Hashimoto's Thyroiditis is a condition that affects a significant number of people around the world. According to some estimates, about 15% of people in the United States take thyroid hormone on a regular basis. Of those patients, the majority have Hashimoto's thyroiditis. So what is it, and how does it affect your thyroid?
Hashimoto's Thyroiditis is an auto-immune condition in which your body attacks your thyroid. It is more common among those with a family history of thyroid problems, and Hashimoto's disease makes it more likely that a person will develop thyroid cancer. It is similar but different to other autoimmune conditions that affect the thyroid, such as Graves' disease: where Graves' disease stimulates the thyroid to release too much thyroid hormone, Hashimoto's slowly kills the thyroid so that it eventually stops working.
It should be noted that there are other reasons that the thyroid might not work well, but these are thought to be less common. These would usually be thought of as intrinsic thyroid problems, or problems that don't involve the immune system.
For most people, the diagnosis of WHY the thyroid isn't working is less important than knowing that it's not working. But this DOES vary from patient to patient, and working with your doctor over time is the most important thing to know what is right for you. It is also important to remember that the symptoms of perimenopause and Hashimoto's thyroiditis are very similar. It can be hard even for doctors to differentiate which is causing symptoms, and so we tend to be cautious because we know that the risks of overtreating can be significant.
In addition to affecting thyroid function, Hashimoto's can have a significant impact on the quality of life of patients who it afflicts. The impact can be far ranging, affecting everything from energy levels to libido to hair loss to eyebrows to weight gain to mood and many more things. It is also important to know that some of these impacts can be felt before the labs necessarily show that damage is being done to the thyroid. Checking labs over a period of years can often give doctors critical information about trends and help them know when to intervene.
So what do you do about Hashimoto's disease? This is a complicated question. While many people with Hashimoto's disease never need any treatment, it is common that a significant percentage of patients will ultimately need some supplemental thyroid hormone. The timing and the dosing of this is critical, however, as too much thyroid hormone too quickly can increase the risk of significant long term effects such as osteoporosis or even heart disease. Either of those can shorten your life over time.
Another thing that you CAN do even before you require thyroid hormone is to optimize your overall wellness. Weight loss is a critical step to decrease overall inflammation in your body. Exercise can likewise play a significant role. For some people, adding nutrients such as selenium or iodine can be necessary (although deficiency in these nutrients is very rare in the United States). For others, there may be other chronic conditions that are contributing.
There is one specific aspect of Hashimoto's disease that sometimes becomes a surgical problem: There are some patients with very advanced Hashimoto's who feel significant compressive symptoms in their neck. They might have a hard time swallowing or even feel that their neck is sensitive to the touch (some people can't wear a necklace or a turtle neck shirt due to this sensitivity). For these patients, there is some research that suggests that they may achieve symptomatic improvement with thyroid surgery. At the Russell Center, we usually don't recommend this as a first step for patient's with Hashimoto's, but it can be a valuable treatment for some people. Usually, we would start with the minimal amount of surgery (a hemithyroidectomy) before we would remove the entire thyroid, because the risks are lower and removing half is usually sufficient. This can usually be done without a scar.
While all of these things can play a role in helping your condition, it is important to realize that for most people, Hashimoto's thyroiditis is a condition that slowly progresses over time because it has a genetic predisposition. You should not feel shame or guilt if you can't make your thyroid hormone levels perfect. You also should not feel shame or guilt if you need to take some additional thyroid hormone. The goal of any treatment is to improve your overall well being. Continue to make healthy changes and work with your doctor to find the path forward that gives you the best endocrine health.
