Hashimoto Laser Treatment

Hashimoto's Disease

The thyroid gland is a butterfly-shaped gland located in the front of our neck. It secretes T3 and T4 hormones, which are necessary for the functioning of metabolism. When the amounts of these hormones decrease, hypothyroidism occurs, and when they increase, hyperthyroidism occurs. When the hormones secreted by the thyroid gland decrease, effects such as fatigue, increased need for sleep, weight gain, hair loss, menstrual irregularity, constipation, mood changes and depression are observed.

Hashimoto's disease; The thyroid gland is attacked by antibodies created by the person's own immune system, which may result in hypothyroidism due to damage to the gland over time. Hashimoto's disease is the most common cause of underactive thyroid gland.

There are 3 stages, but these stages can be completed without causing symptoms.

• 1. Stage:Initially, antibodies damage the thyroid gland and the thyroid tissue begins to break down.cDue to the thyroid hormones mixed into the circulation, t3 and T4 increase and TSH decreases, as if the thyroid gland is working fast,
• 2. Stage: Over time, the thyroid tissue circulating in the circulation decreases and if the damage to the gland is not excessive, thyroid functions begin to return to normal. In some people, the damage is self-limiting and thyroid functions may remain normal throughout life.
• 3. Stage: Since the thyroid gland is damaged due to antibodies in circulation, it becomes unable to secrete the hormone over time and T4 decreases, TSH increases and hypothyroidism develops.

How to Diagnose Hashimoto's Disease:

Diagnosis is made by blood test and thyroid ultrasonography. TSH, ST3, ST4, Anti TP, Anti TG are checked in the blood.

The presence of Anti TPO, Anti TG elevation and heterogeneous appearance on ultrasound establishes the diagnosis of Hashimoto's.

Hashimoto Treatment:

In the conventional approach, in Hashimoto's disease, TSH, ST3, ST4 levels are monitored, medication requirements are determined and dosage is adjusted.

What is DDLT (Low Dose Laser Therapy)?

Low dose laser therapy (DDLT), which was first used in the early 1970s to accelerate wound healing, is an athermic (non-heat-emitting) and photobiological treatment method that is based on the principle of applying milliwatts of laser beam to living tissue, does not cause destruction in the applied area.

Low dose laser therapy has been used for many years for muscle and joint pain and problems due to its inflammation-reducing and blood-enhancing effects. No side effects have been reported in these applications. This dose is 1/1000th of the laser dose used in surgeries.

Low-level laser therapy is defined as a special type of laser (near infrared light (600-1100 nm)) that affects cellular biology and signaling pathways. DDLT application leads to suppression of inflammation and reduction of pain and triggers tissue regeneration. DDLT has been used for many years in various diseases such as low back pain, stroke, neurodegenerative disorders, rheumatoid arthritis and wound healing.

Recent data from studies have shown that LLLT is safe and may have beneficial effects in patients with hypothyroidism.

Hashimoto's Disease Cellular Changes

Hashimoto's thyroiditis is often characterized by infiltration of immune cells, including antigen-presenting cells, macrophages, plasma cells, and lymphocytes, in the thyroid parenchymal tissue. Immune responses lead to the production of thyroglobulin (TG) and thyroid peroxidase auto-antibodies (TPO). T cells and autoantibodies cause damage and destruction to thyroid cells.

It has also been shown that TH1 cells and their associated chemokine receptors (CXC)R3 receptor have an important role in the pathogenesis of GD. Tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) inflammatory cytokines play a role in inflammatory immune responses.

Cellular Changes of Laser Treatment in Hashimoto's Disease

DDLT, or photobiomodulation, is a non-invasive treatment that does not produce heat or vibration and uses a single wavelength of light. For treatment, near-infrared laser beam with a wavelength between 600 and 1100 nm, a power of 1-500 mW, and low energy density is used. DDLT may act at different cellular and molecular levels. LLLT at wavelengths from 632 to 1064 nm can stimulate cellular responses. Laser irradiation at a specific wavelength affects cellular biochemistry and can alter the entire cellular metabolism and cell fate. Moreover, DDLT has photo-biomodulation effects and can reduce inflammatory responses and modulate the immune system. Studies have shown that LLLT reduces inflammation, pain, and edema. LLLT can induce collagen synthesis and accelerate the tissue restructuring process.

Are There Any Side Effects of Laser Treatment?

No side effects have been observed or reported in the applications and studies carried out to date. 

Sample Laser Treatment Research

In a recent study (Erbil et al.), DDLT, thyroid functions, antibody levels and the effect of reducing or completely discontinuing hormone therapy were investigated in 350 patients with Hashimoto's disease. All 350 patients were diagnosed with Hashimoto's thyroiditis based on antibodies and/or ultrasound findings and were included in the study. 96% of the patients were women. Their mean age was 37 ± 8 years. While all patients were receiving thyroid hormone therapy (Levothyroxine-T4) due to hypothyroidism, they had normal T3, T4 and TSH levels. Those with other autoimmune diseases, those who had previously received neck radiation, and those who had thyroid surgery were not included in this study.

Hashimoto patients were divided into two groups:

• 1. group (210 patients) laser treatment and dietary support (D-Vitamin + Iron + Selenium),
• Group 2 (140 patients) received only dietary support. All patients with vitamin D levels below 40ng/dl and iron levels below 30ng/dl were given supplements. Thyroid hormone (T4) requirements of all Hashimoto patients were evaluated 3 months after the end of the study. T3, T4, TSH levels, T3 to T4 ratio (T3/T4) and thyroid antibody levels were examined and compared with pre-treatment values.

In the study, no side effects were observed due to laser treatment in any patient. In the Hashimoto group receiving laser treatment; While T3 levels, T3/T4 ratio, Vitamin-D, selenium and iron levels increased, anti-TPO antibody and weekly thyroid hormone requirement decreased significantly. In other words, the hormone needs of the patients decreased significantly. No change was seen in the other group that did not receive laser treatment.

In the logistic analysis performed as a result of the study, it was understood that laser treatment in Hashimoto's thyroiditis was 70 times effective in increasing the T3/T4 ratio and 15 times effective in reducing the dose of hormone drugs taken by the patient. It has been shown that laser treatment for Hashimoto increases thyroid functions and patients need less thyroid hormone. It is also understood that after a while, the drug can be stopped completely in some patients. This is a feature that protects patients from the osteoporosis effects of thyroid hormone medication.

Parrado and his colleagues found in a study that laser beams increased the microcirculation of thyroid tissue. Another study (Azevedo et al.) showed that laser treatment in mice supported and increased thyroid hormone levels. The T4 hormone, produced from iodine in the thyroid, turns into T3 by losing one iodine. The T3/T4 ratio indicates this conversion. This rate decreases in Hashimoto's patients. This shows us that in Hashimoto's there is a decrease in the conversion of T4 to T3, which is the active hormone. After laser treatment, this rate increases and the conversion of T4 to T3, the active hormone, also increases. This results in an increase in T3 levels.

How is Hashimoto Laser Treatment Done?

Hashimoto laser treatment can be performed on patients with high thyroid antibodies and/or findings of thyroiditis on thyroid ultrasound. Especially in patients receiving thyroid hormone therapy, laser treatment is preferred if T3, T4 and TSH are within normal limits. These are patients whose thyroid functions have declined and who have developed or are developing permanent hypothyroidism. In addition, these are patients who are candidates for using thyroid hormone (Levotroxin) for many years, and therefore side effects of this drug (such as osteoporosis) may occur. Laser treatment is not preferred in those who have another autoimmune disease, thyroid nodules, those who have received radiation therapy to the neck area, those who have had thyroid surgery, and those who have other diseases that affect thyroid metabolism. Drug doses, T3, T4 and TSH levels and thyroid antibody levels (anti-TPO) of all patients before laser treatment are recorded.

Laser irradiation Output power: 100mW, wavelength: 850Nm The laser probe is applied within the borders of the thyroid gland after the patients' neck is slightly extended. By determining the borders of the thyroid gland, 6 target points are determined. These; The upper and lower borders of the thyroid poles are the right and left of the isthmus. Low level laser beam (20.57 J/㎠) is applied to the thyroid gland at 1cm intervals. Radiant energy is applied to each application point on the skin for 20 seconds. (No Pain or Heat) It is performed as "6 Sessions" in 3 days in total. (or 6 sessions are completed within 1 month in total. The total dose is 96-J. The laser device is calibrated after each session. Since it is a low-level (dose) laser, it does not have any side effects.

Who Can Get Laser Treatment for Hashimoto's Disease?

Patients that can be included in the laser treatment program in Hashimoto's thyroiditis alarm; These are patients with high thyroid antibodies (anti-TPO) and/or findings of thyroiditis on thyroid ultrasound and who are taking medication (thyroid hormone), T3, T4 and TSH levels are within normal limits. It is the right approach to start laser treatment, especially for Hashimoto patients who have been using medication for a long time. Laser treatment for Hashimoto's; It is not applied to people with other autoimmune diseases, those who have had radiation therapy to their neck, those who have had thyroid surgery, and those with thyroid nodules.

Things to Consider After Treatment

Laser treatment for Hashimoto does not have any side effects. There are no special restrictions after treatment. If supplements and vitamins are given, they should be taken without interruption. Regular daily walks or other sports (exercise) are recommended. If the patient smokes, it is recommended to reduce or quit smoking. Approximately after 2 months, the patient should have T3, T4, TSH and antibody tests done, share them with the treating physician and go for routine check-ups.