Let's learn about Hashimoto's Disease in simple terms.

Do you also feel unusually tired and sluggish for no reason some days? Do you feel a little heavier? Do you feel cold more often? Although we often think that these are normal things, sometimes the cause of these symptoms may be a condition called Hashimoto's Disease. Don't worry, this is not as dangerous as the name suggests. Let's talk about this simply and clearly.

What is Hashimoto's Disease?

Simply put, Hashimoto's is a condition in which the thyroid gland is affected by a problem with our immune system. This is called an autoimmune condition . This means that our body's defense system mistakenly attacks our own healthy cells, in this case the thyroid gland. This is usually a lifelong (chronic) condition.

Think about it, the thyroid gland is a small butterfly-shaped gland located under the skin in the front of our neck. It is part of our endocrine system. It produces thyroid hormones and controls many things in our body.

The main function of the thyroid gland is to control the rate of our body's metabolism. That is, the rate at which the food we eat is converted into energy. When we hear the word metabolism, we often think only of weight gain and loss. But in reality, this process affects every organ in the body, including our heart and brain.

With Hashimoto's disease, our immune system attacks the thyroid gland, causing it to not produce enough thyroid hormones. This condition is called hypothyroidism . This slows down our metabolism and causes various symptoms.

How common is this disease? Who is most likely to get it?

Hashimoto's is actually a very common disease. In countries like America, 5 out of 100 people have this disease. This condition is now becoming more common in Sri Lanka. In countries where iodized salt and food are abundant, Hashimoto's disease is the main cause of hypothyroidism.

Although this disease can develop at any age, women are about 10 times more likely to develop it than men. It is most commonly diagnosed in women between the ages of 30 and 50.

What are the symptoms of Hashimoto's disease?

Some people with Hashimoto's disease don't have any symptoms in the early stages. As the disease progresses, the thyroid gland can sometimes become swollen. This is called a goiter . This is often the first sign of Hashimoto's disease. Although it is not painful, you may feel a lump in the front of your neck. Your neck may also appear swollen.

Over time, if hypothyroidism develops due to Hashimoto's disease, the following symptoms may appear one after the other.

How does your body feel when you have Hashimoto's?

If you have Hashimoto's but not hypothyroidism, you may not notice any changes.

But if you have hypothyroidism, you may feel like everything in your body is working in "slow motion."

If you too feel like your body and mind are stuck and working slowly, definitely talk to your doctor.

Why does Hashimoto's disease occur? What are the risk factors?

As we mentioned earlier, Hashimoto's is an autoimmune disease. This means that our body's own defense system is working against us. Normally, our immune system protects us from foreign invaders like bacteria and viruses. But in Hashimoto's, this is what happens:

1. For an unknown reason, your immune system begins to make antibodies that attack the thyroid gland.

2. A large number of white blood cells, especially a type called lymphocytes , accumulate in the thyroid gland.

3. This causes the thyroid gland to become inflamed. This is called thyroiditis . This inflammation and antibody attacks damage the gland.

4. Over time, this damage causes the thyroid gland to be unable to produce enough hormones for the body, resulting in hypothyroidism .

There are several risk factors for developing Hashimoto's disease:

• Family history: If someone in your family has Hashimoto's disease or other thyroid conditions, you are more likely to develop it. Research suggests that 80% of cases are genetic.
• Sex: As we mentioned earlier, women are 10 times more likely to develop this disease.
• Age: The risk of developing this disease increases with age.

Also, you are more likely to develop Hashimoto's if you have another autoimmune condition. For example:

• Type 1 diabetes
• Rheumatoid arthritis
• Lupus
• Celiac disease

How is Hashimoto's disease diagnosed?

After asking about your symptoms, your doctor will first examine you. He will especially palpate your neck to check for a swollen thyroid gland (goiter). He will then order several blood tests to confirm the diagnosis.

• TSH (Thyroid-Stimulating Hormone) Test: A high TSH level means that your thyroid gland is not producing enough T4 hormone. This is a major sign of hypothyroidism.
• Free T4 (Thyroxine) test: If the T4 level is low, it further confirms the condition of hypothyroidism.
• Antithyroid Antibody Test: If you have these specific antibodies in your blood, it can be definitively determined that the cause of your hypothyroidism is Hashimoto's disease.

In some cases, your doctor may also recommend a thyroid ultrasound to check the size of your thyroid gland and whether there are any nodules.

How is it treated?

Not everyone with Hashimoto's disease will develop hypothyroidism. If your blood levels of antibodies are high but your TSH and T4 levels are normal, your doctor may not start treatment, but will monitor you with regular blood tests.

But if hypothyroidism is caused by Hashimoto's, the main and best treatment is a medication called levothyroxine . This is a synthetic T4 hormone. This medication is taken as a pill daily.

The dose of medication you need may change over time. Therefore, it is very important to have regular blood tests as prescribed by your doctor and adjust the dose as needed.

Are there any side effects to the medicine?

Side effects from levothyroxine are rare. If they do occur, the main reason is that you are taking more than you need. This can lead to a condition called thyrotoxicosis , where the body produces too much thyroid hormone. The symptoms are:

• Heart rate (tachycardia) - usually more than 100 beats per minute.
• Irregular heartbeat (arrhythmia).
• Weight loss without any reason.
• Feeling shaky.
• Restlessness, irritability.
• Heat intolerance and excessive sweating.

If you experience these symptoms, inform your doctor immediately.

Is there a special diet for Hashimoto's patients?

There is no specific diet for Hashimoto's disease. However, some foods, medications, and vitamins can interfere with the absorption of levothyroxine. Examples include:

• Iron and calcium supplements.
• Some types of antacids.

If you take something like this, you can avoid this problem by taking your thyroid pill 4 hours before or after.

Eating well, exercising, getting enough sleep, and managing stress can all help your immune system. But no matter what you do, if you have hypothyroidism, it's important to take your medication exactly as prescribed by your doctor.

Is Hashimoto's disease dangerous during pregnancy?

If hypothyroidism is left untreated during pregnancy, it can be dangerous for both mother and baby.

• Miscarriage
• Premature birth
• High blood pressure during pregnancy (preeclampsia)

Also, if left untreated, it can affect the baby's growth and brain development. So if you have Hashimoto's and are planning to get pregnant or are already pregnant, inform your doctor immediately. With proper treatment and monitoring, there is no problem in giving birth to a healthy baby.

Cases requiring emergency treatment (cases requiring going to the ETU)

In cases of untreated, very severe hypothyroidism, a rare but life-threatening emergency called myxedema coma can occur. If the following symptoms are present, immediately take the patient to the nearest hospital's Emergency Department (ETU) .

• Very low body temperature (hypothermia).
• Swelling of the body, especially the face, tongue, and legs.
• Very slow heartbeat and weak pulse.
• Breathing is very slow or difficult.
• Confusion or loss of consciousness.

It's normal to feel scared and anxious when you're newly diagnosed with a condition. But the best part is that Hashimoto's is a treatable and manageable condition. If you have these symptoms, or if someone in your family has thyroid disease, don't hesitate to see your doctor. A simple blood test can tell you if your thyroid is working properly.

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