What is Hashimoto's Disease?

Hashimoto's disease is an autoimmune disease that affects the thyroid gland, causing hypothyroidism, or underactivity. In this condition, immune system cells can cause the death of the thyroid's hormone-producing cells. This condition, which typically results in decreased hormone production (hypothyroidism), can affect various parts of the body, causing symptoms such as fatigue, weight gain, and constipation. The disease can be treated with medications.

Hashimoto's is an autoimmune disease that occurs when thyroid hormone production decreases, and is also known as lymphocytic thyroiditis. It is named after the Japanese scientist Akira Hashimoto, who described it in 1912. In this disease, the body produces large amounts of anti-TPO antibodies and anti-thyroglobulin antibodies to destroy the thyroid gland. These antibodies bind to the thyroid gland, destroying thyroid cells and causing inflammation. As a result, thyroid hormone production decreases.

Initially, the disease presents with a small goiter and elevated anti-TPO antibody levels, while TSH, T3, and T4 hormones may be normal. However, over time, the disease progresses, and thyroid insufficiency develops. Therefore, complete thyroid failure may occur in the later stages of the disease.

What are the symptoms of Hashimoto's disease?

Symptoms of Hashimoto's disease include:

• Fatigue and weakness
• Sensitivity to chills and cold
• Somnolence
• Dry skin
• Constipation
• Hair loss
• Muscle weakness
• Weight gain
• Difficulty concentrating
• Presence of goiter
• Mood changes such as depression and irritability
• Swelling under the eyes and on the face
• Getting cold easily
• Cramps
• Change in voice
• Menstrual irregularity
• Anorexia
• Slowness and forgetfulness in speech
• Decrease in pulse rate
• Patients with advanced hypothyroidism may also experience the following symptoms:
• Fluid accumulation in the lungs and heart membranes
• Carpal tunnel syndrome
• Sleep apnea
• Milk discharge from the breasts or an increase in the prolactin hormone
• Decreased sexual desire
• Low blood sodium levels

Cholesterol levels can often be high in Hashimoto's disease, and therefore, the patient may also experience cardiovascular disease. In advanced cases, complications such as fluid retention in the pericardium (pericarditis), lungs (pleurisy), and abdominal ascites can occur.

Causes and Risk Factors of Hashimoto's Disease

The primary cause of Hashimoto's disease is the immune system's mistaken identification of its own tissues as foreign and its subsequent attack on the thyroid gland. However, genetic and environmental factors can also contribute to the development of Hashimoto's. Risk factors and associated conditions include:

• Type 1 diabetes
• Vitiligo
• Celiac Disease
• Addison's Disease
• Rheumatoid arthritis
• Pernicious Anemia
• Butterfly Disease (Lupus)
• Anti-TPO positivity (presence of anti-thyroperoxidase antibodies)
• Individuals with heart failure

Hashimoto's disease is generally more common in women. Estrogen levels and genetic predisposition are among the risk factors for this condition. While less common in men, it is a significant cause of thyroid hormone deficiency in men.

Complications Caused by Hashimoto's Disease

When Hashimoto's disease and hypothyroidism are left untreated, a number of complications can occur:

• Goiter : As thyroid hormone production decreases, the thyroid gland may receive more stimulation from the pituitary gland, leading to a goiter. This can cause visual discomfort and interfere with breathing.
• Heart problems: Hypothyroidism caused by Hashimoto's can cause poor heart function or irregular heartbeats. You may also have high levels of low-density lipoprotein (LDL) cholesterol, which can increase your risk of cardiovascular disease and heart failure.
• Mental health problems: Hashimoto's disease may trigger depression or other mental health disorders early on.
• Reproductive problems: In women, hypothyroidism can cause decreased libido, ovulation problems, and irregular menstrual periods. In men, hypothyroidism can cause decreased libido, erectile dysfunction, and decreased sperm count.
• Pregnancy complications: Hypothyroidism during pregnancy can increase the risk of miscarriage or premature birth. Babies born to women with untreated hypothyroidism may experience developmental disabilities such as decreased intellectual ability, autism, and speech delays.

Hashimoto's disease can also cause endocrine disorders (e.g., adrenal gland problems or diabetes), musculoskeletal disorders (e.g., rheumatic diseases), and psychiatric disorders (e.g., depression). Thyroid nodules can also occur when the disease causes structural abnormalities in the thyroid gland and may require monitoring.

Tests and Treatment Methods Used in the Diagnosis of Hashimoto's Disease

The tests and treatment methods used in the diagnosis of the disease are as follows:

Diagnostic methods

• Thyroid hormone tests: Diagnosis of Hashimoto's disease involves testing thyroid hormone levels. These include free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH). Thyroid hormone levels are normal in most patients, but hypothyroidism can occur in approximately 10% of cases.
• Antibody tests: Most people with Hashimoto's disease have lifelong anti-TPO and anti-TG antibodies. These antibodies predict the development of hypothyroidism in later stages of the disease.
• Ultrasound : Ultrasound examination of the thyroid gland is used to assess the presence of nodules and the structure of the thyroid tissue. A needle biopsy can be performed under ultrasound guidance to determine whether the nodules are benign.

Treatment

• Hormone Therapy: Patients diagnosed with hypothyroidism are prescribed thyroid hormone therapy. In untreated hypothyroidism, the dose is adjusted until TSH levels return to normal. Once within normal limits, the dose is adjusted with regular checkups.
• Monitoring and follow-up: People with Hashimoto's disease should be regularly monitored by their physician. Dosage adjustments may be necessary based on factors such as diet, weight gain, and disease activity. Monitoring is especially important for women during pregnancy and childbearing age.
• Nodule monitoring: Some patients with Hashimoto's disease are more prone to developing thyroid nodules. Regular monitoring of thyroid nodules is important in these patients.

As the disease progresses, problems such as hair loss, difficulty controlling weight, elevated blood lipids, cardiovascular disease, and anemia can occur. Therefore, regular checkups and adherence to treatment are crucial.

Which Department Takes Care of Hashimoto's Disease?

Hashimoto's disease is usually managed by an internal medicine specialist or endocrinologist. These specialists are concerned with the health and function of the thyroid gland. If you have the condition, it would be appropriate to consult one of these specialists.

Nutritional principles in Hashimoto's disease

While there's no specific diet for Hashimoto's disease, a healthy diet is important for people with Hashimoto's disease, as it is for any illness. Making healthy eating choices can alleviate symptoms and support overall health. Here are some nutritional recommendations for patients:

• Selenium: Selenium may reduce the antibody levels in Hashimoto's disease. However, it has not been proven to alter the clinical course of the disease.
• Gluten-free diet: Some studies suggest that a gluten-free diet may help reduce symptoms in patients. Therefore, a gluten-free diet may be recommended for patients with known gluten sensitivity or intolerance.
• Medication intake: It is important for patients taking thyroid hormone medications for hypothyroidism to take them on an empty stomach. Additionally, they should not be taken with foods that can interfere with the absorption of thyroid hormone medication, such as whole grains, yogurt, or milk.
• Balanced and varied diet: A healthy eating plan should include a balance of protein, carbohydrates, healthy fats, fiber, vitamins, and minerals. Eating a variety of foods helps the body get the nutrients it needs.
• Anti-inflammatory foods: Foods with anti-inflammatory properties may be beneficial for people with Hashimoto's. These include fish, olive oil, fruits, vegetables, leafy greens, and spices containing omega-3 fatty acids.
• Water consumption: Hydration is important. Drinking plenty of water helps the body function healthily and regulates metabolism.
• Individual tolerances: Every Hashimoto patient's body is different, so it's important to determine which foods are appropriate for their individual tolerances. Patients with sensitivities to certain foods can avoid them by monitoring their symptoms and consulting with their doctor.

Ultimately, it's important for individuals with Hashimoto's disease to follow a healthy, balanced diet. However, nutritional preferences and diet plans may vary depending on individual health conditions and symptoms. Therefore, it's important to consult a nutritionist or doctor to develop a nutrition plan tailored to their individual needs.

Salt Consumption in Hashimoto's Disease: Recommendations and Cautions

There are no specific restrictions on salt consumption for Hashimoto's disease patients. There is no definitive evidence that iodine affects the clinical course of the disease, either positively or negatively. Therefore, patients can keep their salt intake within normal limits. However, avoiding excessive salt consumption is recommended for a healthy lifestyle. It's important to consult your doctor if you have any dietary concerns.

Weight Loss for Hashimoto's Patients: Suggestions and Tips

Patients can follow the following steps to lose weight:

• Regulation of thyroid hormones: Treatment for hypothyroidism (thyroid hormone deficiency) requires regular medication. Using the correct dosage and timing can help regulate metabolism and control weight.
• Conscious eating: It's important to create a healthy and balanced diet. Consume high-fiber foods, healthy proteins, vegetables, fruits, and whole grains. Also, avoid processed foods, sugary foods, and fatty foods.
• Portion control: Portion control should be implemented to prevent excess calorie intake. Choose low-calorie, nutritious foods.
• Exercise: Regular exercise can speed up weight loss. Aerobic exercise, cardio activities, and resistance training can be beneficial for people with Hashimoto's.
• Stress management: Stress can trigger weight gain. Stress management techniques, such as meditation, deep breathing exercises, or yoga, can reduce stress levels and support weight loss.
• Doctor follow-up: It's important to stay in touch with your doctor during the weight loss process. Regular checkups are essential to ensure proper thyroid hormone regulation and weight loss support.
• Patience and motivation: The weight loss process can be time-consuming and sometimes challenging. It's important to be patient and stay motivated to achieve your goals.

Patients should be careful during the weight loss process and choose healthy weight loss methods. It may be helpful to seek support from a doctor or nutritionist regarding diet and exercise plans.

What Shouldn't a Person with Hashimoto Eat?

Some foods that patients should be careful about when consuming:

• Iodized foods: Iodine plays an important role in the thyroid gland's hormone production. However, excessive iodine consumption can further impair thyroid function in patients. Therefore, seafood, iodized salt, and iodine supplements should be consumed in moderation.
• Gluten: Some research suggests that sensitivity or intolerance to gluten may increase inflammation and worsen symptoms in people with Hashimoto's. Therefore, avoiding foods containing gluten, such as wheat, barley, and rye, may be recommended.
• Soy: Soy products may interfere with the absorption of thyroid hormones and negatively impact thyroid function in some people with Hashimoto's disease. Therefore, consumption of foods containing soy should be limited.
• Raw cabbage and broccoli: Raw cruciferous vegetables, such as cabbage and broccoli, contain compounds that may affect thyroid function in people with Hashimoto's disease. Cooking or steaming these vegetables may reduce these adverse effects.
• Caffeine and alcohol: Caffeine and alcohol can cause hormonal imbalances and worsen symptoms in people with Hashimoto's. Therefore, it's important to limit caffeine and alcohol consumption or avoid it altogether if possible.
• Refined sugar and processed foods: Refined sugars and processed foods can increase inflammation and negatively impact metabolism. Therefore, it's important to avoid refined sugars and processed foods for a healthy diet.
• Food sensitivities: Individuals with Hashimoto's disease may develop sensitivities to certain foods. Therefore, it's important to monitor symptoms and identify which foods worsen them. If necessary, seeking support from a nutritionist or doctor may be helpful.