October 24, 2024 • 11 mins
Hashimoto’s Thyroiditis: What is it? What are the symptoms? How do we treat it? In this episode we will explore the history of Hashimoto’s disease, discuss how it’s diagnosed, and highlight important considerations following a diagnosis. Tune in to find out more!
Check out our website: https://anatomyofillness.com/
Support us on Buy Me a Coffee: https://buymeacoffee.com/anatomyofix
Resources:
American Thyroid Association: https://www.thyroid.org/
British Thyroid Foundation (UK): https://www.btf-thyroid.org/
Australian Thyroid Foundation: https://thyroidfoundation.org.au/
References:
https://www.mp.pl/paim/issue/article/16222/
https://onlinelibrary.wiley.com/doi/full/10.1007/s00268-008-9485-0?saml_referrer
https://pmc.ncbi.nlm.nih.gov/articles/PMC3569966/
https://thecenterforskinandthyroid.com/dr-bishops-blog/f/the-story-of-hashimotos-thyroiditis
https://my.clevelandclinic.org/health/diseases/17665-hashimotos-disease
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/diagnosis-treatment/drc-20351860
https://www.health.com/condition/thyroid/celebrities-with-thyroid-disorders
https://www.thyforlife.com/gigi-hadid-hashimotos/
https://thyroidfoundation.org.au/Hypothyroidism-&-Hashimotos-Disease
https://www.thyroid.org/hashimotos-thyroiditis/
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/
https://www.nm.org/healthbeat/healthy-tips/7-facts-about-your-thyroid
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Recently, you have been feeling exceptionally drained, to the point where you have even
(00:04):
fallen asleep at your desk while attempting to complete your homework.
Despite not changing your diet or your workout routine, you've also noticed an unexpected
increase in your weight.
But even more peculiar is the swelling in your neck, a mystery you've brushed aside
as just another symptom of your weight gain.
Strangely, you've also started to feel unusually cold, even in the middle of summer.
And then there's the hair loss.
(00:24):
Every time you run your fingers through your hair, clumps come away in disheartening handfuls.
With a growing sense of unease you confide in your mother, who sensing the urgency in
your voice, books a doctor's appointment.
(00:50):
Hello and Welcome to Anatomy Of Illness.
Today's episode is about Hashimoto's Thyroiditis.
Before we get into the condition, we are going to start with the history.
So why do we know Hashimoto's Thyroiditis exists?
I may also refer to the condition as Hashimoto's Disease.
We begin in 1912 with Dr. Hakaru Hashimoto.
He published the case of a woman who had undergone a thyroidectomy.
(01:10):
So a removal of the thyroid.
Dr. Hashimoto looked at this thyroid tissue under the microscope, and in his paper on
her case called the condition Struma Lymphomatosa.
However, this article was mostly ignored by the medical community at the time, apart from
the occasional controversy with comparisons between it and the early phase of Riedel
thyroiditis.
This did lead to much negativity directed towards Dr. Hashimoto.
(01:33):
This is evident in 1922, as there was a review on chronic thyroiditis done by Reist.
This essentially stated that Hashimoto's was not a separate condition.
In 1931, Graham and McCullagh would use the term Hashimoto's to describe Struma Lymphomatosa.
They would argue that it was in fact a distinct condition to Riedel's thyroiditis.
In 1939, Cecil Joll, who was a prominent British thyroid surgeon at the time, he began to use
(01:57):
the term Hashimoto's disease.
He used this term in his writings about the condition.
Sadly, Dr. Hashimoto would not see this day, as he had passed away from intestinal typhus
back in 1934, so five years earlier.
In 1951, Helwig proposed his theory of colloidophagy.
So this was when macrophages, which are part of the immune system, these normally engulf
or eat dead cells, but in this case he was suggesting that these macrophages were engulfing
(02:21):
damaged colloids.
This caused them to release the hormones contained inside of them.
This would then attract lymphocytes into the thyroid, which is another type of white blood cell.
These mainly worked to kill viruses, bacteria, cancer cells, and infected cells.
This was due to their late 1920s observations in rodents, and later observations in humans.
In the early 1950s, the understanding of autoimmunity and the field of autoimmunity began to come
(02:46):
into existence.
So we began to understand that our body's defenders could also be our body's attacker
in some cases.
In 1956, an animal model was developed.
This allowed for a better understanding at the time of what was going on.
It also allowed for the dispelling of several different theories of what could have caused
this condition.
And in 1971, genetic predispositions were found that could lead to Hashimoto's thyroiditis.
(03:09):
So what actually causes Hashimoto's thyroiditis?
Hashimoto's thyroiditis, or Hashimoto's disease, is an autoimmune disease.
So in this condition, the immune system makes antibodies that target the thyroid cells.
This leads to a large number of white blood cells, known as lymphocytes, building up in
the thyroid.
This then causes inflammation, which is known as thyroiditis, leading to damage of the thyroid.
(03:29):
This can lead to hypothyroidism, which is low thyroid hormones.
This however is not present in every person with Hashimoto's.
What are some risk factors for developing Hashimoto's thyroiditis?
There are several risk factors that are involved with developing Hashimoto's.
These include family history.
Being a family member with Hashimoto's or another form of thyroid disease, you have
(03:49):
a higher risk of developing Hashimoto's disease.
It is believed that 80% of your risk for developing the condition comes from genetics.
Sex.
Women are 10 times more likely to develop Hashimoto's disease than men.
Age.
As you age, your risk of developing Hashimoto's and other thyroid diseases increases.
Having other autoimmune conditions.
If you have another autoimmune condition, your risk for developing Hashimoto's increases.
(04:13):
Examples of these are lupus, type 1 diabetes, coeliac disease and Addison's disease.
These have all been covered in previous episodes.
Other autoimmune diseases can increase your risk as well.
How do we test for Hashimoto's thyroiditis?
A doctor will first start with a physical examination.
This includes looking at the thyroid.
To do this, they will have to feel the area of the thyroid.
Palpating the area of the thyroid will allow them to feel if the thyroid feels bigger or
(04:36):
if there may be nodules that are quite large on the thyroid.
After this, if a doctor suspects something due to the symptoms, they will request some
blood tests.
These include thyroid stimulating hormone test.
So this is the hormone that encourages your thyroid to produce thyroxine, also known as
T4.
If this is high, then this may indicate low levels of thyroxine.
This is due to negative feedback.
(04:57):
Normally when there is a large amount of thyroxine in the body, this inhibits the production
of the hormone that stimulates the release of thyroid stimulating hormone.
This is a negative feedback loop.
This prevents the hormones in the body from getting too high.
Free thyroxine test.
Low levels of this can indicate hypothyroidism.
Again, this means low levels of thyroid hormones.
(05:18):
Anti-thyroid antibody test.
These are antibodies that can point to a cause of hypothyroidism, this being Hashimoto's
disease rather than an iodine deficiency.
These three are all simple blood tests that can be easily done.
A doctor may also request that they do an ultrasound on the neck.
This is to check the thyroid for nodules or growths.
A combination of these tests will be done to ensure a better picture of what is going
(05:39):
on so a doctor can provide the correct diagnosis.
We will get right into the symptoms and presentation right after this little break.
If you have been enjoying this episode, you can check out the notes on our Buy Me A Coffee.
What symptoms might you have if you had Hashimoto's thyroiditis?
(06:06):
Symptoms can vary from person to person and can also vary with how long you've had Hashimoto's
disease.
Some of the more common symptoms of the condition are having a goiter.
This is an enlarged thyroid.
This is normally a lump in the lower neck and can create a sense of fullness in the
area.
It may also make your neck look swollen.
Normally this is not painful.
You may also have fatigue, lethargy and excessive sleeping.
(06:27):
Weight gain, constipation, dry skin.
You may also feel cold all the time.
You can also have bradycardia which is a slower than normal heart rate.
Joint stiffness and muscle pain.
Your hair may also be affected.
It may be dry or brittle.
It may grow slowly or you may have hair loss.
You may also have low or depressed moods.
Your eyes may be puffy or you may have a puffy face.
(06:50):
You may also have difficulty concentrating or have issues with your memory.
You may also struggle with infertility.
This is for both men and women.
You may also struggle with libido, so sex drive.
And for women you may also have irregular or heavy periods.
What are some of the things a doctor should be aware of if their patient has Hashimoto's
disease?
Some complications a doctor should be aware of are high cholesterol, also known as hypercholesterolemia.
(07:15):
This is normally if the condition is poorly controlled.
Goiter.
This is the enlargement of the thyroid in the lower part of the neck.
If this is not caught it may cause issues with swallowing and breathing.
Heart problems.
Hashimoto's thyroiditis can lead to poor heart function.
This may be abnormal heart rates, heart disease and heart failure.
(07:35):
Sexual and reproductive dysfunction.
So this can be reduced libido and sexual desire, an inability to ovulate, irregular and heavy
menstrual bleeding, as well as for men low sperm count and erectile dysfunction.
There may also be pregnancy complications.
For those who have hypothyroidism during pregnancy, there is an increased risk of several complications.
(07:55):
These include an increased risk of miscarriage and preterm birth.
These babies also have an increased risk of developmental delays.
Myxedema.
This is a rare and uncommon condition that occurs when hypothyroidism is left untreated.
This normally presents with extreme drowsiness and lethargy and can lead to a coma and even
death.
This can be brought on by exposure to cold and sedatives in those with untreated hypothyroidism
(08:18):
or Hashimoto's disease.
Another thing doctors should be aware of is interactions with medications.
There are some foods and medications that can affect how certain medications like levothyroxine
are absorbed.
These include soy products, high fibre foods, iron supplements or multivitamins containing
iron, calcium supplements, certain anti-acids and also medications, and some types of high
(08:40):
blood pressure medications.
These may need to be taken at a separate time to not affect the absorption of thyroxine.
How do we treat Hashimoto's thyroiditis?
We normally manage Hashimoto's thyroiditis through the use of synthetic hormones to replace
the hormones that the body is unable to effectively make.
These are normally through levothyroxine, which is a replacement for thyroxine, which
you may also know as T4.
(09:02):
Because these hormones are being taken, the amount in the bloodstream needs to be monitored
regularly to ensure that the right amount is being taken and that it is being absorbed
by the body.
For those who do not have an adequate response to synthetic thyroxine therapy, there is also
synthetic triiodothyronine or T3 replacement or you could be prescribed a combination of
(09:22):
T4 and T3 replacements.
T3 is the hormone that thyroxine converts into and normally the synthetic hormone is
able to do this, but some people still have issues.
This will also need to be monitored to ensure the levels in the blood of these hormones
are adequate and not too much or too little, as too much can cause hyperthyroidism.
Who are some famous people that have Hashimoto's thyroiditis?
(09:45):
There is Gigi Hadid.
She is a supermodel and in 2018 she revealed her diagnosis.
After several comments online were made about her appearance, which had changed due to her
being undiagnosed and then going through treatment, she claims to be doing much better now.
There is also Gina Rodriguez, which you may know her from her role in Jane the Virgin.
She initially got diagnosed with hypothyroidism at age 19 when she was attending college.
(10:08):
10 years later she was diagnosed with Hashimoto's disease.
If you would like to check out a foundation, there is for those in the US, the American
Thyroid Association.
They fund research into thyroid related conditions through their various partnerships.
They also publish several thyroid and endocrinology journals for researchers.
They also have one for the general public to allow for people to get a better understanding
(10:29):
of the current knowledge and the most recent advancements in the field.
For those in the UK, there is the British Thyroid Foundation.
They provide funding for research through research awards to improve patient care and
treatment.
They also help with the training of endocrine nurses, midwives and other specialists and
provide patients with opportunities to meet fellow peers, aiming to provide information
and education to those throughout their journey with thyroid conditions.
(10:52):
For those in Australia, there is the Australian Thyroid Foundation.
They aim to raise awareness about thyroid diseases and they also aim to collaborate
with healthcare professionals to ensure that their patients are getting proper diagnoses,
treatment and support.
They also raise awareness for the need of iodine throughout the life to prevent certain
types of hypothyroidism.
If you want to check out the sources, social media links or any other links, you can head
(11:13):
to anatomyofillness.com.
If you enjoyed this episode and would like to hear more, subscribe to be notified about
our latest episodes.
If you would like to join our community, you can join us on Discord or Instagram.
If you want to check out more interesting content, you can check us out on YouTube.
Otherwise stick around for the next episode.
(11:41):
Did you know women are more likely than men to face thyroid issues throughout their lifetime?
The risk of this increases during menopause and after pregnancy due to the changes in
hormones at these times.
It is estimated that 1 in 8 women will suffer from a thyroid issue in their lifetime.
Recently, you have been feeling exceptionally drained, to the point where you have even
(00:04):
fallen asleep at your desk while attempting to complete your homework.
Despite not changing your diet or your workout routine, you've also noticed an unexpected
increase in your weight.
But even more peculiar is the swelling in your neck, a mystery you've brushed aside
as just another symptom of your weight gain.
Strangely, you've also started to feel unusually cold, even in the middle of summer.
And then there's the hair loss.
(00:24):
Every time you run your fingers through your hair, clumps come away in disheartening handfuls.
With a growing sense of unease you confide in your mother, who sensing the urgency in
your voice, books a doctor's appointment.
(00:50):
Hello and Welcome to Anatomy Of Illness.
Today's episode is about Hashimoto's Thyroiditis.
Before we get into the condition, we are going to start with the history.
So why do we know Hashimoto's Thyroiditis exists?
I may also refer to the condition as Hashimoto's Disease.
We begin in 1912 with Dr. Hakaru Hashimoto.
He published the case of a woman who had undergone a thyroidectomy.
(01:10):
So a removal of the thyroid.
Dr. Hashimoto looked at this thyroid tissue under the microscope, and in his paper on
her case called the condition Struma Lymphomatosa.
However, this article was mostly ignored by the medical community at the time, apart from
the occasional controversy with comparisons between it and the early phase of Riedel
thyroiditis.
This did lead to much negativity directed towards Dr. Hashimoto.
(01:33):
This is evident in 1922, as there was a review on chronic thyroiditis done by Reist.
This essentially stated that Hashimoto's was not a separate condition.
In 1931, Graham and McCullagh would use the term Hashimoto's to describe Struma Lymphomatosa.
They would argue that it was in fact a distinct condition to Riedel's thyroiditis.
In 1939, Cecil Joll, who was a prominent British thyroid surgeon at the time, he began to use
(01:57):
the term Hashimoto's disease.
He used this term in his writings about the condition.
Sadly, Dr. Hashimoto would not see this day, as he had passed away from intestinal typhus
back in 1934, so five years earlier.
In 1951, Helwig proposed his theory of colloidophagy.
So this was when macrophages, which are part of the immune system, these normally engulf
or eat dead cells, but in this case he was suggesting that these macrophages were engulfing
(02:21):
damaged colloids.
This caused them to release the hormones contained inside of them.
This would then attract lymphocytes into the thyroid, which is another type of white blood cell.
These mainly worked to kill viruses, bacteria, cancer cells, and infected cells.
This was due to their late 1920s observations in rodents, and later observations in humans.
In the early 1950s, the understanding of autoimmunity and the field of autoimmunity began to come
(02:46):
into existence.
So we began to understand that our body's defenders could also be our body's attacker
in some cases.
In 1956, an animal model was developed.
This allowed for a better understanding at the time of what was going on.
It also allowed for the dispelling of several different theories of what could have caused
this condition.
And in 1971, genetic predispositions were found that could lead to Hashimoto's thyroiditis.
(03:09):
So what actually causes Hashimoto's thyroiditis?
Hashimoto's thyroiditis, or Hashimoto's disease, is an autoimmune disease.
So in this condition, the immune system makes antibodies that target the thyroid cells.
This leads to a large number of white blood cells, known as lymphocytes, building up in
the thyroid.
This then causes inflammation, which is known as thyroiditis, leading to damage of the thyroid.
(03:29):
This can lead to hypothyroidism, which is low thyroid hormones.
This however is not present in every person with Hashimoto's.
What are some risk factors for developing Hashimoto's thyroiditis?
There are several risk factors that are involved with developing Hashimoto's.
These include family history.
Being a family member with Hashimoto's or another form of thyroid disease, you have
(03:49):
a higher risk of developing Hashimoto's disease.
It is believed that 80% of your risk for developing the condition comes from genetics.
Sex.
Women are 10 times more likely to develop Hashimoto's disease than men.
Age.
As you age, your risk of developing Hashimoto's and other thyroid diseases increases.
Having other autoimmune conditions.
If you have another autoimmune condition, your risk for developing Hashimoto's increases.
(04:13):
Examples of these are lupus, type 1 diabetes, coeliac disease and Addison's disease.
These have all been covered in previous episodes.
Other autoimmune diseases can increase your risk as well.
How do we test for Hashimoto's thyroiditis?
A doctor will first start with a physical examination.
This includes looking at the thyroid.
To do this, they will have to feel the area of the thyroid.
Palpating the area of the thyroid will allow them to feel if the thyroid feels bigger or
(04:36):
if there may be nodules that are quite large on the thyroid.
After this, if a doctor suspects something due to the symptoms, they will request some
blood tests.
These include thyroid stimulating hormone test.
So this is the hormone that encourages your thyroid to produce thyroxine, also known as
T4.
If this is high, then this may indicate low levels of thyroxine.
This is due to negative feedback.
(04:57):
Normally when there is a large amount of thyroxine in the body, this inhibits the production
of the hormone that stimulates the release of thyroid stimulating hormone.
This is a negative feedback loop.
This prevents the hormones in the body from getting too high.
Free thyroxine test.
Low levels of this can indicate hypothyroidism.
Again, this means low levels of thyroid hormones.
(05:18):
Anti-thyroid antibody test.
These are antibodies that can point to a cause of hypothyroidism, this being Hashimoto's
disease rather than an iodine deficiency.
These three are all simple blood tests that can be easily done.
A doctor may also request that they do an ultrasound on the neck.
This is to check the thyroid for nodules or growths.
A combination of these tests will be done to ensure a better picture of what is going
(05:39):
on so a doctor can provide the correct diagnosis.
We will get right into the symptoms and presentation right after this little break.
If you have been enjoying this episode, you can check out the notes on our Buy Me A Coffee.
What symptoms might you have if you had Hashimoto's thyroiditis?
(06:06):
Symptoms can vary from person to person and can also vary with how long you've had Hashimoto's
disease.
Some of the more common symptoms of the condition are having a goiter.
This is an enlarged thyroid.
This is normally a lump in the lower neck and can create a sense of fullness in the
area.
It may also make your neck look swollen.
Normally this is not painful.
You may also have fatigue, lethargy and excessive sleeping.
(06:27):
Weight gain, constipation, dry skin.
You may also feel cold all the time.
You can also have bradycardia which is a slower than normal heart rate.
Joint stiffness and muscle pain.
Your hair may also be affected.
It may be dry or brittle.
It may grow slowly or you may have hair loss.
You may also have low or depressed moods.
Your eyes may be puffy or you may have a puffy face.
(06:50):
You may also have difficulty concentrating or have issues with your memory.
You may also struggle with infertility.
This is for both men and women.
You may also struggle with libido, so sex drive.
And for women you may also have irregular or heavy periods.
What are some of the things a doctor should be aware of if their patient has Hashimoto's
disease?
Some complications a doctor should be aware of are high cholesterol, also known as hypercholesterolemia.
(07:15):
This is normally if the condition is poorly controlled.
Goiter.
This is the enlargement of the thyroid in the lower part of the neck.
If this is not caught it may cause issues with swallowing and breathing.
Heart problems.
Hashimoto's thyroiditis can lead to poor heart function.
This may be abnormal heart rates, heart disease and heart failure.
(07:35):
Sexual and reproductive dysfunction.
So this can be reduced libido and sexual desire, an inability to ovulate, irregular and heavy
menstrual bleeding, as well as for men low sperm count and erectile dysfunction.
There may also be pregnancy complications.
For those who have hypothyroidism during pregnancy, there is an increased risk of several complications.
(07:55):
These include an increased risk of miscarriage and preterm birth.
These babies also have an increased risk of developmental delays.
Myxedema.
This is a rare and uncommon condition that occurs when hypothyroidism is left untreated.
This normally presents with extreme drowsiness and lethargy and can lead to a coma and even
death.
This can be brought on by exposure to cold and sedatives in those with untreated hypothyroidism
(08:18):
or Hashimoto's disease.
Another thing doctors should be aware of is interactions with medications.
There are some foods and medications that can affect how certain medications like levothyroxine
are absorbed.
These include soy products, high fibre foods, iron supplements or multivitamins containing
iron, calcium supplements, certain anti-acids and also medications, and some types of high
(08:40):
blood pressure medications.
These may need to be taken at a separate time to not affect the absorption of thyroxine.
How do we treat Hashimoto's thyroiditis?
We normally manage Hashimoto's thyroiditis through the use of synthetic hormones to replace
the hormones that the body is unable to effectively make.
These are normally through levothyroxine, which is a replacement for thyroxine, which
you may also know as T4.
(09:02):
Because these hormones are being taken, the amount in the bloodstream needs to be monitored
regularly to ensure that the right amount is being taken and that it is being absorbed
by the body.
For those who do not have an adequate response to synthetic thyroxine therapy, there is also
synthetic triiodothyronine or T3 replacement or you could be prescribed a combination of
(09:22):
T4 and T3 replacements.
T3 is the hormone that thyroxine converts into and normally the synthetic hormone is
able to do this, but some people still have issues.
This will also need to be monitored to ensure the levels in the blood of these hormones
are adequate and not too much or too little, as too much can cause hyperthyroidism.
Who are some famous people that have Hashimoto's thyroiditis?
(09:45):
There is Gigi Hadid.
She is a supermodel and in 2018 she revealed her diagnosis.
After several comments online were made about her appearance, which had changed due to her
being undiagnosed and then going through treatment, she claims to be doing much better now.
There is also Gina Rodriguez, which you may know her from her role in Jane the Virgin.
She initially got diagnosed with hypothyroidism at age 19 when she was attending college.
(10:08):
10 years later she was diagnosed with Hashimoto's disease.
If you would like to check out a foundation, there is for those in the US, the American
Thyroid Association.
They fund research into thyroid related conditions through their various partnerships.
They also publish several thyroid and endocrinology journals for researchers.
They also have one for the general public to allow for people to get a better understanding
(10:29):
of the current knowledge and the most recent advancements in the field.
For those in the UK, there is the British Thyroid Foundation.
They provide funding for research through research awards to improve patient care and
treatment.
They also help with the training of endocrine nurses, midwives and other specialists and
provide patients with opportunities to meet fellow peers, aiming to provide information
and education to those throughout their journey with thyroid conditions.
(10:52):
For those in Australia, there is the Australian Thyroid Foundation.
They aim to raise awareness about thyroid diseases and they also aim to collaborate
with healthcare professionals to ensure that their patients are getting proper diagnoses,
treatment and support.
They also raise awareness for the need of iodine throughout the life to prevent certain
types of hypothyroidism.
If you want to check out the sources, social media links or any other links, you can head
(11:13):
to anatomyofillness.com.
If you enjoyed this episode and would like to hear more, subscribe to be notified about
our latest episodes.
If you would like to join our community, you can join us on Discord or Instagram.
If you want to check out more interesting content, you can check us out on YouTube.
Otherwise stick around for the next episode.
(11:41):
Did you know women are more likely than men to face thyroid issues throughout their lifetime?
The risk of this increases during menopause and after pregnancy due to the changes in
hormones at these times.
It is estimated that 1 in 8 women will suffer from a thyroid issue in their lifetime.
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