What Exactly Is Hashimoto’s Hypothyroidism

Dr. Hakaru Hashimoto, a Japanese physician, was researching goiters and iodine deficiencies. At this time, goiters and thyroid disease were strongly linked to a dietary lack of iodine. While researching, Dr Hashimoto found a type of goiter that appeared to be unrelated to an iodine deficiency. He biopsied these goiters and his histopathology findings noted lymphocyte infiltration, fibrosis, parenchymal atrophy, and eosinophilic changes of acinar cells. He called this special characteristic of a new type of lymphomatous thyroid disorder “Hashimoto’s thyroiditis” or lymphocytic thyroiditis.

At the time Dr. Hashimoto reported his findings in 1912, German was considered the scientific language. In seeking the widest audience for his discovery, Dr. Hashimoto published his work in a German journal. He wanted to make his important work known around the world and felt this would be the best way to do so. It wasn’t until many years later, however, that he was credited for the first recognized autoimmune condition.

Till this day, 101 years later, Hashimoto’s thyroiditis is still somewhat of an enigma. The reason for this is the diversity of symptoms that patients present.

Side Note: Some papers on Hashimoto’s thyroiditis state that at times patients will report no symptoms. This is inaccurate and probably due an inexperienced person taking the patient’s history. Patients with Hashimoto’s do have a wide range of symptoms with varying severity and a thorough history will reflect this symptomatology.

It is not unusual for a patient with Hashimoto’s thyroiditis to have symptoms of both hypothyroidism and hyperthyroidism. The most common symptom is fatigue but someone with Hashimoto’s can also present with a racing heart, a feeling of being “on edge” or nervousness, and brain fog or loss of mental clarity.

Hyperthyroidism symptoms are evident when the thyroid has produced too much of a thyroid hormone called thyroxine. This creates “hyper” signs and symptoms by accelerating the body’s metabolism significantly. Typically these symptoms include inability to gain weight or sudden loss of weight, sweating, rapid and irregular heart rate, nervousness, diarrhea and irritability. Hashimoto’s causes the release of too much thyroxine when the thyroid gland is under an active attack by the body’s own immune system. During the attack the thyroid tissue is destroyed and any thyroxine within this tissue is released into the body causing a surge of this hormone into the bloodstream. This is the reason a person with Hashimoto’s thyroiditis can experience temporary bouts of hyperthyroidism then a return of hypothyroidism symptoms.

After the attack has leveled off there is less functioning thyroid gland able to produce thyroid hormones and this shows itself by a slowed metabolism. Weight gain, constipation, fatigue, slowed heart rate, and depression are several symptoms that reflect this “hypo” or decreased thyroid hormone output otherwise known as hypothyroidism.

Hashimoto’s is a gradual destruction of the thyroid gland by the body’s own immune system. Often, a person will suffer with Hashimoto’s for years before seeking help. Even then, traditional allopathic treatment is typically only directed toward achieving a TSH (thyroid stimulating hormone) blood level in the “normal” range. Although this thyroid hormone replacement (HRT) treatment is necessary at times, the underlying autoimmunity problem needs support as well or the thyroid gland will continue to be destroyed. Also, it is common for patients who are taking thyroid replacement hormones to continue to experience symptoms.

Another important point is a person with Hashimoto’s has an autoimmune problem that may not stop at just attacking the thyroid gland. Other organs, including the pancreas and brain, are all at risk. It’s vital to diagnose this condition as early as possible.

Do not assume that just because there is no family history of thyroid disease in your family that you are not susceptible. Also don’t think that thyroid conditions are relegated to middle-age women. We are seeing more 20 and 30-year old women and men presenting with thyroid symptoms and many do have Hashimoto’s thyroiditis. Often, when taking the history of this group, they report experiencing their symptoms since they were children or teenagers. This leaves us to believe that there are a number of undiagnosed children and adolescents suffering with Hashimoto’s thyroiditis in the U.S.

With fluctuating hormone levels depending on what part of hyper/hypo state is present at the time, it can be difficult for an inexperienced practitioner to diagnose a patient with Hashimoto’s simply through basic thyroid lab tests. If Hashimoto’s thyroiditis is suspected, a practitioner can order blood tests that evaluate the body’s antibody count against thyroglobulin (TG) and thyroid peroxidase (TPO). A needle biopsy may also be ordered to rule out the presence of lymphocytes and macrophages. The majority of the time a needle biopsy is not necessary to diagnose Hashimoto’s.

A goiter or enlargement of the thyroid gland is sometimes associated with Hashimoto’s disease. A goiter can be so large as to be disfiguring or the enlarged thyroid size can simply make it uncomfortable to wear scarves or neckties. At times, the neck or throat will be sore or tender.

Functional medicine uses a treatment approach well suited for autoimmune thyroid disease (AITD) like Hashimoto’s disease. Causative factors such as food allergens with cross-reactivity are addressed with functional medicine as well as the other involved systems beyond the immune system.