Hypothyroidism and hyperthyroidism are erratic? It may be Hashimoto's thyroiditis

Author: Lu Ping Harbin Medical University

Reviewer: Gao Chunyan, Professor of Harbin Medical University

Wei Jiangbo, Chief Physician, Daqing Traditional Chinese Medicine Hospital

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disease. The disease was first reported by Dr. Hashimoto of Kyushu University in Japan, hence the name Hashimoto's thyroiditis. Although Hashimoto's thyroiditis sounds like a rare disease, it is actually one of the most common autoimmune diseases in the world.

How does Hashimoto's thyroiditis occur?

If you have Hashimoto's thyroiditis, your immune system identifies the thyroid gland as foreign or harmful, just as it would an invading virus, bacteria, or other pathogen, and initiates an immune response against thyroid cells, attacking them. This immune response against the thyroid gland ultimately leads to damage to the cells that produce thyroid hormones.

As thyroid cells are damaged and destroyed by the immune system, thyroid hormone stored in the cells is released into the circulation, resulting in excessive thyroid hormone levels and temporary hyperthyroidism. When the extra hormone is cleared by the body, and the thyroid gland is damaged and cannot produce enough thyroid hormone, the patient will experience symptoms of hypothyroidism.

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What are the symptoms of Hashimoto's thyroiditis?

Compared with non-autoimmune hypothyroidism, Hashimoto's thyroiditis has a unique set of symptoms. Hashimoto's thyroiditis has the characteristics of insidious onset, slow development, and long course of disease. Typical clinical symptoms do not appear in the early stage of the disease. A small number of patients will show symptoms of thyrotoxicosis, and goiter and hypothyroidism symptoms will appear when the disease progresses. Typical symptoms of hyperthyroidism include: hand tremors, heat intolerance, sweating, restlessness, palpitations, weight loss, irregular menstruation, etc. Continuous hypothyroidism will stimulate compensatory hyperplasia of the thyroid gland to release more hormones and cause goiter. Patients may also experience symptoms of hypothyroidism: fear of cold, puffiness, constipation, listlessness, irregular menstruation, etc. During the course of Hashimoto's thyroiditis, the patient's symptoms can fluctuate between hypothyroidism and hyperthyroidism, and even symptoms of both diseases may appear at the same time.

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Can Hashimoto's thyroiditis be cured?

Although Hashimoto's thyroiditis cannot be cured, symptoms can be improved through treatment. For patients with no obvious clinical symptoms and normal thyroid function test indicators, a follow-up observation treatment strategy is usually adopted. Depending on the condition, a review is conducted every six months or one year to check thyroid function and thyroid autoantibodies. Ultrasound examinations can also be performed. If the patient has hypothyroidism, thyroid hormones can be supplemented. If the thyroid gland is particularly enlarged, causing compression symptoms such as difficulty breathing and swallowing, or if thyroid malignant lesions are considered, surgical treatment can be considered.

What should patients with Hashimoto’s thyroiditis pay attention to in their daily life management?

Patients need to strengthen self-management, such as quitting smoking and drinking, maintaining an optimistic attitude, ensuring adequate sleep, avoiding excessive tension and drastic mood swings, etc. Arrange work reasonably and combine work and rest. Ensure that the iodine in the diet is within the normal range, reasonably consume trace elements, eat more eggs, lean meat, garlic, corn, shrimp, oysters and other foods rich in selenium, eat less kelp, seaweed and other high-iodine foods, and replenish sufficient water. Pay attention to keeping warm, especially in winter, to avoid cold. Do moderate exercise every day, face the disease with a more positive attitude, and avoid negative emotions such as fear and anxiety.