Introduction to Hashimoto's thyroiditis Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.

It is named after the first doctor who described this condition, Dr. Hakaru Hashimoto, in 1912. What causes Hashimoto's thyroiditis? Hashimoto's thyroiditis is a condition caused by inflammation of the thyroid gland. It is an autoimmune disease, which means that the body inappropriately attacks the thyroid gland--as if it was foreign tissue. The underlying cause of the autoimmune process still is unknown. Hashimoto's thyroiditis tends to occur in families, and is associated with a clustering of other autoimmune conditions such as Type 1 diabetes, and celiac disease. Hashimoto's thyroiditis is 5-10 times more common in women than in men and most often starts in adulthood. Blood drawn from patients with Hashimoto's throiditis reveals an increased number of antibodies to the enzyme, thyroid peroxidase an enzyme (protein) found within the thyroid gland. As result of the antibodies' interaction with the enzyme, inflammation develops in the thyroid gland, the thyroid gland is destroyed, and the patient ultimately is rendered hypothyroid (too little thyroid hormone). What are the symptoms of Hashimoto's thyroiditis? The symptoms of Hashimoto's thyroiditis are similar to those of hypothyroidism in general, which are often subtle. They are not specific (which means they can mimic the symptoms of many other conditions) and are often attributed to aging. Patients with mild hypothyroidism may have no signs or symptoms. The symptoms generally become more obvious as the condition worsens and the majority of these complaints are related to a metabolic slowing of the body. Common symptoms are listed below: Fatigue Depression Modest weight gain Cold intolerance Excessive sleepiness Dry, coarse hair Constipation Dry skin Muscle cramps Increased cholesterol levels Decreased concentration Vague aches and pains

Swelling of the legs

As hypothyroidism becomes more severe, there may be puffiness around the eyes, a slowing of the heart rate, a drop in body temperature, and heart failure. In its most profound form, severe hypothyroidism may lead to a lifethreatening coma (myxedema coma). In a severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. This condition requires hospitalization and immediate treatment with thyroid hormones given by injection. Properly diagnosed, hypothyroidism can be easily and completely treated with thyroid hormone replacement. On the other hand, untreated hypothyroidism can lead to an enlarged heart (cardiomyopathy), worsening heart failure, and an accumulation of fluid around the lungs (pleural effusion). There are a few patients with Hashimoto's thyroiditis who may undergo a hyperthyroid phase (too much thyroid hormone), called hashitoxicosis, before eventually becoming hypothyroid. Other symptoms and signs include: Swelling of the thyroid gland (due to the inflammation), leading to a feeling of tightness or fullness in the throat A lump in the front of the neck, (the enlarged thyroid gland) called a goiter

Difficultly swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the esophagus What are the symptoms of Hashimoto's thyroiditis? The symptoms of Hashimoto's thyroiditis are similar to those of hypothyroidism in general, which are often subtle. They are not specific (which means they can mimic the symptoms of many other conditions) and are often attributed to aging. Patients with mild hypothyroidism may have no signs or symptoms. The symptoms generally become more obvious as the condition worsens and the majority of these complaints are related to a metabolic slowing of the body. Common symptoms are listed below: Fatigue Depression Modest weight gain Cold intolerance Excessive sleepiness Dry, coarse hair Constipation Dry skin Muscle cramps

Increased cholesterol levels Decreased concentration Vague aches and pains Swelling of the legs

As hypothyroidism becomes more severe, there may be puffiness around the eyes, a slowing of the heart rate, a drop in body temperature, and heart failure. In its most profound form, severe hypothyroidism may lead to a lifethreatening coma (myxedema coma). In a severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. This condition requires hospitalization and immediate treatment with thyroid hormones given by injection. Properly diagnosed, hypothyroidism can be easily and completely treated with thyroid hormone replacement. On the other hand, untreated hypothyroidism can lead to an enlarged heart (cardiomyopathy), worsening heart failure, and an accumulation of fluid around the lungs (pleural effusion). There are a few patients with Hashimoto's thyroiditis who may undergo a hyperthyroid phase (too much thyroid hormone), called hashitoxicosis, before eventually becoming hypothyroid. Other symptoms and signs include: Swelling of the thyroid gland (due to the inflammation), leading to a feeling of tightness or fullness in the throat A lump in the front of the neck, (the enlarged thyroid gland) called a goiter

Difficultly swallowing solids and/or liquids due to the enlargement of the thyroid gland with compression of the esophagus The blood tests also usually include an analysis of antibodies (anti-thyroid peroxidase antibodies) to aid in the diagnosis. If the gland is large- or there are symptoms of esophageal compressive, anultrasound may be performed to see if the gland is compressing either the esophagus or the trachea (the food and breathing pipes).

What is the treatment of Hashimoto's thyroiditis? There is no cure for Hashimoto's thyroiditis. There is no way to know how long the autoimmune process and inflammation will continue. In the vast majority of patients, hypothyroidism results from the inflammatory process. Thyroid hormone medication can replace the hormones the thyroid made before the inflammation started. There are two major thyroid hormones made by a healthy gland (T3 and T4). Replacing one or both of these hormones can alleviate the symptoms caused by the absolute or relative lack of hormones as a consequence of Hashimoto's thyroiditis. Without medication, there is very little chance the thyroid would be able to maintain hormone levels within the normal range, and symptoms and signs of hypothyroidism would occur or worsen. Should I be concerned if I have Hashimoto's thyroiditis and want to become pregnant? Hashimoto's thyroiditis is not a reason to avoid pregnancy. However, some women with Hashimoto's thyroiditis do have trouble conceiving. In some patients, supplementation with selenium is used to try and decrease antibody

levels. (The theory is that lower antibody levels may lead to better success in conception.) Both before and during pregnancy, the levels of thyroid hormones need to be checked to make certain they are in the optimal range for pregnancy. This is usually within the range for nonpregnant women but at the higher end of the range. Conclusions If you think you may have Hashimoto's thyroiditis, ask your doctor to check your thyroid and order blood tests to help make a diagnosis. If you know you have Hashimoto's thyroiditis, stay on your medication as directed by your physician and follow-up with him or her for regular thyroid blood tests, which will help you to optimize your treatment. Some of the key vitamins and minerals that help lessen the symptoms and progression of Hashimoto's disease are easily found in common foods. In their natural food form, vitamins and minerals are often combined with elements that support their function in the body, or help them to be absorbed more easily. You are very unlikely to overdose on vitamins or minerals in the natural form, but equally, you are unlikely to be able to put right a severe deficiency. Ideally, have your body levels tested (by blood tests or hair mineral analysis tests) to determine the level of need. Selenium A selenium deficiency is thought to contribute towards the development of Hashimotos, and a re-introduction of this mineral can reduce the level of autoimmune anti-bodies. Selenium is found in: Brazil nuts (buy organic if possible, to avoid sulphates) Brewers yeast which also contains the vital energy-giving B vitamins (yeast spreads such as Marmite and Vegemite fall into this category) Cooked broccoli (avoid raw broccoli with any form of hypothyroidism, as the raw form is goitrogenic) Brown rice Dairy foods these also contain small amounts of iodine, which is necessary for the conversion of the thyroid hormone T4 to T3 Garlic Molasses Onions Herbs: Alfalfa, burdock root, cayenne, chamomile, fennel seed, fenugreek, garlic, ginseng, hawthorn berry, hops, parsley, peppermint, rosehips, yarrow. Whole grains Wheat germ contains selenium, but as gluten can worsen the symptoms of Hashimotos, this may be better avoided.

Iron

Many people develop pernicious aenemia when they have Hashimotos disease, and need to look at their B12 status while increasing their iron levels. Iron is found in: Beets (beetroot) this is incredibly high in absorbable iron Spinach this is high in iron, but tends to deplete zinc, so use sparingly Dried herbs: Thyme, Spearmint, Marjoram, Cumin seed Dates but these are high on the glycemic index, and can lead to a hypothyroid energy dip if you eat too many Raisins Green leafy vegetables Whole grains and cereals but be wary of introducing too much gluten Avocados Dried prunes & dried apricots

Potassium Hypothyroidism of all forms has been associated with potassium deficiency. There is a strong interaction between sodium, potassium, calcium and magnesium excess amounts or deficiencies of any one of the four may severely disrupt thyroid function (http://www.ithyroid.com/potassium.htm), so be careful to maintain a good balance. Potassium is found in: Dried parsley Herbs: Chervil, Basil, Dill, Taragon, Chives, Nettle, Sage, Skullcap instant coffee (but go easy on the caffeine) Sun-dried tomatoes Palm hearts

Zinc Zinc is often low in people with Hashimotos or with hypothyroidism, and high in those hitting a hyper state (also found in Hashimotos). Gastrointestinal problems including gluten-intolerance can also cause zinc deficiency. But supplementation can adversely affect copper and iron levels, so is best found in food sources, as given below. Avoid zinc-depleting food too, such as spinach and food containing phytate, found on some cereals and corn. Zinc is found in: Oysters Wheat germ (but watch for gluten intolerance in Hashimotos)

Pumpkin, sesame and squash seeds Beef Chervil, dandelion, eyebright, fennel seed, hops, milk thistle, mullein, skullcap.

Chromium Chromium is brilliant at helping the body balance its blood-sugar levels. It can be found in: Broccoli (always cook, as brocolli is goitrogenic when raw) Grape juice, orange juice Potatoes Herbs: Basil Garlic Red wine Apples Bananas Licorice but this is wildly stimulating to the thyroid and adrenals, and can throw a Hashimoto's patient into a dangerous state. Use only in tiny quantities, if at all.

Calcium Calcium is involved in almost every biological function, but works in balance with potassium, magnesium and sodium, so is better absorbed in food form rather than as supplements. Calcium-rich foods include: Dairy products milk, cheese, yogurt, Sardines Orange juice Salmon Spinach Kale Herbs: chicory, dandelion, fennel seed, parsley, paprika, raspberry leaves, yarrow.

Magnesium Working synergistically with potassium, calcium and sodium, magnesium is the great relaxer. This is what you need if youre having trouble sleeping, or suffering from cramps. It is found in: Nuts almonds, cashews Halibut Spinach Oatmeal

Potatoes Yogurt Rice Lentils Avocados Beans blackeye, kidney, pinto Banana

Magnesium is also found in high quantities in peanuts and soybeans but avoid these if you have Hashimotos, as they worsen symptoms. Vitamin E The supplemental form of vitamin E usually contains soya, which is best avoided if you have Hashimotos it aggravates hypothyroidism and increases goitre growth. Choose a food form of vitamin E supplementation instead, as given below. Vitamin E is found in: Nuts Almonds, Hazelnuts Seeds Sunflower Oils Sunflower, Safflower, Corn spinach Broccoli (cooked) Kiwi Mango