The thyroiditis I am inflammatory processes affecting the thyroid, a small endocrine gland located in the front part of the neck, responsible for controlling metabolic activities, stimulating cellular activities and intervening in the growth and development processes of many tissues. There are different forms of thyroiditis but the most common one is certainly the Hashimoto’s thyroiditis.
Very frequent in females (about 9 cases out of 10), Hashimoto’s thyroiditis is one autoimmune disease: that is, the immune defenses mistakenly attack the thyroid cells, not recognizing them as their own. To do this, the immune system deploys a large quantity of white blood cells (lymphocytes), which insinuate themselves and accumulate in the thyroid, altering its structure and activity. For their part, the thyroid cells develop a chronic inflammatory process which, in the long run, can lead to hypothyroidism. It is a condition characterized by the inability of the thyroid to produce hormones adequately sufficient for the body’s needs.
What are the causes?
The reasons why the immune system attacks the thyroid gland through antibodies to the point of altering its functionality are still being studied. However, it appears that Hashimoto’s thyroiditis is one pathology with a strong familial imprint, whose predisposition is therefore genetically transmitted (it is not uncommon, in fact, for parents, uncles or grandparents to suffer from it). Among the predisposing factors there would also appear to be a certain type of diet: iodine deficiency, or on the contrary excesscould favor the onset of the disease.
Among the risk factors there are also: sex (as we have seen, it prevails in the female one), theage (appears especially in women between 30 and 50 years old), stress, exposure to radiation and, finally, already present autoimmune diseases. Those with rheumatoid arthritis, type 1 diabetes, vitiligo, lupus, celiac disease, Addison’s disease are also more likely to experience Hashimoto’s thyroiditis.
What are the symptoms of Hashimoto’s thyroiditis?
Symptoms of Hashimoto’s thyroiditis can vary depending on the stage of the disease and may not even be present at all (asymptomatic form). In general, these disorders may appear, more or less marked:
excessive and inexplicable tiredness; weakness; lack of concentration; memory impairment; pale and/or dry skin; reduced tolerance to low temperatures; states of anxiety and depression; constipation; irregular menstrual cycles; enlargement of the thyroid (goiter); development of lumps in the neck.
Many are convinced that Hashimoto’s thyroiditis and hypothyroidism also lead to significant weight gain. In reality only one can occur slight weight gain (2-3 kilos)which can be related to the fact that those suffering from these conditions tend to accumulate liquids.
How is the diagnosis made?
It is likely that an initial suspicion of Hashimoto’s thyroiditis is raised by general practitioners, gynecologists and specialists who treat autoimmune diseases, such as rheumatologists and allergists. Subsequently, the patient is directed to theendocrinologistreference figure for thyroid diseases.
To confirm the diagnosis, the specialist checks the values of TSH (the hormone that indicates thyroid function), of T3 (the hormone triiodothyronine) e T4 (the hormone thyroxine) through a simple blood test. Again through a sampling, the values of the blood are measured anti-thyroglobulin antibodies (AbTG) e anti thyrooperoxidase (AbTPO): these are the antibodies produced by the immune system and responsible for the onset of Hashimoto’s thyroiditis. Often these values far exceed the parameters considered normal.
To complete the picture, the specialist can also perform an ultrasound of the thyroid which, in the presence of thyroiditis, highlights an ongoing inflammatory process.
How is it treated?
Hashimoto’s thyroiditis, and the resulting hypothyroidism, can be kept at bay with hormone replacement therapy. This is based on the assumption of levothyroxine, a synthetic analogue of the hormone thyroxine (T4) produced by the thyroid. Today we have available different formulations – from tablets to soft capsules, up to the liquid form – which allow you to personalize the treatment.
The daily administration of levothyroxine allows the thyroid hormones to be brought back to normal values, positively resolving the symptoms associated with the pathology. The dosage varies according to the stage of the disease and can be modified over time depending on periodic blood tests. During pregnancy, for example, it may be necessary to increase the dosage. Since Hashimoto’s thyroiditis is a chronic disease, the therapy must be taken for life.
Hashimoto’s thyroiditis and pregnancy
Before trying to get pregnant
«When you start trying to get pregnant, in addition to the routine exams recommended by your gynecologist, it is important to measure TSHto make sure that the thyroid is working well, especially if you are over 30 or if you have a family history of autoimmune diseases or thyroid diseases”, he explains Alfredo Pontecorvi, director of the Internal Medicine, Endocrinology and Diabetology Unit of the Agostino Gemelli IRCCS University Polyclinic Foundation. «If the tests reveal hypothyroidism, it is necessary immediately regulate thyroid function».
If left untreated, in fact, Hashimoto’s thyroiditis is associated with an increased risk of multiple abortions«not only due to the poor functionality of the thyroid, but also due to the presence of a hyperactive immune system, which can cause very early miscarriages in the first weeks of pregnancy», continues Pontecorvi.
Pregnant
During gestation, the expectant mother’s thyroid requires extra work because it must also supply thyroid hormones to the fetus, especially in the first trimester. In fact, the fetus begins to produce thyroid hormones independently only from the 12th week of pregnancy.
«Women already on levothyroxine replacement therapy due to hypothyroidism due to autoimmune thyroiditis, during pregnancy must increase the usual dosage of the drug by 30-50%.to cope with this increased demand for maternal thyroid hormones,” he says Carlos Rotaendocrinologist at the Agostino Gemelli IRCCS University Polyclinic Foundation.
This is crucial because an untreated hypothyroidism in the first three months of pregnancy can have serious repercussions on the child’s neurological development. In the second and third trimesters, however, maternal hypothyroidism can increase the risk of fetal distress and low birth weight or cause premature birth.
How often do you take exams?
«A hypothyroid woman who already takes levothyroxine must check her TSH before pregnancy, then every 4 weeks in the first trimester, finally every two months until the end of pregnancy. Then, with every change in therapy, the tests must be repeated two weeks later”, continues Rota.
«At the 32nd week, in hypothyroid women due to chronic autoimmune thyroiditis, anti-TSH receptor antibodies must be measured because there is a variant that can inhibit TSH», explains Professor Potecorvi. «Blocking antibodies can remain in the newborn’s blood for a few months after birth and block his thyroid which, however, must function perfectly because otherwise important alterations in brain development can occur. Neonatal hypothyroidism due to anti-TSH blocking antibodies are transient forms but must be managed carefully together with the neonatologist.”
After pregnancy
After the baby is born, the mother can return to the usual dosage of levothyroxine. «However, it is good to do a thyroid check 6-8 weeks after giving birth because in the post-partum period there is a risk of worsening of Hashimoto’s thyroiditis”, concludes Professor Rota.