developing Hashimoto's thyroiditis.

How is Hashimoto's Thyroiditis Diagnosed?

Hashimoto thyroiditis is diagnosed with some blood tests and thyroid ultrasonography:

• Hormone test: Blood tests can determine the amount of thyroid hormones produced by the thyroid gland and pituitary gland. If the thyroid gland is working slowly, thyroid hormone levels will be low. At the same time, the TSH level also increases as the pituitary gland tries to stimulate the thyroid gland to produce more hormones.
• Antibody test: Since Hashimoto's thyroiditis is an autoimmune disease, abnormal antibody production is characteristic. A blood test may indicate the presence of antibodies to thyroid peroxidase (TPO antibodies), which play an important role in the production of thyroid hormones. Another antibody that is less specific but is often found to be high is anti-thyroglobulin (anti-Tg) antibody.

Thyroid Ultrasonography: The most common thyroid gland is diffusely enlarged and has heterogeneous parenchymal echogenicity.

What Methods Do We Use in the Treatment of Hashimoto's Thyroiditis?

The stage of Hashimoto's disease is a very important factor here. Many of our patients come with a diagnosis of hypothyroidism and have been using medication for years, and they come to see if their disease can be treated; Our goal here is to find the cause of the person's autoimmunity and organize the treatment accordingly, to improve the quality of life and to ensure that the body can use the medicine it takes functionally. During this process, medication doses may be reduced for some of our patients, and medications may be discontinued for others. However, if the disease has existed for a very long time and the thyroid tissue is very damaged, this may not be possible.

Only in patients presenting with antibody positivity, drug use and additional autoimmune diseases that may be added in the future can be prevented.

In the treatment of Hashimoto's disease, while preparing personalized nutrition, exercise, vitamins and minerals, the methods of coping with the stress factor that exists at every moment of our lives are also determined individually.

These are the basis of treatmentWhile creating; In treatment, we can perform complementary practices (acupuncture, ozone therapy, iv treatments (glutathione, alpha lipoic acid, vitamin C, cupping) that strengthen our hands and accelerate the process.

Treatment with Synthetic Hormones

If Hashimoto's thyroiditis causes thyroid hormone deficiency, replacement therapy with thyroid hormone may be required. This is usually administered through daily use of the synthetic thyroid hormone levothyroxine.  Synthetic levothyroxine is similar to thyroxine, the natural version of the hormone produced by the thyroid gland. With oral administration, it provides adequate hormone levels and relieves all symptoms of hypothyroidism.

Monitoring Drug Dosage and Things to Consider Before Testing

In order to determine the correct dosage of levothyroxine at the beginning, TSH, ST3, ST4  level is checked.

When levothyroxine is used at the appropriate dose, no significant side effects are expected  It is a low-cost medicine.

Levothyroxine is the synthetic form of natural T4. T4 is converted to T3 in the body. While most patients are successfully treated with levothyroxine alone, some patients' complaints do not fully improve with levothyroxine. In this case, adding a small amount of T3 to standard T4 treatment may be beneficial, but dose adjustment is a very sensitive process and is done mostly with symptom control.

In our patients using T3, T3 preparation should be discontinued 48 hours before thyroid function tests are checked, and levothroxine should be discontinued 24 hours before.

Things to consider when using levothyroxine:

It should be taken in the morning on an empty stomach, then fast for at least one hour and supplements containing calcium, iron and magnesium should not be used within 4 hours.

Hashimoto and Nutrition

In Hashimoto's thyroiditis, which is an autoimmune disease, the use of foods that we know to stimulate autoimmunity, especially gluten, should be limited, plenty of seasonal vegetables should be consumed and brassicas should not be avoided. (Cabbages have an iodine-binding effect and can cause enlargement of the thyroid gland, but this is only observed when consumed in very high amounts.)

Is Selenium Supplementation Helpful in the Treatment of Hashimoto's Thyroiditis?

Selenium is the cofactor of the thyroid peroxidase (TPO) enzyme in the thyroid hormone synthesis steps. In Hashimoto's thyroiditis, antibodies are formed against this enzyme. Many studies have shown that selenium supplementation can reduce these antibody levels.

Iodine Use in Hashimoto's Thyroiditis Patients

Excessive iodine exposure may deepen hypothyroidism by increasing antibody levels and increasing thyroid gland damage in Hashimoto's thyroiditis. However, this can happen with high intake of iodine. There is no need to restrict iodine or use non-iodized salt in patients unless they have hyperthyroidism. Daily iodine needs must be met; You should continue to use iodized salt.

Iodine supplements should be taken under doctor's supervision by monitoring the deficiency.

What Should Be Considered During Pregnancy Follow-Up in Women with Hashimoto's Thyroiditis?

The first three months of pregnancy is a critical period in which a significant part of the development of the fetus's organs and systems takes place. In this process, thyroid hormone is an absolute requirement and this need of the fetus is met by the hormones of the mother. A woman with Hashimoto should start this process ready. This is only possible by being under the control of the relevant specialist physician from the moment the pregnancy is planned. Target TSH, st4, st3 value will change. This goal should be achieved before pregnancy. The dose of the patient using medication may vary. Those who do not use medication may need to start medication. Therefore, a sensitive follow-up process will be required from the moment the pregnancy is planned until the end of the pregnancy.