Womenshealth.gov Hashimoto's Disease Facts

Most of those who know me, know that I have Hashimoto's Thyroiditis. I thought I would share these facts that

put out in regards to Hashimoto's Disease.

What is Hashimoto's disease?

Hashimoto’s disease is an autoimmune disease that affects the thyroid. It also is called Hashimoto’s thyroiditis (theye-royd-EYET-uhss). The thyroid is a small gland in the front of the neck. The thyroid makes hormones called T3 and T4 that regulate how the body uses energy. Thyroid hormone levels are controlled by the pituitary, which is a pea-sized gland in the brain. It makes thyroid stimulating hormone (TSH), which triggers the thyroid to make thyroid hormone.

With Hashimoto’s disease, the immune system makes antibodies that damage thyroid cells and interfere with their ability to make thyroid hormone. Over time, thyroid damage can cause thyroid hormone levels to be too low. This is called an underactive thyroid or hypothyroidism (heye-poh-THEYE-royd-ism). An underactive thyroid causes every function of the body to slow down, such as heart rate, brain function, and the rate your body turns food into energy. Hashimoto’s disease is the most common cause of an underactive thyroid. It is closely related to Graves’ disease, another autoimmune disease affecting the thyroid.

What are the symptoms of Hashimoto's disease?

Many people with Hashimoto’s disease have no symptoms for years. An enlarged thyroid, called a goiter, is often the first sign of disease. The goiter may cause the front of the neck to look swollen. You or your doctor may notice the goiter. If large, it may cause a feeling of fullness in the throat or make it hard to swallow. It rarely causes pain.

Many people with Hashimoto’s disease develop an underactive thyroid. They may have mild or no symptoms at first. But symptoms tend to worsen over time. Symptoms of an underactive thyroid include:

• Fatigue
• Weight gain
• Pale, puffy face
• Feeling cold
• Joint and muscle pain
• Constipation
• Dry, thinning hair
• Heavy menstrual flow or irregular periods
• Depression
• A slowed heart rate
• Problems getting pregnant

Who gets Hashimoto’s disease?

Hashimoto’s disease is about 7 times more common in women than in men. It can occur in teens and young women, but more commonly shows up in middle age. People who get Hashimoto’s disease often have family members who have thyroid or other autoimmune diseases. People who get Hashimoto’s disease sometimes have other autoimmune diseases, such as:

• Vitiligo (vit-ihl-EYE-goh) — a disease that destroys the cells that give your skin its color
• Rheumatoid arthritis — a disease that affects the lining of the joints throughout the body
• Addison’s disease — a disease that affects the adrenal glands, which make hormones that help your body respond to stress and regulate your blood pressure and water and salt balance
• Type 1 diabetes — a disease that causes blood sugar levels to be too high
• Graves’ disease — a disease that causes the thyroid to make too much thyroid hormone
• Pernicious (pur-NISH-uhss) anemia — a disease that keeps your body from absorbing vitamin B12 and making enough healthy red blood cells
• Lupus — a disease that can damage many parts of the body, such as the joints, skin, blood vessels, and other organs

What causes Hashimoto’s disease?

Many factors are thought to play a role in getting Hashimoto’s disease. These include:

• Genes. Some people are prone to Hashimoto’s disease because of their genes. Researchers are working to find the gene or genes involved.
• Gender. Sex hormones also might play a role. This may help to explain why Hashimoto’s disease affects more women than men.
• Pregnancy. Pregnancy affects the thyroid. Some women have thyroid problems after having a baby, which usually go away. But about 20 percent of these women develop Hashimoto’s disease in later years. This suggests that pregnancy might trigger thyroid disease in some women.
• Too much iodine and some drugs may trigger the onset of thyroid disease in people prone to getting it.
• Radiation exposure has been shown to bring on autoimmune thyroid disease. This includes radiation from the atomic bomb in Japan, the nuclear accident at Chernobyl, and radiation treatment of Hodgkin’s disease (a type of blood cancer).

How do I find out if I have Hashimoto’s disease?

If you have symptoms of Hashimoto’s disease, your doctor will do an exam and order one or more tests. Sometimes, routine screening of thyroid function reveals a mildly underactive thyroid in a person with no symptoms. Tests used to find out if you have Hashimoto’s disease include:

• Thyroid function tests. A blood test is sent to a lab to see if your body has the right amount of TSH and thyroid hormone (T4). An above normal level of TSH is a sign of an underactive thyroid. When the thyroid begins to fail, the pituitary makes more TSH so as to trigger the thyroid to make more thyroid hormone. For a while, the thyroid can keep up, and the blood test will show slightly higher TSH levels with normal T4 levels. This is called subclinical hypothyroidism. But over time, the damaged thyroid cannot keep up, and T4 levels will drop below normal while TSH levels are high.
• Antibody test. A blood sample is sent to a lab to look for antibodies that suggest Hashimoto’s disease. Most people with Hashimoto’s disease will have specific antibodies that people with other causes of an underactive thyroid do not have. Some people have the antibodies seen with Hashimoto’s disease, but have normal thyroid function. Having only the antibodies does not cause any symptoms.

Hashimoto’s disease can be harder to diagnose during pregnancy. For one, Hashimoto’s disease has many of the same symptoms as normal pregnancy, such as fatigue and weight gain. Yet untreated underactive thyroid during pregnancy may affect the baby’s growth and brain development. So make sure to tell your doctor if you have symptoms of thyroid problems.

How is Hashimoto’s disease treated?

Hashimoto’s disease responds well to treatment. It is treated with a single daily tablet of levothyroxine (lee-voh-thye-ROKS-een). This is a manmade form of T4 thyroid hormone. It also is called thyroid replacement therapy because it restores back to normal the T4 that the damaged thyroid can no longer make. It almost always needs to be taken for the rest of a person’s life and in the same manner each day.

Thyroid replacement medication comes in different amounts. The exact dose depends on:

• Age
• Weight
• Severity of the underactive thyroid, if present
• Other health problems
• Use of other medicines that can interact with levothyroxine

When you start treatment, you will need a follow-up TSH test so your doctor can fine-tune your dose. Thyroid hormone acts very slowly in the body, so it can take several months after the start of treatment for symptoms to go away and goiter to shrink. If the dose is too strong, thyroid hormone levels will become too high. This is called hyperthyroidism. Too much thyroid hormone can cause heart problems and bone loss. So finding the right dose is important.

Once the TSH level is normal, your doctor will need to see you less often. Most people have a thyroid checkup and TSH test once a year. Usually, the same treatment dose works for a long time and often does not need to be adjusted until a person’s 70s or 80s. Yet, the dose may need to be changed in some cases, such as with pregnancy, heart disease, or if using menopausal hormone therapy.

Whether to treat a mildly underactive thyroid without symptoms is an area of debate. Hashimoto’s disease is the cause in most cases. Many doctors feel that treatment can help these patients. Treatment will keep symptoms from starting. Also, some studies have shown that a mildly underactive thyroid can increase the risk of other health problems, including heart disease. We don’t know yet if treating a mildly underactive thyroid will lower these risks. But some studies have shown thyroid hormone treatment might protect against heart disease. If a screening test reveals you have a mildly underactive thyroid without symptoms, talk to your doctor about your options.

What would happen if Hashimoto’s disease is not treated?

Without treatment, Hashimoto’s disease may progress and symptoms of an underactive thyroid can get worse. An untreated underactive thyroid can cause further problems, including:

• Infertility
• Miscarriage
• Giving birth to a baby with birth defects
• High cholesterol

Severe underactive thyroid called myxedema (mik-suh-DEE-muh) can very rarely lead to:

• Heart failure
• Seizures
• Coma
• Death

Does pregnancy affect the thyroid?

Normal hormone changes during pregnancy cause thyroid hormone levels to increase. The thyroid may enlarge slightly in healthy women during pregnancy, but not enough to be felt. These changes do not affect the pregnancy or unborn baby. Yet, untreated thyroid problems can threaten pregnancy and the growing baby. Symptoms of normal pregnancy, like fatigue, can make it easy to overlook thyroid problems in pregnancy. So if you have symptoms of an underactive thyroid or notice a goiter, make sure to tell your doctor.

Thyroid hormone is vital during pregnancy. The unborn baby’s brain and nervous system need thyroid hormone to develop. During the first trimester, the baby depends on the mother’s supply of thyroid hormone. At 10 to 12 weeks of pregnancy, the baby’s thyroid begins to work on its own. But the baby still depends on the mother for iodine, which the thyroid uses to make thyroid hormone. Pregnant women need about 250 micrograms (mcg) of iodine a day. Some women might not get all the iodine they need through the foods they eat or prenatal vitamins. Choosing iodized salt — salt that has had iodine added to it — over plain table salt is one way to ensure you get enough iodine. Also, prenatal vitamins that contain iodine are recommended.

Some women develop thyroid problems in the first year after giving birth. This is called postpartum thyroiditis (theye-royd-EYET-uhss). It often begins with symptoms of an overactive thyroid, which last 2 to 4 months. Mild symptoms might be overlooked. Most women then develop symptoms of an underactive thyroid, which can last up to a year. An underactive thyroid needs to be treated. In most cases, thyroid function returns to normal as the thyroid heals.

Do I need a thyroid test if I become pregnant?

Experts have not reached agreement on whether all pregnant women should be routinely screened for thyroid problems. But, if an underactive thyroid with or without symptoms is found during pregnancy, your doctor will treat you to lower your risk of pregnancy problems. An underactive thyroid without symptoms occurs in 2 to 3 in every 100 pregnancies. If you want to become or are newly pregnant, talk to your doctor about thyroid screening.

I have Hashimoto’s disease and want to have a baby. What should I do before I try to get pregnant?

Women being treated for Hashimoto’s disease can become pregnant. But make sure your pregnancy is planned. Thyroid function must be well-controlled before you get pregnant.

Untreated or poorly treated underactive thyroid can lead to problems for the mother, such as:

• Preeclampsia (pree-ee-CLAMP-see-uh)
• Anemia
• Miscarriage
• Placental abruption
• Postpartum bleeding

It also can cause serious problems for the baby, such as:

• Preterm birth
• Low birth weight
• Stillbirth
• Birth defects
• Thyroid problems

Talk to your doctor about how to prepare for pregnancy or about birth control if you do not want to become pregnant.

How is Hashimoto’s disease treated during pregnancy?

During pregnancy, you may need to see both your OB/GYN and an endocrinologist (en-doh-krih-NOL-uh-jist), a doctor who treats people with hormone problems. Levothyroxine is safe to use during pregnancy and necessary for the health of the baby. Women with Hashimoto’s disease or an underactive thyroid who are taking levothyroxine before pregnancy may need a higher dose to maintain normal thyroid function. Thyroid function should be checked every 6 to 8 weeks during pregnancy. After you have your baby, you will likely go back to your pre-pregnancy dose.

Can I breastfeed if I am using thyroid replacement therapy?

Levothyroxine does pass through breast milk. But it is not likely to cause problems for the baby. Also, you may not be able to make breast milk if your thyroid is underactive. Your doctor can help you decide what is best for you and your baby.

For more information

For more information about Hashimoto’s diseases, call womenshealth.gov at 800-994-9662 or contact the following organizations:

Endocrine and Metabolic Diseases Information Service, NIDDK, NIH, DHHS
Phone: 888-828-0904
Internet Address: http://www.endocrine.niddk.nih.gov

American Autoimmune Related Diseases Association, Inc.
Phone: 586-776-3900; Toll-Free: 800-598-4668 (for literature requests)
Internet Address: http://www.aarda.org

American Thyroid Association
Phone: 800-THYROID (849-7643)
Internet address: http://www.thyroid.org

The Hormone Foundation
Phone: 800-HORMONE (467-6663)
Internet address: http://www.hormone.org

New York Thyroid Center
Phone: 800-543-2782; 212-305-0442
Internet Address: http://cpmcnet.columbia.edu/dept/thyroid

Reviewed by:

David S. Cooper, M.D.
Professor of Medicine
The Johns Hopkins University School of Medicine

***This was taken from Womenshealth.gov. included is the original copyright disclaimer from the website page: "All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated."***

Tdap and Thyroid: My Reaction to the Injection

I know, as a person with an autoimmune disease, that I need to keep up with my shots. I had not had a tetanus booster in over 20 years. At the last doctor visit I had, I was told that I needed to get the tdap (tetanus, diptheria, pertussis) booster. I had kept forgetting to go by the injection clinic and get it done. Couple Tuesdays ago, when my daughter had teen group, I decided that I would get it done then (because I remembered this time!).

While the injection itself did not hurt, they did tell to keep my arm moving or massage it, because it would stiffen up and be sore. That soreness came about 10 minutes after, and it's still here. As a matter of fact, it's worse now than it was the day before. I remember getting these shots as a kid, and even when I had my car accident in 1987, but I don't remember feeling this miserable. I don't remember how much it hurts to lift my right arm above my head, or my whole arm and neck being affected, or how much more tired I've been since receiving the shot. I also had somewhat of a brain fog. I kept thinking the assignment I did, for a class I'm taking at the community college, was going to come back with a very low grade. I honestly couldn't focus on it.

I can't honestly say if it was my thyroid disease that contributed to the reaction I got from the injection, but I do know that that has never happened to me before. I wonder if anyone else with thyroid disease has had this reaction. I think it's time to research a little.

Hair Today, Gone Tomorrow: Good Thing I'm Not Vain

One of the things that those with thyroid disease experience is hair loss. This was a BIG indicator back in the early days, back before it was diagnosed and I was put on medication. I guess it's lucky that I'm not a super vain person, because I went from thick, beautiful, long, and shiny hair to thin, dry, and dull hair. It is still long but it took a long time to grow after a short haircut. I never had that problem when I was younger. I was convinced that my hair grew at rates that were faster than normal.

For awhile, after I had gone on medication, the hair loss wasn't as bad as it had been. I believed that I was on the right track. I'm not sure what happened between the onset of my thyroid disease and now in regards to the hair loss, because I didn't really pay attention. I'm paying attention now. It has gotten pretty bad. It's in the drain, on the floor, on the carpet and so when anything is on the carpet or floor it's going to get hair on it, too. I think I read somewhere that being on too much thyroid medication could possibly make you lose hair like crazy. I'm not too sure about that, but what I do know is that if I have to suffer this hair loss to feel good, I'm not too proud to admit it. I will NOT and CANNOT live without my Cytomel (T3 medication). I did try the generics, but that didn't work out so well as I had mentioned.

I just realized that I didn't get around to the brand and generic comparison of T3 medication. I will have to do that soon, because it really is amazing to me on what a difference there is in the makeup and the affects.

Vacation and Hashimoto's Don't Mix

Vacation can be the worst in the life of someone with Hashimoto's. At least in my case, it increases my symptoms. I found that I'm not as responsible with staying on top of my meds during vacation. I eat way too much of all the wrong things. I drink far more soda than I ever would at home. As always, when it's unbearably hot, I swell up. All these things combined made me swell twice as much as I normally do. I swear, my feet felt like they were gonna pop. As a matter of fact, they are still swollen. I also gained 2 or 3 pounds on vacation.

Why is it that I think that vacation gives me the right to do all the things that I shouldn't be doing? I gotta get myself into shape, especially since, in about three weeks, I will be taking a p.e. class in college that requires me to work out. I'll probably be the only old fatty in there with all the thin young people. *sigh*

Mini-Me's Diagnosis

With symptoms like weight gain, tiredness, mental fog, depression, and easily irritated, I had thought, no had HOPED that maybe my daughter had a thyroid issue. At least THAT I can handle, THAT is easier to cope with for the most part for her and for me (least I think it would be). It turns out that it's teen depression. It's something that is more common than most people think. We went a couple of weeks to see if there were some coping strategies, but for her, there were none. It was hit or miss as far as her moods went. She's been somewhat happy since she got a boyfriend, but I need to make sure that if something ever happens between them (being young you know this will eventually happen) that she doesn't go back to bottom. She asked for the meds. So today it begins...

Teen Depression or Thyroid Disease?

Mini-Me had slowly been getting a little more mouthy, easy to anger, and she had been talking to me less about things that had been bothering her. I attributed it to the fact maybe it was the hormonal change that she was going through and the fact that she had started her cycle during the summer. During this school year, the mood swings had been getting progressively worse. Her grades had been slowly going down hill, but I didn't think that it was bad enough to warrant too much attention. I did what I normally would do and just tell her that she needed to work harder. Then I got a call from her teacher to come meet with her.

Mini-Me's teacher had told me that it seemed like Mini-Me had depression, and the reason she had mentioned it was because she had been there before and knew the symptoms. I still wasn't sure if that was truly the problem, so I didn't make an appointment with Mini-Me's doctor. Well, just before break, I was informed that in three of her classes her grades had done a considerable drop. She wasn't doing her work. I also knew that this meant that probably after Christmas break she would be on activity restriction which means no cheering or being able to attend the dance that's at the end of this month, something she had been looking forward to. I ended up getting another call from her teacher. She pretty much told me that Mini-Me had started becoming withdrawn from most people. She wasn't staying focused, and she wasn't doing her work. I met with the teacher after school, and we discussed the depression issue again. I decided that I would finally get a doctor's appointment.

Because of my thyroid disease, I, too, sometimes get depressed or angry. I know that, in my case, it is hormonal. I wanted to meet with Mini-Me's doctor to do another thyroid assessment. I was told that he would order the test, but that he suggested she go to Kaiser's Mental Health. We went for the first appointment yesterday. I think in some way it helped her. At first, she was a bit nervous about it all, and a couple of days before she asked if only she and I could handle it. I just think it was beyond her and I handling it especially if sometimes I get into my own moods. Sometimes I don't deal with my depression/irritability as well as I can. One major difference is that I don't just 'check out'. I force myself to focus, because I know that my girls need me.

There's also another issue. Mini-Me's best friend is kind of like her. She gets down about things that are out of their control. Not only that, but a lot of friends that they know and talk to are similar. In fact, one boy always says he's going 'away'. I don't think that can be good. Luckily, she doesn't hang with this boy or talk to him often. Mini-Me's best friend actually asked if Mini-Me could take her to the counseling session. I think it would be good for her friend to seek counseling as well, but she doesn't think that her uncle (who is her guardian) cares about her. I think he does, but in his own way. I really don't know how he'd react if she asked to go counseling.

Everyday is not a down day for Mini-Me or her friend, but there are more down days than up lately. When the psychologist asked if I was interested in medication for Mini-Me, I said that I wasn't prepared to go down that road just yet. I thought maybe she could find some tools to learn to deal with the moods, and if that didn't work, then we could discuss the options of medication. Mini-Me got to see the psychologist alone and told her that she was interested in medication.

Luckily, the psychologist is on the same page as I in regards to medication. Because while sometimes I think it can help, I also believe that sometimes it makes things worse. Besides, I want to see if this is a thyroid thing first (as sometimes it can be hereditary). Herein lies the problem: Kaiser is one to base whether one has thyroid issues on one thing and one thing only: TSH test.

I often was told that my thyroid was normal. I also had been told that maybe it was depression since it was during the time that I was going through my divorce. Well, it had been a few years really(that I had been having symptoms), but I knew that whatever was going on with me at the time was definitely not going to be cured by the Zoloft they had given me a prescription for. I never did get it filled. It took an endocrinologist and a more thorough thyroid panel to find the root of my problem: Hashimoto's.

I took Mini-Me in for her TSH test today. They actually wanted to do a lipid panel, but since she didn't fast, we have to wait on that one. Had I known they wanted to do that, I would have taken her early one morning this week. Depending on what I see when the TSH results come back, I'll know whether to ask her doctor for more testing. I HATE the fact that Kaiser still uses the old guidelines for TSH of .3 to 5.5. UGH! I never feel good unless I'm around 1.0 or just under. A 'normal' person, on average, has a TSH of 1.3. I have had TSH tests done on Mini-Me before. The first was 1.3, but the second was 2.0. This is why I'll know more if this is what's causing her to get more emotional, tired, and unfocused.

My husband's telling me to try not to 'find' things that aren't there. I'm sorry, but I've been there and done that. I got tired of people telling me it was something that it wasn't. Even worse yet, is when my ex had called me a hypochondriac. I think we often know our bodies better than anyone else, and when I don't feel like myself, I know it. I really hope we can pinpoint this thing in regards to Mini-Me. Whether it happens to be, depression medications or thyroid medications, at least we'll know and get her on the right path. BTW, did i mention that there were tons of teenagers at the clinic?

Googlechondriac

Need to make a doctor appointment for this week, but I don't know why I haven't yet. Discovered a lump along my right lower jaw. Of course, I have become a googlechondriac. Goggled all the things it could be, and I'm SURE it's one of those things. LOL I wonder when this lump started and how long I've had it. I was sick again for the second time in a month. I got sick right before Christmas and was still feeling a little under the weather when my son and mom visited. I also wasn't hungry for days, though I can't decide why I would eat anyways. Is it habit? I honestly could have gone without food for about four days. I never once got hungry or anything. I probably should have not eaten on those days, too, because it just made me feel worse. I've also been extra tired...way more tired than usual. I haven't been going to bed before 3 AM since my son and mom left. I guess that could be part of the problem. But, even when I was going to bed early, I still have been extremely tired. To make things worse, I also felt what seems like will be a UTI. Hopefully, it will not develop fully. I don't need that on top of everything else. When I see the doctor this week, I will ask for a TSH test. Gotta see where my levels are. I have a feeling they're not where they need to be.