From the Guidelines
Hashimoto's thyroiditis typically presents with symptoms of hypothyroidism, including fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol, muscle aches and stiffness, joint pain, irregular or heavy menstrual periods, depression, and impaired memory. The condition is an autoimmune disorder where the immune system mistakenly attacks the thyroid gland, gradually destroying its ability to produce sufficient thyroid hormones 1. Some patients may also experience a painless enlargement of the thyroid gland called a goiter, which can cause a feeling of fullness in the throat. In the early stages of Hashimoto's, some people may temporarily experience hyperthyroidism symptoms like anxiety, rapid heartbeat, and insomnia as inflamed thyroid cells release excess hormones before becoming damaged 1. Diagnosis typically involves blood tests measuring thyroid-stimulating hormone (TSH), free T4, and thyroid antibodies, particularly thyroid peroxidase antibodies (TPO) 1. Key signs and symptoms to look out for include:
- Fatigue
- Increased sensitivity to cold
- Constipation
- Dry skin
- Unexplained weight gain
- Puffy face
- Hoarseness
- Muscle weakness
- Elevated blood cholesterol
- Muscle aches and stiffness
- Joint pain
- Irregular or heavy menstrual periods
- Depression
- Impaired memory
- Painless enlargement of the thyroid gland (goiter)
- Temporary hyperthyroidism symptoms in early stages, such as anxiety, rapid heartbeat, and insomnia. Treatment usually involves daily synthetic thyroid hormone replacement (levothyroxine) at doses typically starting at 1.6 mcg/kg body weight, adjusted based on TSH levels every 6-8 weeks until optimal levels are achieved 1.
From the Research
Signs and Symptoms of Hashimoto's (Autoimmune) Thyroiditis
- The condition is characterized by autoimmune-mediated destruction of the thyroid gland, leading to hypothyroidism 2, 3, 4, 5.
- Patients may present with or without signs or symptoms of hypothyroidism, often with a painless goiter, and are associated with elevated thyroid peroxidase antibodies 3, 4, 5.
- The disease may progress through a triphasic pattern of thyroid dysfunction, including an initial phase of hyperthyroidism, followed by hypothyroidism, and eventual restoration of normal thyroid function or permanent hypothyroidism 3.
- Systemic manifestations due to thyroid gland damage may occur, resulting in primary hypothyroidism 5.
- Some patients may experience a transient hyperthyroid phase, while others may develop frank hypothyroidism 4.
Diagnostic Features
- Diagnosis is suggested by a typical ultrasound pattern and the presence of antithyroid antibodies 4.
- Blood analysis of thyroid function and thyroid antibodies is essential for diagnosis 2.
- Cytological examination may show lymphocytic infiltration, lymphoid follicle formation with germinal centers, and parenchymal atrophy 5.
Clinical Presentation
- Patients may have variable thyroid function at presentation, ranging from hyperthyroidism to hypothyroidism 4.
- Some patients may have a family history of thyroid disease, which may be associated with an increased incidence of recovery of normal thyroid function 6.
- The presence of a larger goiter and high thyrotropin levels at the time of diagnosis may be related to an increased incidence of hypothyroidism remission 6.