The thyroid gland is a hormone-synthesizing (endocrine) gland in the neck, in front of the trachea, consisting of two interconnected parts. The word thyroid is of Latin origin, meaning shield. The thyroid gland continues to work under the control of the hypothalamus and pituitary gland, which are the upper centers in the brain. The hormones it synthesizes have a stimulating effect on the metabolism of all body cells. Thus, in order to provide energy balance, it increases the absorption of sugar taken with food from the intestines. It allows the sugar stored in the liver to pass into the blood circulation for use by the cells whose metabolism is accelerated. Thyroid hormones are also important for brain development in infants and children.
What is Hashimoto's (Hashimato) Disease?
The name of this disease comes from Hakaru Hashimoto, the doctor who discovered the disease in 1912. Hashimoto's disease is a disease that results in chronic destruction of the thyroid gland after the struggle of defense cells against the thyroid gland. It is also called autoimmune thyroiditis. Defense cells both surround the thyroid gland and synthesize antibodies against the gland. Detection of these synthesized antibodies in the bloodstream is an important finding for the diagnosis of the disease.
The hormones of the thyroid gland are produced in the presence of iodine, and in general, the biggest obstacle to the functioning of the gland is insufficient iodine intake. Despite the absence of iodine deficiency, the most common reason for the thyroid gland to not function fully is Hashimoto's disease (Hashimato thyroiditis).
Hereditary features are also important in the emergence of the disease. The possibility of Hashimoto's disease may increase with the effect of environmental factors in individuals who are genetically prone to the disease. can also be found. Some of the most common among these diseases are:
- Graves' disease
- Type 1 diabetes
- Addison's disease (adrenal gland -cortisol deficiency)
- Testicular and ovarian inflammation
- Parathyroid hormone deficiency
- Pituitary gland inflammation
- Due to vitamin B12 deficiency anemia
- Vitiligo (white areas on the skin)
- Rheumatoid Arthritis (small joint inflammation)
- Lack of blood cells called platelets
- Myasthenia gravis (a muscle disease that causes pain and weakness in the muscles)
Hashimoto's Disease (Thyroiditis) and Youth
Hashimoto's disease is the most common thyroid disease seen in young ages. . Its incidence in children and adolescents increases especially after the age of 6. It reaches its highest level during adolescence. Hashimoto's disease is 2-4 times more common in girls than boys. The most common symptoms are goiter and growth-development retardation.
In the adult age group, Hashimoto's disease may occur in approximately 1 out of every 1000 people. It is seen 5-20 times more in women. Because the thyroid gland is gradually damaged by the defense cells, the disease is most commonly detected in adults between the ages of 30-50.
What are the Symptoms of Hashimoto (Hashimato) Disease?
During the course of the disease, the thyroid gland functions normally, overworks and underworks periods are seen. During these periods, different symptoms occur due to the nature of the disease. Even the first stages of the disease can be passed without any obvious finding. In the following periods, with the destruction of the thyroid gland, the previously produced and stored thyroid hormones pass into the blood circulation in an excessive amount, and this may cause symptoms of hyperthyroidism such as rapid heart rate, excessive sweating, and irritability. As the disease progresses, the destruction of the thyroid gland increases and the hormone levels produced in the gland and secreted into the bloodstream decrease and hypothyroidism symptoms occur. The skin is generally flaky and dry. Hair growth slows down, hair becomes weak and breaks easily.
Following the decrease in thyroid functions, the functioning of the heart is also adversely affected. The heartbeat may slow down. Fatigue, shortness of breath during exertion, or exertion, with the effect of the heart's work A decrease in the capacity to do so may be added to the symptoms.
In the early period after the onset of the disease, constipation, weakness, dry skin and weight gain are among the symptoms. As the disease progresses, intolerance to cold, decreased sweating, depression, memory loss, cramps, joint pain, menstrual irregularities and hair loss may be added to the disease table.
Many more physical signs of the disease may occur:
- Edema, especially on the face and around the eyes (it can also be seen on the skin of the hands and feet)
- Fragile nails
- Increased blood pressure
- Slowing speech
- Language enlargement
How to Diagnose in Hashimoto's Disease?
thyroid gland enlargement may occur. In Hashimoto's disease, the goiter is hard and irregular. If nodule formation has occurred in the gland, these structures can be detected during physical examination.
With the use of ultrasonography, one of the imaging methods, it is possible to distinguish whether the nodule structures detected during physical examination are real or false (pseudonodule) nodules.
Changes in thyroid hormone levels can be detected with the help of biochemical tests. In order to stimulate the functioning of the thyroid gland, the amount of TSH (thyroid stimulating hormone) secreted from the pituitary gland increases. In response to high TSH, hormone synthesis and release from the damaged thyroid gland do not occur and the value of T4 (thyroxine) thyroid hormone is determined as low.
The basis of being an autoimmune disease is the antibodies produced by the defense cells against the thyroid gland. Anti-TPO (anti thyroid peroxidase), example of antibodies that attack the thyroid gland. Normally, while this enzyme is involved in the production of hormones, when it is attacked, hormone production in the thyroid gland is interrupted. Anti-thyroglobulin is another antibody that causes Hashimoto's disease. Any of these antibodies is detected with a 90% probability. While both antibodies are detected high in some people, it should be kept in mind that there may be patients with 10% probability that both antibodies cannot be detected. Apart from these two antibodies, blocking antibodies against the receptor of TSH can be detected rarely. Decrease in kidney function and increase in creatine kinase value can be detected. High prolactin and other biochemical findings that may accompany high cholesterol can be given as examples.
How to Treat Hashimoto's (Hashimato) Disease?
The treatment of Hashimoto's disease is carried out by thyroid hormone drugs and observing the effectiveness of these drugs. . If results showing that the thyroid gland functions normally in people who do not have any evidence of hormone deficiency, a "wait and see" approach may be preferred by the physician. If hypothyroidism has developed and drug treatment is needed, the treatment period is lifelong. In some of the patients, it can be observed that the disease gets better on its own, albeit rarely.
The aim of treatment in hypothyroid diseases is to replace the missing hormones. For this purpose, patients are given thyroid hormone daily. Absorption of the thyroid hormone drug called levothyroxine reaches its highest level if it is taken during the day and on an empty stomach.
In determining the dose of exogenous thyroid hormone, how TSH hormone level is affected by the treatment can be examined. Along with the treatment, it is aimed to maintain high TSH values at the level of 1.5-2.5 international units per liter. It is recommended to start treatment at a standard dose in people younger than 50 years of age, but for cardiovascular problems. i In various health conditions, lower dose treatment can be planned. A lower dose of thyroid hormone drug may be preferred in people older than the limit age, which is one of the criteria in the selection of treatment. Extra care should be taken in the presence of thyroid disease in people who are pregnant or who want pregnancy. In these patients, doses above the standard dose may be preferred in the planning of treatment because the TSH level is reduced to normal levels and the required thyroid hormone level is higher in pregnant women.
What is the Hashimato Diet? How should Hashimoto patients be fed?
First of all, let us state that there is no treatment for Hashimoto's disease with diet and medication should be used. Hashimoto patients should pay attention to the following issues in their diet:
1. Do not use iodized salt and iodized cough syrup.
2. You can take selenium support. 100-200 micrograms of selenium per day may be beneficial for your disease
3. Drink thyroid hormone drugs on an empty stomach. If it hurts your stomach, take it on a full stomach, but remember that it is best to take it on an empty stomach. The absorption of the medicine taken on an empty stomach is better.
4. If you forget to take your medicine with the meal you always take, take it with the next meal. If you forgot to take it the day before, take it twice in the morning and evening the next day.
5. Another medicine at the meal you take the medicine try not to take it. Especially calcium, iron and stomach medications impair the absorption of thyroid medication.
6. Women who are considering getting pregnant should definitely consult their doctor about medication. Thyroid medications will also be taken when pregnant.
It is not harmful to the child. The risk of miscarriage increases if you don't take thyroid medication. Have your check-ups done after delivery.
What Happens If Hashimoto's Patients Are Not Treated?
In Hashimoto's patients who remain untreated;
- Because the thyroid gland tries to make more hormones, gets too big. With goiter, a large swelling occurs in the neck and in some cases it can cause difficulty in swallowing and breathing.
- The level of LDL-cholesterol, also known as bad cholesterol, rises. The risk of cardiovascular disease increases. Heart enlargement and heart failure may occur.
- Depression may develop in the early stages of the disease and may deepen over time. The mental functions of the patients have slowed down. sexual desire a
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