Inflammation of the thyroid gland (Hashimoto’s thyroiditis)

Inflammation of the thyroid gland (known medically as thyroiditis) is fortunately extremely rare. In most cases, an autoimmune disease – such as Hashimoto’s thyroiditis – is the cause of an inflamed thyroid gland.

The medical term ‘autoimmune disease’ describes any malfunction of the immune system in which the body attacks its own structures, i.e. cells and organs. The autoimmune disease Hashimoto’s thyroiditis (the most common form of thyroid inflammation) leads to a chronic disease of the thyroid gland, which means that the organ no longer produces enough hormones.

Symptoms

Causes

Diagnosis

Treatment

Aftercare

FAQs

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Two progressive forms

In the course of this autoimmune disease, the body’s own immune system attacks the thyroid gland. Patients develop ‘autoantibodies’ (antibodies that target the body’s own healthy tissue), which destroy the thyroid gland by breaking down its proteins. It is crucial to distinguish between clinical cases, i.e. Hashimoto’s thyroiditis, which presents with symptoms, and cases in which autoantibodies are detected in the blood but the patient does not have any symptoms of a thyroid disorder.

There are two forms of Hashimoto’s thyroiditis:

the classic form, in which the thyroid gland becomes enlarged and forms a goitre, impairing its function, and
the atrophic form, whereby the thyroid tissue is destroyed and the organ eventually dies

In medicine, the atrophic form of Hashimoto’s thyroiditis is diagnosed more often than the classic form. Hashimoto’s disease results in hypothyroidism. Hashimoto’s thyroiditis is extremely common and mostly occurs between the ages of 30 and 50. It occurs much more frequently in women than in men.

Symptoms

Symptoms rarely occur in the early stages of the disease, which is why the disease is often diagnosed at an advanced stage. This is usually the case if Hashimoto’s thyroiditis leads to an underactive thyroid (known medically as hypothyroidism). This also makes the following symptoms more noticeable:

apathy and disinterest
exhaustion
constant fatigue
difficulties with concentration
memory problems
hoarseness
hypersensitivity to cold
constipation
brittle hair and increased hair loss
dry skin and brittle nails
menstrual disorders and reduced fertility
weight gain despite consistent eating habits
increased blood values

At the onset of the disease, other symptoms associated with temporary hyperthyroidism may also occur (hashitoxicosis):

nervousness and restlessness
irritability and mood swings
palpitations, racing pulse or cardiac arrhythmia
high blood pressure
clammy skin
increased sweating

Causes

Hashimoto’s thyroiditis is an autoimmune disease in which the body starts to produce autoantibodies against thyroid proteins for unknown reasons, resulting in an inflamed thyroid gland. This inflammation destroys the cells of the thyroid gland that are responsible for producing the two vital thyroid hormones T3 and T4. Subsequently, the affected thyroid gland no longer produces enough hormones, resulting in hypothyroidism.

Hashimoto’s thyroiditis often occurs in members of the same family, suggesting that genetic mutations may be responsible for this type of thyroid inflammation. In addition, certain infections or stress can increase the likelihood of developing Hashimoto’s thyroiditis, as can excessive iodine consumption and smoking.

Gender also plays a role in Hashimoto’s disease, as in some cases the autoimmune disease is thought to be triggered by female oestrogens.

Diagnosis

Every medical diagnosis begins by ascertaining the patient’s medical history. This is followed by a physical examination. The doctor will then arrange for a blood test to detect any thyroid dysfunction. The main purpose of the blood test is to measure the concentration of the thyroid hormones T3 and T4 and the THS level.

The blood is also tested for autoantibodies that attack the thyroid proteins, as these are characteristic of Hashimoto’s disease.

The final examination used to diagnose Hashimoto’s disease is usually a sonography or ultrasound. If the ultrasound shows that the thyroid gland is smaller than normal and also has a uniformly dark structure, this would indicate the presence of Hashimoto’s thyroiditis.

As patients with Hashimoto’s disease have a slowed metabolism, the doctor can also verify their diagnosis with the help of thyroid scintigraphy. Thyroid scintigraphy is a nuclear medical examination of the thyroid gland, which makes it possible to visualise not only its shape, position and size, but also the function of the thyroid gland.

Last but not least, the doctor may also use a fine-needle biopsy (FNB) to take a tissue sample from the thyroid gland and have it examined for the concentration of white blood cells, as patients with Hashimoto’s disease have significantly more white blood cells in their tissues than healthy people.

Treatment

In principle, it should be noted that there is no treatment available that can successfully combat the cause of thyroiditis. However, any symptoms that originate from the underactivity of the thyroid gland caused by Hashimoto’s disease can be treated with medication. Patients take tablets containing the artificial hormone L-thyroxine. This functions the same way as the thyroid hormone T4, and is converted into the more metabolically active hormone T3 in the body.

If Hashimoto’s disease results in an enlargement of the thyroid gland (a goitre), the thyroid gland is surgically removed, either partially or entirely.

Excessive iodine consumption may have an impact on the development of Hashimoto’s thyroiditis and may also have a negative influence on the course of the disease, which is why people with Hashimoto’s thyroiditis should be careful not to ingest too much iodine.

Aftercare

It is difficult to predict the exact course of Hashimoto’s disease. As this autoimmune disease rarely resolves on its own, regular monitoring of thyroid hormone levels is essential.

In addition, the destruction of the thyroid tissue caused by the inflammation cannot be reversed, which means that hypothyroidism caused by Hashimoto’s thyroiditis requires the patient to take thyroid hormones for the rest of their life.

FAQs

What characterises thyroid inflammation (known medically as thyroiditis)?

Thyroiditis causes inflammation of the thyroid tissue. It can be triggered by various factors. The resulting symptoms can occur suddenly (acute), within weeks (subacute) or slowly and persistently (chronic).

Forms of acute thyroiditis include suppurative (bacterial) thyroiditis and nonsuppurative thyroiditis, which may occur after injury or radiation/radioiodine therapy.
Forms of subacute thyroiditis include de Quervain thyroiditis, which occurs after a viral infection, or silent thyroiditis. The latter is a painless autoimmune inflammation of the thyroid gland that typically develops after childbirth and tends to go away on its own.
Types of chronic thyroid inflammation include, for example, Hashimoto’s thyroiditis, Graves’ disease, postpartum thyroiditis (thyroiditis occurring after pregnancy) or drug-induced thyroiditis.

How is Hashimoto’s disease treated during pregnancy?

As the need for hormones increases during pregnancy, doctors will closely monitor the thyroid levels in the expectant mother’s blood and adjust the dose of L-thyroxine tablets accordingly, which is essential for the normal development of the unborn child.