Symptoms of Hashimoto's Disease

Common and Uncommon Signs of Autoimmune Hypothyroidism

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When discussing the symptoms of Hashimoto's disease (Hashimoto's thyroiditis), most are usually referring to the clinical symptoms of low thyroid function—fatigue, sensitivity to cold, hair loss, constipation, and others. Though Hashimoto's impairs the thyroid gland's ability to produce hormones that the body needs to maintain normal metabolism (the conversion of oxygen and calories into energy), it isn't until the associated inflammation of the thyroid gland—known as chronic lymphocytic thyroiditis—causes hypothyroidism that symptoms are usually detected.

symptoms of hashimoto's disease
Illustration by Emily Roberts, Verywell

Frequent Symptoms

Though most people with Hashimoto's have no obvious symptoms at the early stages of the disease, some may experience mild swelling at the front of the throat (goiter) caused by the direct inflammation of the gland.

Hashimoto's disease typically worsens slowly over many years and causes progressive damage to the thyroid gland, leading to an associative decline in thyroid hormone output.

While some people use the terms Hashimoto's disease and hypothyroidism synonymously, Hashimoto's is more aptly characterized as the disorder that often, but not always, leads to hypothyroidism.

As such, lists of Hashimoto's and hypothyroidism symptoms are the same. The most common ones include:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Pale and dry skin
  • A puffy face
  • Brittle nails
  • Hair loss (alopecia)
  • Enlargement of the tongue
  • Unexplained weight gain despite no change in your diet
  • Muscle aches (myalgia)
  • Joint pain (arthralgia)
  • Muscle weakness
  • Heavy menstrual bleeding (menorrhagia)
  • Irregular menstruation (oligomenorrhea)
  • Depression
  • Lapses in memory ("brain fog")
  • Low sex drive
  • Growth delay in children

Complications

As Hashimoto's disease progresses, it can cause permanent damage to the thyroid gland. In an effort to produce more thyroid hormone, the gland itself will start to enlarge, leading to the development of a goiter.

There are different types of goiter:

  • Diffuse, characterized by smooth and generalized swelling
  • Nodular, characterized by a lump
  • Multinodular (multiple lumps)
  • Retrosternal (extending backward toward the windpipe)

While smaller goiters may not require treatment, radioactive iodine (RAI) may be needed to reduce the size of larger ones. Retrosternal goiters occasionally require surgical removal if they interfere with breathing or swallowing.

The progressive dysregulation of metabolism and growing imbalances in hormonal output can begin to affect multiple organ systems, leading to a cascade of complications that extend well beyond the thyroid gland itself.

Infertility

If thyroid hormone levels are too low, they can affect the hormonal mechanisms that regulate the menstrual cycle and trigger ovulation. This can lead to infertility, which can affect up to 50 percent of women with Hashimoto's, according to research published in the International Journal of Endocrinology.

Even with the proper treatment of hypothyroidism, there is no guarantee that fertility can be fully restored in women severely affected by Hashimoto's.

Heart Disorders

Even mild hypothyroidism can have a profound effect on your heart health. The dysregulation of thyroid hormones can instigate increases in "bad" LDL (low-density lipoprotein) cholesterol, leading to the hardening of arteries (atherosclerosis) and increasing the risk of heart attacks and stroke.

Pericardial effusion, the buildup of fluid around the heart, can affect anywhere from 30 percent to 80 percent of people with hypothyroidism.

While most cases are mild, severe hypothyroidism can lead to a pericardial tamponade, a condition in which the heart is less able to pump blood. In some cases, it can lead to a potentially fatal drop in blood pressure.

Pregnancy Complications

Because maternal thyroid hormone is vital to fetal development, untreated hypothyroidism during pregnancy can lead to potentially serious complications for both the mother and baby.

According to research, untreated hypothyroidism nearly doubles the risk of premature birth and significantly increases the risk of low birth weight, premature rupture of membranes, fetal heartbeat irregularities, and fetal respiratory distress.

Even with subclinical hypothyroidism (in which there are no observable symptoms), pregnant women are at greater risk of preeclampsia, gestational diabetes, post-delivery hemorrhage, and postpartum depression than women without thyroid disease.

Hashimoto's Encephalopathy

Hashimoto's encephalopathy is a rare complication in which the swelling of the brain can cause profound and debilitating neurological symptoms. The condition only affects around two of every 100,000 people each year and usually between the ages of 41 and 44. Women are four times more affected than men.

Hashimoto's encephalopathy typically manifests in one of two ways:

  • A steady decline in cognitive function leading to tremors, sleepiness, confusion, hallucinations, dementia, and, in rare cases, coma
  • Seizures or sudden stroke-like attacks

Hashimoto's encephalopathy is usually treated with intravenous corticosteroid drugs like prednisone to quickly bring down the inflammation and swelling of the brain.

Myxedema

Myxedema is a severe form of hypothyroidism in which metabolism slows to a point where you can fall into a coma and potentially die. It is associated with untreated disease and can be recognized by characteristic changes in the skin and other organs, including:

  • Swollen and puffy skin
  • Drooping eyelids
  • Severe intolerance to cold
  • A drop in body temperature leading to hypothermia
  • Slowed breathing
  • Extreme exhaustion
  • Slowed movement
  • Confusion
  • Psychosis
  • Shock

Myxedema is considered a medical emergency requiring immediate medical assistance.

Cancer

Hashimoto's disease places you at increased risk of not only thyroid cancer but colorectal cancer as well. In fact, the dysregulation of hormonal activity as a result of Hashimoto's confers to a 1.68-fold increase in the risk of all cancers, according to a study from Taiwan involving 1,521 people with Hashimoto's disease and 6,084 matched individuals without Hashimoto's disease.

Cancer tends to develop in people with Hashimoto's between the ages for 35 and 55. Research suggests that the disease is associated with no less than a 4.76-fold increase in the risk of colorectal cancer and an 11.8-fold in the risk of thyroid cancer.

As a result of these and other findings, thyroid cancer prevention efforts should begin soon after Hashimoto's disease is diagnosed. This includes making diet changes and, in some cases, the preemptive removal of the thyroid gland if the risk of cancer is high.

Routine colorectal screening, starting in some cases before the age of 50, would be recommended to detect the early development of malignant or premalignant nodules.

When to See a Doctor

As a largely "invisible" disease in the early stages, Hashimoto's is often only discovered during a routine exam when thyroid hormone levels are found to be abnormally low.

As Hashimoto's disease tends to run in families, you may be well served to have yourself tested if someone in your family has the disease or you experience the classic signs of hypothyroidism, including persistent tiredness, facial puffiness, dry skin, hair loss, abnormal periods, and weight gain despite a reduced caloric intake. Early diagnosis and treatment almost always confer to better outcomes.

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