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Thyroiditis is an inflammation - not an infection - of the thyroid gland. Hashimoto's thyroiditis, also called autoimmune or chronic lymphocyctic thyroiditis, is the most common type of thyroiditis and manifests itself as a painless, diffuse enlargement of the thyroid gland occurring predominantly in middle-aged women. Thyroid function is often normal, but hypothyroidism may develop, and rarely, hyperthyroidism. Often, autoantibodies (antibodies your body makes against itself) are present.
Postpartum thyroiditis is the most common thyroid disease to occur after delivery and results in temporary hyperthyroidism or hypothyroidism. Some 5-7% of women worldwide develop the disease after giving birth, according to the American Thyroid Association.
When the thyroid becomes inflamed, it will first emit larger quantities of thyroid hormone into the bloodstream (hyperthyroidism). During this phase, most women are unaware of any symptoms, which are often mild and short-lived. Once this initial phase passes, a woman either recovers completely or has sustained damage to her thyroid. If the thyroid gland was damaged, this damage - together with a depleted reservoir of thyroid hormones - can lead to hypothyroidism. This condition also may clear up or result in further damage and complications. Postpartum thyroiditis symptoms usually do not appear until three to eight months after childbirth. Symptoms are also often mistaken for normal signs of recovery from childbirth.
Hashimoto's disease may rarely be associated with other endocrine disorders caused by the immune system. When Hashimoto's disease occurs with adrenal insufficiency and type 1 diabetes mellitus, the condition is called type 2 polyglandular autoimmune syndrome (PGA II).
Less commonly, Hashimoto's disease occurs with hypoparathyroidism, adrenal insufficiency, and fungal infections of the mouth and nails in a condition called type 1 polyglandular autoimmune syndrome (PGA I).
Incidence; Causes & Development
It is caused by a reaction of the immune system against the thyroid gland. Thyroiditis is more common than Graves' disease when mild cases are included, and the prevalence among women is at least 2%.
The onset of the disease is slow, and it may take months or even years for the condition to be detected. Chronic thyroiditis is most common in women and individuals with a family history of thyroid disease. It is estimated to affect between 0.1% and 5% of all adults in Western countries.
Hashimoto's thyroiditis occurs when autoantibodies attack the thyroid tissue, confusing it with a foreign substance. Theories about why this occurs emphasize a basic abnormality in the immune system, which in many patients somehow allows autoimmunity to develop against thyroid tissues as well as other tissues, including those of the stomach, adrenal glands and ovaries. Other autoimmune diseases are frequently seen in these patients, such as rheumatoid arthritis, SLE (lupus), and Sjogren's syndrome.
Some researchers believe that Hashimoto's thyroiditis, primary myxedema and Graves' disease (hyperthyroidism) are different expressions of a basically similar autoimmune process, and that the clinical appearance reflects the immune response in that particular patient.
The gland affected by thyroiditis tends to lose its ability to store iodine and is inefficient in making thyroid hormone.
Diagnosis & Tests
Diagnosis is made by the finding of a painless, smooth, firm goiter in a young woman, with positive levels of anti-thyroid hormones and a euthyroid (normal thyroid) or hypothyroid metabolic status. Since progression of symptoms may be subtle, thyroiditis is difficult to diagnose at times.
Treatment & Prevention
A patient with a small goiter and euthyroidism does not require therapy unless the TSH level is elevated. The presence of a large gland, progressive growth of the goiter, or hypothyroidism indicates the need for replacement thyroid hormone. Surgery is rarely indicated. Development of a lymphoma, though very unusual, must be considered if there is growth or pain in the involved gland.
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Conditions that suggest Chronic Thyroiditis: | | | | | Autoimmune |  Gluten Sensitivity / Celiac Disease | In one study, 83 patients with autoimmune thyroid disorder were screened for celiac disease. Three patients with asymptomatic celiac disease were found along with one who had previously been diagnosed, giving an overall frequency of 4.8%. By contrast, only one of 249 age- and sex-matched blood donors was found to have celiac disease. |
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Circulation |
Megaloblastic Anemia / Pernicious Anemia |
Mental |
Panic Attacks |
Musculo-Skeletal |
 Rheumatoid Arthritis |
Skin-Hair-Nails |
Hives| | Amongst patients with chronic hives and either treated hypothyroidism or a normally functioning thyroid gland, it is reasonable to test for anti-thyroid antibodies. In a study of 10 patients with chronic hives, thyroxine (T4) was administered for a minimum of 12 weeks. Of 7 patients with elevated anti-thyroid antibodies at baseline, all had complete resolution of hives or marked improvement within 4 weeks. Two patients required an increase in the thyroxine before complete resolution was seen. In 2 others, already on thyroxine therapy for hypothyroidism, an increase in the dose also resulted in resolution of the hives.
The initial dose was on average 100mcg per day, which was increased if the initial dose failed to produce clinical improvement. The highest dose used was 250mcg per day. The 3 patients without elevated anti-thyroid antibodies did not respond to thyroxine therapy. There was a recurrence of hives after treatment was stopped which resolved again after treatment was restarted. There was no consistent correlation between improvement in symptoms and reduction in thyroid antibody levels. [J Allergy Clin Immunol 1995;96: pp.901-5] |
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Symptoms - Immune System |
 Chronic thyroiditis (confirmed) |
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Risk factors for Chronic Thyroiditis:
Chronic Thyroiditis suggests the following may be present:
Recommendations and treatments for Chronic Thyroiditis:
KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link |  | | May do some good |  | | Likely to help |  | | Highly recommended |
GLOSSARY
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Adrenal Insufficiency (Adrenal Exhaustion, Low Adrenal Function)
A condition in which the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Asymptomatic
Not showing symptoms.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
DHEA (DHEA-S)
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Fibromyalgia (FMS)
Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Goiter (Goitre)
A chronic enlargement of the thyroid gland (visible between the Adam's apple and the collarbone at the front of the neck) produced by the body in an attempt to increase hormone production from limited amount of iodine. It is not due to cancerous growth.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypochlorhydria (Hypochlorhydric)
The condition of having low hydrochloric acid levels in the stomach, often the cause of digestive disorders.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Iodine
A essential mineral that is an integral part of the thyroid hormones, thyroxin and triiodothyronine which have important metabolic roles and govern basal metabolism. The best known iodine deficiency symptom is goiter. Other iodine deficiency problems are reduced vitality, hypothyroidism, inability to think clearly, low resistance to infection, loss of control of the muscles of the mouth resulting in mouth contortion and drooling, defective teeth, tendency to obesity and cretinism which is a congenital abnormal condition marked by physical stunting and mental deficiency.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Lymphoma (Lymphomas)
Any tumor of the lymphatic tissues.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milliliter (mL)
0.001 or one thousandth of a liter.
Myxedema
A condition arising from diminished thyroid function, characterized by hard swelling of subcutaneous tissue, hair loss, lower temperature, muscle debility, hoarseness and the slow return of a muscle to neutral position after a tendon jerk. Resulting thyroid cell destruction eventually progresses to thyroid failure.
Osteoarthritis (Osteoarthritic)
A condition involving degeneration of cartilage and supporting joint tissue, which results in pain, swelling and reduced mobility, as the cartilage wears away and allows bone to rub against bone.
Ovary (Ovaries)
Ovaries are about the size of an almond and lie on either side of the lower abdomen beside the uterus. They usually produce one egg each month and whether the egg is fertilized or not, the reproductive process follows a monthly cycle, with constant changes in various hormone levels, preparing another opportunity for conception. The ovary is responsible for most of the estrogen production in women. At menopause (sometime after middle-age), egg production ceases and hormone levels drop significantly.
Panic Attack (Panic Attacks)
A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.
Postpartum
After childbirth.
Rheumatism (Rheumatoid)
General term applied to conditions of pain, or inability to articulate, various elements of the musculoskeletal system.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Saliva (Salivary)
The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
Selenium
An essential element involved primarily in enzymes that are antioxidants. Three selenium- containing enzymes are antioxidant peroxidases and a fourth selenium-containing enzyme is involved in thyroid hormone production. The prostate contains a selenium-containing protein and semen contains relatively large amounts of selenium. Clinical studies show that selenium is important in lowering the risk of several types of cancers. In combination with Vitamin E, selenium aids the production of antibodies and helps maintain a healthy heart. It also aids in the function of the pancreas, provides elasticity to tissues and helps cells defend themselves against damage from oxidation.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Thyroiditis (Chronic Thyroiditis, Hashimoto's Thyroiditis)
Inflammation of the thyroid; there are several forms of thyroiditis, including chronic or Hashimoto's thyroiditis (also called autoimmune or chronic lymphocyctic thyroiditis), subacute thyroiditis, and painless or postpartum thyroiditis. Thyroiditis often results in hypothyroidism.
Thyrotoxicosis (Graves Disease, Graves' Disease)
Also known as Graves' disease, is a disorder of excess thyroid hormone production. It is usually linked to an enlarged thyroid gland and bulging eyes (exophthalmos).
Thyroxin (T4)
A thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.
Urticaria (Hives)
Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergies to foods or medications as well as viral illness are frequent causes of acute urticaria which usually lasts only a few hours but may last up to 6 weeks. Chronic urticaria (lasting more than 6 weeks) is more complex, given the vast number of potential triggers. Symptoms include sudden onset; initial itching; then swelling of the surface of the skin into red or skin-colored welts (wheals) with clearly defined edges; welts turn white on touching; new welts develop when the skin is scratched; usually disappear within minutes or hours. Welts enlarge, change shape, spread or join together to form large flat raised areas.
Last updated: Mar 18, 2009
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