- Originaltext:
Nicole Rolfsmeier
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Übersetzung:
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The Hashimoto
Thyreoiditis is generally considered as a harmless illness,
which causes no complaints and which must be observed, but not
necessarily be treated. Frequently it is an accidental finding
during a routine examination, but sometimes it is diagnosed
after a long tale of woe. In view of this the insufficient
knowledge of physicians is a scandal. About 10 % of the
population is afflicted with this disease.
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The Hashimoto
Thyreoiditis is no trifle, which can be neglected, but a chronic
disease which requires a consistent and individually adapted
treatment. This thyroid illness durably impaired in the quality
of life means no expression of being exaggerated sniveling nor
sign of will weak. The Hashimoto Thyreoiditis is no
psychosomatic disease.
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In many cases the
late beginning of treatment is the main cause that not all
symptoms are reversible. By the way it is a problem that only
the hypothyroidism can be treated and not the causes of the
autoimmune process which makes also complaints.
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The
thyroid is part of the neck. It lies before the air tube, scarce
underneath the larynx. The thyroid is reminiscent of the form of
a butterfly. With 15 – 25 g the thyroid is very small, but
those of it produced hormones are genuine multi-talents. Almost
all organs are influenced by the thyroid homones thyroxin (T4)
and trijodthyronin (T3).
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Definition:
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The
Hashimoto Thyreoiditis (autoimmune thyreoiditis) is a chronic
inflammation of the thyroid. This inflammation is not caused by
viruses or bacteria, but goes back on a defect in the immune
system. The defense cells from the immune system normally
arranged against body-stranger intruders do falsely attack
body-own tissue. Relevant to this the Hashimoto-Thyreoiditis is
the frequent autoimmune disease of human beeings. The
Hashimoto-Thyreoiditis is named after its disoverer, the
japanese physician Dr. Hakaru Hashimoto, who described this
disease 1912. Relative to the Hashimoto Thyreoiditis there are
two different variants. On the one hand the hypertrophe variant
(enlargement of the thyroid) and on the other hand the atrophe
variant (reduction of the thyroid).
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Causes:
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The
exact causes for the raise of the Hashimoto thyreoiditis are not
scientifically investigated. Presumable there is not only one
cause, but several factors must assemble before it comes to the
outbreak of disease. A genetic predisposition, chronic
infections, stress, iodine exposition, smoking, quicksilver or
changes of sexual hormones (puberty, pregnancy, climacteric
period) are discussed causes.
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Diagnosis:
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First
reference to the existance of thyroid disease give the results
of a blood test. Referring to the Hashimoto Thyreoiditis it must
be differentiated between the hormones (TSH, fT4, fT3) an the
anti-bodies (TPO-AK, TG-AK, TRAK). The hormones describe the
thyroid function, the antibodies are important for the
diagnosis. Independently whether these blood values are still in
the normal range, there should be enforced an ultrasonic
diagnosis. Because in the initial stage of the Hashimoto
Thyreoiditis there is no restriction of the thyroid function.
The inflammatory destruction process runs slowly and for a
period of months or years there is no measurable loss of
function. Therefore a TSH about 2 uIU/ml can be a hint to
hypothyroidism. Also the absence of anti-bodies does not exclude
a Hashimoto Thyreoiditis. Decisive is the ultrasonic diagnosis
of the thyroid which showes the inflammation. If on this
occasion a thyroid volume smaller than 10 ml is determined this
fact point to hypothyroidism. In individual cases further
examinations can be necessary.
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Progress
of disease:
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At
the beginning of the inflammation the thyroid hormone cells are
destructed. The elevated hormones get released and effect
symptoms of hyperthyroidism (for example: sweating,
restlessness, trembling, diarrhea, loss in weight). This phase
is also called hashitoxicosis. In the progress of disease the
inflammation leads to a complete destruction of the thyroid.
There are no longer enough hormones to supply the organism. This
phase is called hypothyroidism. There is no possibility to
restore the Hashimoto Thyreoiditis.
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Symptoms:
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The complaints,
which can be caused by a Hashimoto Thyreoiditis are very
versatile because they do not only affect the thyroid, but also
different organ systems can be afflicted. The way and mode oft
the symptoms is individually different.
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The following
impairments are possible:
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Local symptoms:
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Throat feels full,
sore throat, hoarseness, local skin rash, pain of the neck and
facial muscles, toothache
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Skin and hair:
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Swelling around the
eyes (eyelid edemas), dry skin, itching, rough hair, loss of
hair, fingernails bittle and break
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Cardiovascular
system:
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Heart beating, heart
trouble, vertigo, diastolic high blood pressure (rare: slow
blood pressure), slow pulse, difficulties in breathing
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Metabolism:
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Increase in weight,
unable to lose weight, weakness, fatigue, lethargy, low body
temperature, high cholesterin
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Stomach intestine
system:
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Loss of appetite,
nausea, heartburn, stomachache, flatulance, obstruction
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Muscles and
joints:
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Muscular ache, loss
of muscular strength, muscular atrophy, pain in the limbs,
rheumatism, carpal tunnel syndrom
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Psyche:
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Tearful, depressing,
restless, irritability, nervousness, anxiousness, panic attacks,
difficulty to concentrate or remember things, sleeplessness
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Sexual hormones:
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Irregular
menstruation, sterile
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Therapy:
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The Hashimoto
Thyreoiditis is treated by the lifelong substitution of the
missing thyroid hormones. Normally by the daily income 30 to 60
minutes before breakfast. The cause of Hashimoto Thyreoiditis is
not influenced by the thyroid homone therapy. In this coherence
it is important that the thyroid hormone dose does only slowly
increased (25 µg per week). Bloodtests are regularly
necessary – normally every 3 to 6 months. Before the blood
tests do not take your medicament!
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There are different
possibilities of treatment: treatment only with T4, treatment
with T4 plus T3 or treatment with natural hormone. Many patients
feel fine under this therapy, but there is a little group of
patients which have continuing problems. For these patients
there is unfortunately hardly any alternative treatment.
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The treatment with
iodine makes no sense. On the contrary the inflammation will be
stimulated. The daily income of 200 µg selenium can sink
the concentration of the thyroid anti-bodies. This is proved by
several studies. Selenium affects as a antioxidans. But selenium
is even important for the conversion of the inactive hormon T4
to the metabolist active hormon T3.
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An
operation is rarely necessary, only in case of a present goiter.
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