Hashimoto's thyroiditis

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Hashimoto's thyroiditis

• b i n u r a j

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Introduction

• 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. The
  thyroid glands of these patients were
  characterized by diffuse lymphocytic
  infiltration, fibrosis, parenchymal atrophy, and
  an eosinophilic change in some of the acinar
  cells.

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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.

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PATHOGENESIS

• Related to a genetically conditioned defect in
  antigen-specific suppressor T-Cell with formation
  of auto antibodies the latter include antibodies
  to TSH receptor, thyroid microsomes,
  thyroglobulin, T3, T4 and follicular cell
  membrane, as well as blocking antibodies to
  these groups. TSH receptor antibodies include
  thyroid-stimulating fractions (TSI) and
  growth-promoting fractions (TGI). TGI activities
  are more pronounced than TSI effects in this
  condition.
• the mechanism of thyroid injury is still
  uncertain antibody-dependent cell-mediated
  cytotoxicity, complement-mediated cytotoxicity
  and cytotoxic T-Cells are implicated.

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• Clinical Features
• 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

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• 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

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• 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 life-threatening
  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.

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• 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).

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• 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

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• 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

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• However, there is one exception. If the decrease
  in thyroid hormone is actually due to a defect of
  the pituitary or hypothalamus, then the levels of
  TSH are abnormally low. As noted above, this kind
  of thyroid disease is known as "secondary" or
  "tertiary" hypothyroidism. A special test, known
  as the TRH test, can help distinguish if the
  disease is caused by a defect in the pituitary or
  the hypothalamus. This test requires an injection
  of the TRH.

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• The blood work mentioned above confirms the
  diagnosis of hypothyroidism, but does not point
  to an underlying cause. A combination of the
  patient's clinical history, antibody screening
  (as mentioned above), and a thyroid scan can help
  diagnose the precise underlying thyroid problem
  more clearly. If a pituitary or hypothalamic
  cause is suspected, an MRI of the brain and other
  studies may be warranted.

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• 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 compression, an ultrasound may be
  performed to see if the gland is compressing
  either the esophagus or the trachea.

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How is Hashimoto's thyroiditis diagnosed?

• In diagnosing Hashimoto's thyroiditis, a
  physician should assess symptoms and complaints
  commonly seen in hypothyroidism, examine the
  neck, and take a detailed history of family
  members. Blood tests are extremely useful in
  diagnosing Hashimoto's thyroiditis. The blood
  tests look at the thyroid function in general.
  (With hypothyroidism, a high thyroid stimulating
  hormone and low thyroid hormone would be
  expected.)

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• When hypothyroidism is present, the blood levels
  of thyroid hormones can be measured directly and
  are usually decreased. However, in early
  hypothyroidism, the level of thyroid hormones (T3
  and T4) may be normal. Therefore, the main tool
  for the detection of hyperthyroidism is the
  measurement of the TSH. TSH is secreted by the
  pituitary gland. If a decrease of thyroid hormone
  occurs, the pituitary gland reacts by producing
  more TSH and the blood TSH level increases in an
  attempt to encourage thyroid hormone production.
  This increase in TSH can actually precede the
  fall in thyroid hormones by months or years.

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• Thus, the measurement of TSH should be elevated
  in cases of hypothyroidism. However, there is one
  exception. If the decrease in thyroid hormone is
  actually due to a defect of the pituitary or
  hypothalamus, then the levels of TSH are
  abnormally low. As noted above, this kind of
  thyroid disease is known as "secondary" or
  "tertiary" hypothyroidism. A special test, known
  as the TRH test, can help distinguish if the
  disease is caused by a defect in the pituitary or
  the hypothalamus.

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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

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Homoeopathic Medicines

• Calcarea Carb raised blood coagulability.It is
  a heamostatic. Persons of scrofulous type,who
  take all easily, with increased mucus
  secreations,with large head and abdomen, pale
  skin chalky look,the so called leuco-phlegmatic
  temperament.
• Lapis Albus This is the silico-fluride of
  calcium.It corresponds to simple goiter of a soft
  doughy feel, rather than the hard indurate
  encapsulated varieties.It suits well persons of
  anemic tendancy.
• Iodine In the simple soft variety it is useful
  but in the indurated variety better results will
  be hard with the higher potencies. The general
  lymphatic glandular involvement is an additional
  indication of Iodine.

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• Spongia tosta It is well known that spongia
  contains iodine . Cardiac treamur is
  characterstic.
• Thyroidine Produced anemia, emaciation ,
  swetting and a persistance frontal headache and
  muscular weakness. Tachycardia with palpitation
  from the least excitement. Higher potencies are
  more efficient.
• Natrum Mur Effective in subjects of a cachectic
  appearance. There is palpitation of the heart
  and the heart beat seems to shake the entire
  body. It is likely to be a very useful remedy to
  finish and fix the cure begun by some other
  remedy.