Similar to other tissues, the thyroid can also be affected by an autoimmune disease. This is the case with Hashimoto’s thyroiditis, also known as chronic lymphocyte thyroiditis. This disease is the most common cause of hypothyroidism and goiter in adults. What are the risk factors? We talk about this topic with Professor Andrea Lania, Professor of Endocrinology at Humanitas University and Head of the Operating Unit of Endocrinology of Humanitas.
Hashimoto’s thyroiditis may occur at any age but it predominantly affects adult subjects, especially middle-aged women (with an incidence of 3.5 cases per 1,000 inhabitants compared to 0.8 cases per 1,000 registered in the male sex), whereas it is very rare in children. The underlying causes of the immune system’s “aggression” against glandular tissues are unknown. The result is clear: the thyroid gland begins to produce a small amount of thyroid hormones.
However, it must be emphasized – explains Professor Lania – how it is necessary to destroy 90% of the gland in order to manifest a condition of frank hypothyroidism. The diagnosis is based on the finding of thyroid antibodies (antibodies to thyroglobulin and thyrooperoxidase antibodies) and/or a thyroid ultrasound pattern characterized by a hypoecogenic gland of increased size and uneven appearance.
It should also be remembered that Hashimoto’s thyroiditis may be associated in some patients with other endocrinological autoimmune diseases (such as diabetes type 1, hyposurrenalism type I or Addison’s disease) and non-endocrinological diseases (such as celiac disease or vitiligo)”.
Family history is also a risk factor behind Hashimoto’s thyroiditis
In the case of a subject with a family history of autoimmune thyroidopathies, it will be sufficient to assess the integrity of thyroid function, the absence of thyroid antibodies and the normal ultrasound pattern. In these cases, it will not be necessary to carry out further investigations unless there are signs or symptoms of thyroid hypofunction (such as, easy tiredness, difficulty in concentration, constipation, cold intolerance) over time”, the specialist remembers.
In the event that the ultrasound picture or positive results for anti-thyroid antibodies lead to the diagnosis of Hashimoto’s thyroiditis, annual monitoring of circulating levels of TSH (the thyroid stimulating hormone), a control to be anticipated in the event of pregnancy or the onset of symptoms attributable to altered thyroid function, will suffice “.
What is the treatment of Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis itself does not require any specific treatment at least until thyroid function is normal. L-tyroxine replacement therapy is indicated in patients with frank hypothyroidism, in patients with subclinical hypothyroidism with TSH above 10 U/L or in patients with subclinical hypothyroidism during pregnancy or in anticipation of pregnancy,” concludes Professor Lania.
