Does Hashimotos get worse over time?
Fatigued or Full Throttle: Is Your Thyroid to Blame?
Feeling all revved up, even at bedtime? Or maybe your throttle’s on idle with symptoms of depression, fatigue, and weight gain. In both cases, the root cause may be your thyroid.
The thyroid — a butterfly-shaped gland in the front of your neck — makes hormones that control the way your body uses energy. Your thyroid controls your metabolism, which is how your body turns food into energy, and also affects your heart, muscles, bones, and cholesterol.
While thyroid disorders can range from a small, harmless goiter (enlarged gland) to life-threatening cancer, the most common thyroid problems involve an abnormal production of thyroid hormones. If there is too much of these vital body chemicals, the result is a condition known as hyperthyroidism. Too little hormone production leads to hypothyroidism.
Although the effects of thyroid problems are unpleasant or uncomfortable, most thyroid conditions can be managed well if properly diagnosed and treated.
What Is an Overactive Thyroid?
Hyperthyroidism happens when the thyroid becomes overactive and produces too much of its hormones. Hyperthyroidism affects women five times to 10 times more often than men, and is most common in people younger than 40. People with hyperthyroidism have problems that reflect over activity of the body’s organs, resulting in such symptoms as sweating, feeling hot, rapid heartbeat, weight loss, and sometimes eye problems.
Hyperthyroidism can occur in several ways:
Graves’ disease: The release of excess hormones is triggered by an autoimmune disorder. For some unknown reason, the body attacks the thyroid, causing it to spill out too much hormone.
Toxic adenomas: Nodules (abnormal growths or lumps) develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body’s chemical balance. Some goiters may contain several of these nodules.
Subacute thyroiditis: Painful inflammation of the thyroid causes the gland to enlarge and «leak» excess hormones, resulting in temporary hyperthyroidism, which resolves spontaneously. Subacute thyroiditis generally lasts a few weeks but may persist for months.
Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.
Silent thyroiditis: This is usually a temporary state of excess thyroid hormone release causing mild hyperthyroidism. In some cases it can result in permanent damage to the thyroid and low thyroid hormone production by the gland.
Postpartum thyroiditis: This is a type of hyperthyroidism that occurs in a small percentage of women within months of delivery. It last only a few months, followed by several months of reduced amounts of thyroid hormone production by the gland. Typically these women fully recover normal thyroid function.
Ingestion of excess thyroid hormone can result in hyperthyroidism.
What Is an Underactive Thyroid?
Hypothyroidism, by contrast, stems from an underproduction of thyroid hormones. Since your body’s energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy levels, causing you to feel weak and tired.
Approximately 25 million people suffer with hypothyroidism and about half are undiagnosed. Older adults — particularly women — are more likely to develop hypothyroidism than younger adults. Hypothyroidism also tends to run in families.
If hypothyroidism is not treated, it can raise your cholesterol levels and make you more likely to have a heart attack or stroke. During pregnancy, untreated hypothyroidism can harm your baby. Luckily, hypothyroidism is easy to treat.
Causes of hypothyroidism may include:
Hashimoto’s thyroiditis: In this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones. Other autoimmune disorders occur with this condition and other family members may also be affected by this condition.
Removal of the thyroid gland: The thyroid may be surgically removed or chemically destroyed as treatment for hyperthyroidism.
Exposure to excessive amounts of iodide: The heart medicine amiodarone may expose you to too much iodine. Radioactive iodine treatment for hyperthyroidism can also result in hypothyroidism. You may be at greater risk for developing hypothyroidism, especially if you have had thyroid problems in the past.
Lithium: This drug has also been linked as a cause of hypothyroidism.
If left untreated for a long period of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone injections.
How Is Hypothyroidism or Hyperthyroidism Diagnosed?
Your doctor will ask you about your symptoms and do a physical exam. Then they will order blood tests to see how much thyroid hormone your body is making. In addition, your doctor may discover that you have hyperthyroidism while doing a test for another reason.
Signs and Symptoms of a Thyroid Problem:
- You may feel nervous, moody, weak, or tired.
- Your hands may shake, your heart may beat fast, or you may have problems breathing.
- You may be sweaty or have warm, red, itchy skin.
- You may have more bowel movements than usual.
- You may have fine, soft hair that is falling out.
- You may feel tired, weak, and/or depressed.
- You may have dry skin and brittle nails.
- You may have difficulty standing cold temperatures.
- You may have constipation.
- You may experience memory problems or trouble thinking clearly.
- You may have heavy or irregular menstrual periods.
- You may lose weight even though you eat the same or more than usual.
Symptoms of hypothyroidism occur slowly over time. At first you might not notice these symptoms. Or you might mistake them for normal aging. This is not normal aging. See your doctor if you have symptoms like these that get worse or won’t go away.
Pregnancy, which requires an increased production of thyroid hormone, can cause hypothyroidism. About 2% of pregnant women in the United States get hypothyroidism.
How Is Hyperthyroidism Treated?
Hyperthyroidism is easily treated. With treatment, you can lead a healthy life. Without treatment, hyperthyroidism can lead to serious heart problems, bone problems, and a dangerous condition called thyroid storm.
If your symptoms bother you, your doctor may give you pills called beta-blockers. These can help you feel better while you and your doctor decide what your treatment should be. Even if your symptoms do not bother you, you still need treatment because hyperthyroidism can lead to more serious problems.
Radioactive iodine and anti-thyroid medicine are the treatments doctors use most often. The best treatment for you will depend on a number of things, including your age. Some people need more than one kind of treatment.
After treatment, you will need regular blood tests. These tests check to see if your hyperthyroidism has come back. They also check to see if you are making enough thyroid hormone. Sometimes treatment cures hyperthyroidism but causes the opposite problem-too little thyroid hormone. If this happens, you may need to take thyroid hormone pills for the rest of your life.
What Medicine Is Used for Hypothyroidism?
Doctors usually prescribe thyroid hormone pills to treat hypothyroidism. Most people start to feel better within a week or two. Your symptoms will probably go away within a few months. But you will likely need to keep taking the pills for the rest of your life.
In most cases, thyroid hormone medication works quickly to correct symptoms. People with hypothyroidism who take thyroid hormone medication usually notice:
- Improved energy level
- Gradual weight loss (in people with severe hypothyroidism at the time of diagnosis)
- Improved mood and mental function (thinking, memory)
- Improved pumping action of the heart and improved digestive tract function
- Reduction in the size of an enlarged thyroid gland (goiter), if you have one
- Lower cholesterol and triglyceride levels
It’s important to take your medicine just the way your doctor tells you to. You will also need to see your doctor for follow-up visits to make sure you have the right dose. Getting too much or too little thyroid hormone can cause problems.
If you have mild (subclinical) hypothyroidism, you may not need treatment now. But you’ll want to watch closely for signs that it is getting worse.
Thyroid Disease or Menopause?
According to the American Association of Clinical Endocrinologists (AACE), millions of women with unresolved menopausal-like symptoms, even those taking estrogen, may be suffering from undiagnosed thyroid disease. While symptoms such as fatigue, depression, mood swings, and sleep disturbances are frequently associated with menopause, they may also be signs of hypothyroidism.
A survey done by the AACE showed that only one in four women who have discussed menopause and its symptoms with a physician was also tested for thyroid disease. The thyroid plays a role in regulating overall body metabolism and influences the heart, brain, kidney, and reproductive system, along with muscle strength and appetite.
If you are experiencing symptoms of menopause and the symptoms persist despite appropriate therapy, ask your doctor to do a thyroid screen (TSH). A blood sample is all that is needed to make the initial diagnosis of hypothyroidism and treatment is easily achieved with thyroid replacement therapy.
What About Thyroid Cancer?
Cancer of the thyroid gland is quite rare and occurs in less than 10% of thyroid nodules. You might have one or more thyroid nodules for several years before they are determined to be cancerous. People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy for acne, tend to have a higher-than-normal propensity for thyroid cancer.
Signs and Symptoms:
- You may get a lump or swelling in your neck. This is the most common symptom.
- You may have pain in your neck and sometimes in your ears.
- You may have trouble swallowing.
- You may have trouble breathing or have constant wheezing.
- Your voice may be hoarse.
- You may have a frequent cough that is not related to a cold.
Some people may not have any symptoms. Their doctors may find a lump or nodule in the neck during a routine physical exam.
Most people who have treatment for thyroid cancer do very well, because the cancer is usually found early and the treatments, including surgery, work well. Once treated, thyroid cancer rarely returns.
WebMD Feature Reviewed by Carol DerSarkissian, MD on July 23, 2022
WebMD’s Medical References: «Understanding Thyroid Problems: The Basics.» «Thyroid and Menopause: Confusing the Symptoms.» «Thyroid Storm.»
WebMD’s Medical References: «Hypothyroidism.» «Hypothyroidism Cause.» «Thyroid hormone medications for hypothyroidism.» «Hyperthyroidism.»
© 2008 WebMD, LLC. All rights reserved.
Women’s Health Guide
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Hashimoto’s disease is an autoimmune disorder affecting the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the neck just below the Adam’s apple. The thyroid produces hormones that help regulate many functions in the body.
An autoimmune disorder is an illness caused by the immune system attacking healthy tissues. In Hashimoto’s disease, immune-system cells lead to the death of the thyroid’s hormone-producing cells. The disease usually results in a decline in hormone production (hypothyroidism).
Although anyone can develop Hashimoto’s disease, it’s most common among middle-aged women. The primary treatment is thyroid hormone replacement.
Hashimoto’s disease is also known as Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis.
Hashimoto’s disease progresses slowly over the years. You may not notice signs or symptoms of the disease. Eventually, the decline in thyroid hormone production can result in any of the following:
- Fatigue and sluggishness
- Increased sensitivity to cold
- Increased sleepiness
- Dry skin
- Muscle weakness
- Muscle aches, tenderness and stiffness
- Joint pain and stiffness
- Irregular or excessive menstrual bleeding
- Problems with memory or concentration
- Swelling of the thyroid (goiter)
- A puffy face
- Brittle nails
- Hair loss
- Enlargement of the tongue
When to see a doctor
Signs and symptoms of Hashimoto’s disease vary widely and are not specific to the disorder. Because these symptoms could result from any number of disorders, it’s important to see your health care provider as soon as possible for a timely and accurate diagnosis.
Hashimoto’s disease is an autoimmune disorder. The immune system creates antibodies that attack thyroid cells as if they were bacteria, viruses or some other foreign body. The immune system wrongly enlists disease-fighting agents that damage cells and lead to cell death.
What causes the immune system to attack thyroid cells is not clear. The onset of disease may be related to:
- Genetic factors
- Environmental triggers, such as infection, stress or radiation exposure
- Interactions between environmental and genetic factors
The following factors are associated with an increased risk of Hashimoto’s disease:
- Sex. Women are much more likely to get Hashimoto’s disease.
- Age. Hashimoto’s disease can occur at any age but more commonly occurs during middle age.
- Other autoimmune disease. Having another autoimmune disease — such as rheumatoid arthritis, type 1 diabetes or lupus — increases your risk of developing Hashimoto’s disease.
- Genetics and family history. You’re at higher risk for Hashimoto’s disease if others in your family have thyroid disorders or other autoimmune diseases.
- Pregnancy. Typical changes in immune function during pregnancy may be a factor in Hashimoto’s disease that begins after pregnancy.
- Excessive iodine intake. Too much iodine in the diet may function as a trigger among people already at risk for Hashimoto’s disease.
- Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto’s disease.
Thyroid hormones are essential for the healthy function of many body systems. Therefore, when Hashimoto’s disease and hypothyroidism are left untreated, many complications can occur. These include:
- Goiter. A goiter is enlargement of the thyroid. As thyroid hormone production declines due to Hashimoto’s disease, the thyroid receives signals from the pituitary gland to make more. This cycle may result in a goiter. It’s generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing.
- Heart problems. Hypothyroidism can result in poor heart function, an enlarged heart and irregular heartbeats. It can also result in high levels of low-density lipoprotein (LDL) cholesterol — the «bad» cholesterol — that is a risk factor for cardiovascular disease and heart failure.
- Mental health issues. Depression or other mental health disorders may occur early in Hashimoto’s disease and may become more severe over time.
- Sexual and reproductive dysfunction. In women, hypothyroidism can result in a reduced sexual desire (libido), an inability to ovulate, and irregular and excessive menstrual bleeding. Men with hypothyroidism may have a reduced libido, erectile dysfunction and a lowered sperm count.
- Poor pregnancy outcomes. Hypothyroidism during pregnancy may increase the risk of a miscarriage or preterm birth. Babies born to women with untreated hypothyroidism are at risk for decreased intellectual abilities, autism, speech delays and other developmental disorders.
- Myxedema (miks-uh-DEE-muh). This rare, life-threatening condition can develop due to long-term, severe, untreated hypothyroidism. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.
A number of conditions may lead to the signs and symptoms of Hashimoto’s disease. If you’re experiencing any of these symptoms, your health care provider will conduct a thorough physical exam, review your medical history and ask questions about your symptoms.
Testing thyroid function
To determine if hypothyroidism is the cause of your symptoms, your provider will order blood tests that may include the following:
- TSH test. Thyroid stimulating hormone (TSH) is produced by the pituitary gland. When the pituitary detects low thyroid hormones in the blood, it sends TSH to the thyroid to prompt an increase in thyroid hormone production. High TSH levels in the blood indicates hypothyroidism.
- T-4 tests. The main thyroid hormone is thyroxine (T-4). A low blood level of T-4 confirms the findings of a TSH test and indicates the problem is within the thyroid itself.
More than one disease process can lead to hypothyroidism. To determine if Hashimoto’s disease is the cause of hypothyroidism, your health care provider will order an antibody test.
The intended purpose of an antibody is to flag disease-causing foreign agents that need to be destroyed by other actors in the immune system. In an autoimmune disorder, the immune system produces rogue antibodies that target healthy cells or proteins in the body.
Usually in Hashimoto’s disease, the immune system produces an antibody to thyroid peroxidase (TPO), a protein that plays an important part in thyroid hormone production. Most people with Hashimoto’s disease will have TPO antibodies in their blood. Lab tests for other antibodies associated with Hashimoto’s disease may need to be done.
Most people with Hashimoto’s disease take medication to treat hypothyroidism. If you have mild hypothyroidism, you may have no treatment but get regular TSH tests to monitor thyroid hormone levels.
T-4 hormone replacement therapy
Hypothyroidism associated with Hashimoto’s disease is treated with a synthetic hormone called levothyroxine (Levoxyl, Synthroid, others). The synthetic hormone works like the T-4 hormone naturally produced by the thyroid.
The treatment goal is to restore and maintain adequate T-4 hormone levels and improve symptoms of hypothyroidism. You will need this treatment for the rest of your life.
Monitoring the dosage
Your heath care provider will determine a dosage of levothyroxine that’s appropriate for your age, weight, current thyroid production, other medical conditions and other factors. Your provider will retest your TSH levels about 6 to 10 weeks later and adjust the dosage as necessary.
Once the best dosage is determined, you will continue to take the medication once a day. You’ll need follow-up tests once a year to monitor TSH levels or any time after your provider changes your dosage.
A levothyroxine pill is usually taken in the morning before you eat. Talk to your doctor if you have any questions about when or how to take the pill. Also, ask what to do if you accidentally skip a dose. If your health insurance requires you to switch to a generic drug or a different brand, talk to your doctor.
Because levothyroxine acts like natural T-4 in the body, there are generally no side effects as long as the treatment is resulting in «natural» levels of T-4 for your body.
Too much thyroid hormone can worsen bone loss that causes weak, brittle bones (osteoporosis) or cause irregular heartbeats (arrhythmias).
Effects of other substances
Certain medications, supplements and foods may affect your ability to absorb levothyroxine. It may be necessary to take levothyroxine at least four hours before these substances. Talk to your doctor about any of the following:
- Soy products
- High-fiber foods
- Iron supplements, including multivitamins that contain iron
- Cholestyramine (Prevalite), a medication used to lower blood cholesterol levels
- Aluminum hydroxide, which is found in some antacids
- Sucralfate, an ulcer medication
- Calcium supplements
T-3 hormone replacement therapy
Naturally produced T-4 is converted into another thyroid hormone called triiodothyronine (T-3). The T-4 replacement hormone is also converted into T-3 , and for most people the T-4 replacement therapy results in an adequate supply of T-3 for the body.
For people who need better symptom control, a doctor also may prescribe a synthetic T-3 hormone (Cytomel) or a synthetic T-4 and T-3 combination. Side effects of T-3 hormone replacement include rapid heartbeat, insomnia and anxiety. These treatments may be tested with a trial period of 3 to 6 months.
Products with T-3 and T-4 hormones derived from pigs or other animals are available as prescriptions or as dietary supplements, such as Armour Thyroid, in the United States. Concerns about these products include the following:
- The balance of T-4 and T-3 in animals isn’t the same as in humans.
- The exact amount of T-4 and T-3 in each batch of a natural extract product can vary, leading to unpredictable levels of these hormones in your blood.
Preparing for an appointment
You’re likely to start by seeing your primary care provider, but you may be referred to a specialist in hormone disorders (endocrinologist).
Be prepared to answer the following questions:
- What symptoms are you experiencing?
- When did you start experiencing them?
- Did your symptoms begin suddenly or develop gradually over time?
- Have you noticed changes in your energy level or your mood?
- Has your appearance changed, including weight gain or skin dryness?
- Have your bowel habits changed? How?
- Do you have muscle or joint pain? Where?
- Have you noticed a change in your sensitivity to cold?
- Have you felt more forgetful than usual?
- Has your interest in sex decreased? If you’re a woman, has your menstrual cycle changed?
- What medications do you take? What are these medications treating?
- What herbal remedies, vitamins or other dietary supplements do you take?
- Is there a history of thyroid disease in your family?
Last Updated: January 15th, 2022
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