The doctors , the practice clinic for Diagnostics and Preventive Medicine in Bornheim near Cologne, Bonn and Düsseldorf have been working on the Diagnosis and therapy of Hashimoto's thyroiditisThe thyroid specialists connect the inner Medicine with Naturopathy.
Where does the name come from?
The disease is named after the Japanese Doctor Dr. Hakaru Hashimoto (1881-1934), who first described chronic thyroiditis in 1912 in the German journal 'Archiv für klinische Chirurgie'.
Causes
Hashimoto's thyroiditis is an autoimmune disease.
“Autoimmune” means that the body mistakenly produces antibodies against its own tissue, in the case of Hashimoto’s thyroiditis against the thyroidThis then results in chronic inflammation of the thyroid gland.
Since there is a genetic predisposition, Hashimoto's thyroiditis often occurs more frequently within a family.
The exact causes are not yet known. However, typical triggers are Stress, mental stress and infections. It is assumed that in these cases a particular strain on the immune system is the cause of the trigger mechanism. More and more people are suffering from an autoimmune disease. This applies not only to the thyroid, but also to many other organs.
Initially often an overactive thyroid (hyperthyroidism)
The Disease often begins slowly, so that patients hardly notice the symptoms at first.
In the initial phase, the destruction of the thyroid cells can lead to an overactive thyroid for some time due to the flooding of the body with released thyroid hormones ('Hashitoxicosis').
This then leads to typical symptoms such as sweating, rapid heartbeat, nervousness, insomnia, restlessness or irritability ('always in the fast lane').
Lifelong underactivity (hypothyroidism)
After this initial overactivity, the increasing destruction of the thyroid gland by chronic inflammation very often leads to lifelong hypothyroidism with symptoms such as:
Fatigue, lack of motivation, exhaustion, loss of performance, depression, weight gain, muscle weakness, joint pain, flatulence, constipation, nausea, dry skin, brittle nails, reduced sexual desire, sensitivity to cold, hair loss, increased cholesterol levels, concentration or memory problems.
Concomitant diseases
In association with Hashimoto's thyroiditis, other additional autoimmune diseases may occur or already exist in about 25% of patients:
In our experience, these include: ulcerative colitis, Crohn's disease, vitiligo (white spot disease), sprue (celiac disease), anemia, Addison's disease, pernicious anemia, Diabetes mellitus, lupus erythematosus or rheumatic diseases.
During follow-up examinations for Hashimoto's thyroiditis, these diseases should be ruled out, especially if suspicious symptoms are present. This can usually be done easily by determining specific blood values.
When the eyes are affected, the so-called endocrine orbitopathy, symptoms such as watery eyes, red eyes, dry eyes, sensitivity to glare or a foreign body sensation occur. Impairment or loss of vision can also occur. Endocrine orbitopathy is also an autoimmune reaction. Antibodies react against the eye tissue.
Diagnosis
Ultrasound examination of the thyroid is primarily important for the diagnosis of Hashimoto's thyroiditis.
A typical sign in thyroid sonography is a hypoechoic, usually inhomogeneous internal reflex pattern. This reduced echo density shows the structure of the thyroid cells destroyed by chronic inflammation. Ultrasound examination of the thyroid does not involve radiation exposure and can therefore be repeated as often as required. Scintigraphy with a radioactive test substance is not necessary in Hashimoto's thyroiditis.
In the blood test, the determination of thyroid antibodies is crucial for the diagnosis: TPO antibodies and TG antibodies can both be elevated, but sometimes only one of the antibodies is pathologically altered. Even the absence of antibodies does not completely rule out Hashimoto's thyroiditis. In this case, the diagnosis is made using thyroid sonography.
Since there are transitional forms to Graves' disease (autoimmune hyperthyroidism), we always also determine the TRAK, which is typically elevated in this disease.
We measure whether the thyroid is overactive or underactive by measuring the TSH value in the blood (the pituitary hormone that regulates thyroid function) as well as the biologically active thyroid hormones fT3 and fT4.
Therapy
Hashimoto's thyroiditis is probably only curable with very early treatment.
In the vast majority of cases, it is assumed that the disease is incurable and lifelong, but with consistent treatment and monitoring of the disease progression, it will not lead to a reduction in quality of life or life expectancy. We recommend a check-up every 2-4 weeks during the adjustment phase. The check-up interval can usually be extended to 3-6 months later, depending on the stability of the disease progression.
If hypothyroidism is proven, treatment with thyroid hormones (e.g. Levo-Thyroxine) is necessary. It is advisable to increase the dose slowly and carefully in 25 µg increments. Treatment with thyroid hormones can also be useful in cases of only hidden hypothyroidism (latent hypothyroidism).
However, for us the patient’s well-being is always more important than the laboratory results.
The success of a therapy with thyroid hormones should not only be assessed on the basis of blood values, but also on the basis of the effect on the patient's well-being. Early hormone therapy may also reduce the activity of the autoimmune process. If Thyroid hormones are necessary, they should not be given in combination with iodine, as iodine can lead to an increase in inflammation. In most cases, the hypofunction continues to increase over the course of life and the hormone dose must be increased.
To reduce the autoimmune reaction, we recommend taking 100-300 µg daily, based on our positive experience, particularly with regard to the patient’s well-being and the course of the disease. SeleniumThe additional administration of 25 mg of zinc, vitamin D (e.g. vitamin 3 Hevert tablets) and omega-3 fatty acids (e.g. Omacor) can also be useful in individual cases. In addition, care should be taken to ensure an adequate supply of B vitamins, iron and magnesium.
Patients suffering from Hashimoto’s thyroiditis benefit, like everyone else, from a healthy lifestyle:
sufficient sleep and rest times, avoiding stress, balanced diet without additional iodine supplements, regular exercise and Sport.
Learning relaxation techniques, such as yoga, is also recommended by the doctors at the Bornheim practice clinic who specialize in preventive medicine.
