“Hashimoto thyroiditis” (Hashimoto disease), hereinafter referred to as “HT”. HT is the most common cause of thyroid hormone deficiency in iodine-sufficient areas and is a lifelong progressive disease of the thyroid. The term “Hashimoto thyroiditis” is derived from the pathology report described by Japanese Surgeon Hakaru Hashimoto in 1912. Although it is popularly called 'thyroid gland inflammation', it is more accurate to call it 'thyroid gland damage'. It is found in 2 percent of the population. 95 percent of HT patients are women. Although it can be seen at any age, it is more common between the ages of 30-50. It is 15-20 times more common in women than in men. It is rare to be seen under the age of 5.
IT SHOWS FAMILY FEATURES
HT disease develops as a result of the combination of genetic predisposition and environmental factors. Common transmission among family members (especially among women), the risk of occurrence in siblings being 20 times higher than normal, the possibility of occurrence in identical twins being 30-60 percent, and its frequent occurrence in patients with 'Down' and 'Turner' diseases are the situations that strengthen familial transmission. Therefore, thyroid tests should be performed in the family of an individual with HT. Environmental factors; Infections, stress, sex steroids, number of pregnancies, excessive iodine intake, radiation exposure, smoking and selenium deficiency are blamed.
IT IS AN IMMUNE SYSTEM DISEASE
HT is an immune system disease that we call autoimmune. In autoimmune diseases, the body perceives its own tissue as foreign tissue and wants to destroy it, and a struggle occurs in the body. In HT, the body tries to destroy its own thyroid gland. Our body uses autoantibodies to achieve this; It produces anti-TPO antibody (referred to as TPOAb) and antithyroglobulin antibody (referred to as TgAb). These antibodies bind to the thyroid gland and destroy thyroid cells. Meanwhile, many inflammatory cells accumulate in the thyroid gland. When thyroid cells are destroyed and reduced as a result of inflammation, the gland shrinks and there are no cells left to produce thyroid hormone. In the continuation of these developments, thyroid hormone deficiency develops.
LABORATORY FINDINGS
Initially, with the presence of a small goiter, 95 percent of the blood is present in the blood. TPOAb and 60 percent TgAb are detected, and TSH – pituitary gland hormone – and T3 and T4 – thyroid gland hormones – are normal. Sometimes it can be detected with a 5 percent low TSH and normal or high T3/T4. In this case, incipient hypertension detected may be mistakenly treated for toxic goiter (colloquially called toxic) (Hashitoxicosis), and hormone-lowering drug-induced goiter may develop in patients who remain unfollowed for years. As HT disease progresses over time, first thyroid hormone insufficiency (TSH is high, T3/T4 is normal) and then complete insufficiency (TSH is high, T3/T4 is low) develops. As age progresses, both blood antibody levels and thyroid hormone deficiency increase.
CLINICAL FINDINGS
Most of the patients have no symptoms and the diagnosis can be made incidentally. In the thyroid gland of patients with HT; There is a hardness with the consistency of a 'rubber eraser' and a silent prominence (goiter - thyroid gland enlargement) that does not cause any complaints. Pain and tenderness usually do not occur. These patients often see the doctor because of goiter and thyroid hormone deficiency; It may be applied due to complaints such as fatigue, drowsiness, dry skin, chills, hair loss, poor memory, constipation, weight gain with loss of appetite, shortness of breath, deepening of the voice, swelling in the face/hands and feet. There is no treatment that will completely eliminate HT disease. Treatment consists only of eliminating the goiter and/or thyroid hormone deficiency caused by the disease. These patients are treated with thyroid hormone medication containing the active ingredient 'levothyroxine sodium'. The drug dose is adjusted by your doctor to normalize the serum TSH level. In the elderly and those with coronary artery disease, treatment is started at very low doses and increased at 4-6 week intervals. In patients with osteoporosis - osteoporosis - treatment should not be administered in very high doses. During pregnancy, an increase of 25-50% in the drug dose is required.
Other autoimmune diseases may also be observed in HT patients. Hypogonadism (decrease in sex hormones), Addison's disease (adrenal gland hormone deficiency), Type 1 Diabetes Mellitus (diabetes), Hypoparathyroidism (deficiency of parathyroid hormone and calcium in the blood) and Pernicious anemia (due to vitamin B12 deficiency). Association with anemia is common.
OUR RECOMMENDATIONS
You can take selenium supplement. Foods containing selenium mineral; sunflower seeds, fish meat, turkey meat, chicken breast meat, red meat, offal, eggs, mushrooms, onion, garlic, legumes, green leafy vegetables, dairy products (it is recommended not to consume if it causes bloating), walnuts, etc. is. Although selenium is an important substance for the body, it is likely to harm the body if consumed in excess. Soy, all grains (especially gluten), sugar, caffeine, fluoridated water, and vegetable oils are foods that are not recommended.
Taking thyroid hormone medication once a day is sufficient. It should be taken in the morning, fasting, in a single dose, preferably alone, with some water, and there should be a period of 30 minutes between breakfast and breakfast. If you forget to take your medicine in the morning, you should take it at the time you remember. If you forgot to take it the day before, take it twice in the morning and evening the next day. Try not to take calcium, iron, multivitamins, stomach medications (H2 blockers, proton pump inhibitors, antacids, sucralfate) within four hours of taking your medicine. Carefully comply with the times your doctor invites you for check-ups. If you are thinking of pregnancy, you should definitely consult your doctor. If pregnancy occurs, you should continue taking your thyroid hormone medication as it will not harm your pregnancy. If you do not take your medicine or do not adjust the dose; Know that you run the risk of miscarriage in the first months and premature birth in the following months. Contact your doctor even after pregnancy.
Although it has not been definitively proven, in a study conducted in 2016; A decrease in the antibody levels of patients with HT who were given 1 gram of black cumin powder before lunch and dinner was detected. Therefore, it is thought that black cumin may be beneficial in patients with HT.
SURGICAL TREATMENT
Surgical treatment is the primary plan in patients with HT. It is an unthinkable situation. The most important conditions requiring surgical treatment are; Detection of thyroid cancer and its suspicion in thyroid fine needle aspiration biopsy, shortness of breath, difficulty in swallowing and It is a suspicion of lymphoma disease, which occurs with the presence of pressure symptoms such as hoarseness and sudden enlargement of the thyroid gland. In addition, despite drug treatment, failure to shrink the nodule in a disease with nodules or continued growth in the thyroid gland, cosmetic reasons are among other surgical reasons. Stay cheerful and well…
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