By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and
research papers have been written and published on line, including
world wide health, ezine articles, article base, healthblogs,
selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by
Disilgold.com Named 50 of the best health Tweeters Canada - Huffington
Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as
international journal Pharma and Bio science, ISSN 0975-6299.
Thyroid disease
Thyroid disease is defined as a condition of malfunction of thyroid gland.
Thyroid disease : Hashimoto’s thyroiditis
Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis) is an autoimmune disease in which the immune
system attacks the thyroid gland, causing an
underactive thyroid gland (hypothyroidism).
According to the study by
the University of Pisa, Women with Hashimoto’s thyroiditis (HT) suffer
from symptoms independently from hypothyroidism and regardless thyroid dysfunction(a).
A. Symptoms
1. Dysphagia, shortness of breath, voice changes, and odynophagia
According
to the ata of patients who underwent thyroidectomy
from 2005 through 2009, by the Medical University of South Carolina,
52%, 26% and 8% of
patients experienced symptoms of dysphagia and shortness of breath;
voice changes, and complained of odynophagia, respectively(1).
2. Anxiety, negative mood, depression, dry skin, cold intolerance,
puffy eyes, muscle cramps and fatigue, deep voice, constipation, slow
thinking and poor memory.
Hashimoto’s thyroiditis is a common auto-immune disorder. The most
common presenting symptoms may include anxiety, negative mood,
depression, dry skin, cold intolerance, puffy eyes, muscle cramps and
fatigue, deep voice, constipation, slow thinking and poor memory,
according to the study by the Leiden University Medical Center(2).
3. General health
Women
with Hashimoto’s thyroiditis (HT) also with positive anti-thyroid
autoantibodies(anti-TPO) are experience to a significantly higher
prevalence of general
health symptoms as compared to those without HT(2a).
4. Other symptoms
Swelling in front of the neck along with constipation,
anorexia, weight gain and increasing pallor may also be symptoms of hypothyroid goiter (autoimmune thyroiditis,
Hashimoto’s thyroidits), due to high level of thyroid stimulating
hormone (TSH), low level of T4 with presence of thyroid specific antibodies in
blood(2b).
B. Causes
1. Autoimmune disorder
The
current knowledge on Hashimoto’s
thyroiditis associated with concept of autoimmune thyroid disease is
caused by autoimmune process in stimulation of abnormal production of
antibodies, reacting with
thyroglobulin and thyroid peroxidase(3a).
2. Primary hyperparathyroidism (PHPT)
Patients with primary hyperparathyroidism (PHPT) are susceptible to develop Hashimoto’s
thyroiditis due to similar autoimmune
inflammatory process with the rate ofoccurrenceof 1.89%(3).
2. Cerebellar ataxia
Both hypothyroidism and Hashimoto’s thyroiditis (HT) can rarely be associated with cerebellar ataxia.
but patients with hypothyroidism with history of severe essential tremor may develop Hashimoto’s
thyroiditis(4).
C. Risk factors
1. Childhood weight gain and childhood overweight
Childhood weight gain and childhood overweight conferred an increased risk to later hypothyroidism and thyroid autoimmunity,
particularly in women, according to the study by the Medical Research
Council Unit for Lifelong Health and Ageing(5).
2. Genetic factors
CTLA-4 gene located in chromosome 2q33 region has a strong association with several autoimmune diseases, including Hashimoto’s
thyroiditis(6).
3. Female
If you are female with type I diabetes, you are at increased risk for the development of HT,
according
to the study of thyroid autoimmunity in a very large
nationwide cohort of children and adolescents with type 1 diabetes, 63%
of type I diabetes patients with positive antibodies were
girls, compared with 45% of patients without antibodies(7).
4. Other risk factors
According to the study by the Kaunas University of Medicine, pregnancy,
drugs, age, sex, infection, and irradiation may also be associated to the
risk factors of Hashimoto's thyroiditis (HT)(8).
D. Diseases associated to Hashimoto’s thyroiditis
1. Hashimoto’s encephalopathy (HE)
Hashimoto’s encephalopathy (HE) is a rarely recognized neurocognitive
syndrome associated with thyroid autoimmunity and occurred more common
in women(14).
2. Neurofibromatosis Type 1
Hashimoto’s thyroiditis is a common form of chronic autoimmune thyroid
disease (AITD) and often coexists with other autoimmune diseases, including Hashimoto’s thyroiditis(15).
3. Chronic hepatitis C(CHC)
The prevalence of of thyroid dysfunction is
significantly higher among Chronic hepatitis C patients with Hashimoto’s thyroiditis(HT) than CHC patients
without HT(16).
4. Reactive thrombocytosis
Reactive thrombocytosis, an elevated platelet count (> 450,000/μL) developed secondary to another disorder, including Hashimoto’s thyroiditis and/or
subclinical hypothyroidism(17).
5. Thyroid papillary carcinoma
Patients with Thyroid papillary carcinoma are associated to 26.8% risk of HT without differences in relation to tumor size(18).
E. Misdiagnosis
Although
fine-needle aspiration (FNA)is extremely valuable in the initial
evaluation of thyroid lesions, with an accuracy of 98.6% and 80%
positive predictive value, and 100% negative predictive
value, misdiagnosis can be abserved(19).
1. Overlapping thyroid follicular lesions coexisting with Hashimoto’s thyroiditis
Overlapping
cytological features of FN and HT were showed to be the main causes of
false-positive results in diagnosis of thyroid follicular lesions
coexisting with Hashimoto’s thyroiditis' dominant in some patients, if
not taken account of presented forms of follicular-cell and/or moderate
to
excessive numbers of lymphoid cells(20).
2. Papillary thyroid carcinoma (PTC)
An
association between papillary thyroid carcinoma (PTC) and Hashimoto’s
thyroiditis (HT) is well recognized, but papillary thyroid carcinoma
(PTC) is most often misdiagnosed as either follicular neoplasm or
colloid
nodule with or without HT(21).
3. Follicular adenoma, nodular goiter,
macrofollicular adenoma and malignant lymphoma
Hashimoto’s
thyroiditis (HT) can be misdiagnosed as follicular adenoma, nodular
goiter,
macrofollicular adenoma and malignant lymphoma, if FNABs an associated
lesion was not sampled or some of the cellular features of HT
were misinterpreted(22).
4. Solitary thyroid nodule
Solitary thyroid nodule
also can be misdiagnosed as Hurthle cell neoplasm on FNAC in patients of Hashimoto’s
thyroiditis with marked Hurthle cell change(22a).
F. Diagnosis
After recording the past and present history and completing a physical
exam, including assessing symptoms and complaints commonly seen in
hypothyroidism and neck examination. The tests which your doctor orders
may include
1. Blood test
The aim of the test is to determine the level of thyroid function.
Underactive thyroid gland is presented with the low level of thyroid
hormone with elevated TSH as your pituitary gland tries to
stimulate your thyroid gland to produce more thyroid hormone.
2. An antibody test
The aim of the test is to check for the presence of antibodies against
thyroid peroxidase, the an enzyme which plays an important role in the
production of thyroid hormones.
3. Thyroid scan
Thyroid scan in Hashimoto’s
thyroiditis can mimic a wide range of thyroid disorders, due to overlapping (23).
4. Fine needle aspiration cytology
FNAC can accurately diagnose Hashimoto’s
thyroidits in most patients. However, a small percentage of cases may be
missed due to the limitations of this procedure and the varied sell structures of the disease (24).
G. Prevention
G.1. Diet to prevent Hashimoto’s thyroiditis
1. Brazil Nuts and Sunflower Seeds
Selenium
found abundantly in Brazil Nuts and sunflower seeds was significantly
related to the production of thyroid gland. A low selenium status significantly increased the risk for thyroid enlargementand and development of multiple nodules(25a). Overdose may have a toxic effect on growth hormone, causing adverse effects of anorexia, diarrhea, depression,
hemorrhage, liver and kidney necrosis, blindness, ataxia and respiratory
disturbances(25).
2. Sea buckthorn
Sea buckthorn (Hippophae rhamnoides L.) constitutes thorny nitrogen
fixing deciduous shrub. Sea buckthorn(SBT) is primarily valued for its
very rich vitamins A, B(1), B(12), C, E, K, and P; flavonoids, lycopene,
carotenoids, and phytosterols. and therapeutically important since it
is rich with potent antioxidants. Scientifically evaluated
pharmacological actions of SBT are like inflammation inhibited by
reduced permeability, loss of follicular aggregation of lymphocytes from
the inflamed synovium and suppress lymphocyte proliferation(26).
3. Balanced diet
Several trace minerals, including iodine, iron, selenium, and zinc. and trace elements are essential for normal thyroid
hormone metabolism, Coexisting
deficiencies of these elements can impair thyroid function. Iron
deficiency impairs thyroid hormone synthesis and reduces the efficacy of iodine.
Combined selenium and iodine deficiency leads to severely stunted physical and mental growths(27).
G.2. Phytochemicals and Antioxidants to prevent and treat Hashimoto’s thyroiditis
Patients with in
Hashimoto’s thyroiditis (HT) were found to significant increase in
oxidative stress parameters in serum and LDL-fraction(28).
1. Resveratrol
Resveratrol, found in skin and seed
of grape regulates several biological processes, including sell cycle arrest, in both papillary and follicular thyroid
cancer. resveratrol also influences thyroid function
by enhancing iodide trapping and increasing TSH secretion(29).
2. Polyphenolic flavonoids
Polyphenolic
flavonoids found in
black and green tea extracts showed to alter the thyroid gland
physiology and
architecture, including inhibited enlargement of thyroid gland,
decreased serum T3 and T4, and a parallel increase in serum thyroid
stimulating hormone (TSH) at green tea extract
at 2.5 g% and 5.0 g% doses and black tea extract at 5.0 g% dose(30).
3. Selenium
According to the study by the Hôpital du Cluzeau,
selenium supplementation decreases anti-thyroid antibody levels and
improves the ultrasound structure of the thyroid gland(31).
2. Vitamin D
Vitamin D
deficiency may have a role in the autoimmune process in Hashimoto
thyroiditis in children.
Children with Hashimoto
thyroiditis showed to associate with higher vitamin D deficiency rates
in comparison to vitamin D levels in the Hashimoto group(32).
H. Treatments
A. In conventional Medicine
1. Levothyroxine therapy
Beside
monitoring thyroid functions of the patients with HT periodically for
hypothyroidism, treatment of Levothyroxine therapy is necessary to
improve positively
affect the clinical course of the disease and the antibody titers(33).
2. Combination of liothyronine (T3) and levothyroxine
Although
ombinations of levothyroxine plus liothyronine appear to
have beneficial effects on the mood, quality of life, and psychometric
performance of the patients over levothyroxine alone with the
possibility of adverse effects, large sample size is necessary for
further study(34).
H.2.In Herbal Medicine
1. Alkaloid tetrandrine
According to the study by the
Tri-Service General Hospital, National Defense Medical Center, Taipei,
Taiwan, TTetrandrine (Tet), purified from a creeper Stephania tetrandra S
Moore, used to treat
patients with silicosis, autoimmune disorders, and hypertension in
Mainland China for decades. exhibited a wide variety of immunosuppressive
effects both in vitro and in
vivo(38).
2. Salvia miltiorrhiza, Tripterygium wilfordi, Tanacetum parthenium and Curcuma longa
A number of herbal products used for their immunosuppressive
effects, may be useful in
immune-mediated disorders including autoimmune diseases and organ
transplant rejection, including Salvia miltiorrhiza and
Tripterygium wilfordii functions in reduced inflammatory cytokines
and mediators, Tanacetum parthenium function in inhibited the release
of pro-inflammatory mediators and
Curcuma longa function in down regulates the expression of inflammation(39).
3. Radix Bupleuri
Radix
Bupleuri, used most frequently prescribed crude herbs in
the prescriptions of traditional Chinese medicine for the treatment of
inflammatory diseases and auto-immune diseases showed to inhibit
production of serum autoantibodies and total immunoglobulin G (IgG) with
doses depended for 35 days
(40).
4. Polygonum multiflorum and Artemisia scoparia
According to the study by the National Taiwan University, emodin and
scoparone, the active principles isolated from Polygonum multiflorum and
Artemisia scoparia, respectively, both exhibit vasorelaxant and
immunosuppressive effects. In dose depended the phytochemicals also suppressed the
responses of white blood cells with a one-lobed nucleus, and cell proliferation(41).
H.3. In traditional Chinese Medicine
1. Aconite cake-separated moxibustion and option the better therapeutic program
Application
of
aconite cake-separated moxibustion therapy with acupoints of [(1)
Danzhong (CV 17), Zhongwan (CV 12), Guanyuan (CV 4); (2) Dazhui (GV
14), Shenshu (BL 23), Mingmen (GV 4)] alternatively with oral
administration of 25 microg Euthyrox everyday, showed to improve
clinical symptoms and thyroid function in patients of Hashimoto’s
thyroiditis, in comparison of simple oral administration of Euthyrox
(levothyroxine)(35).
2. Brown seaweed Sargassum
Sargassum spp., a brown seaweed, used in
Traditional Chinese Medicine (TCM) to treat a variety of diseases over 2000 years
including thyroid disease, exhibited its immunomodulator effects
and could be useful in the treatment of thyroid related diseases such as
Hashimoto’s thyroiditis(36).
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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/22191404
(2) http://www.ncbi.nlm.nih.gov/pubmed/23744563
(2a) http://www.ncbi.nlm.nih.gov/pubmed/21112862
(2b) http://www.ncbi.nlm.nih.gov/pubmed/21381622
(3a) http://www.ncbi.nlm.nih.gov/pubmed/19667753
(3) http://www.ncbi.nlm.nih.gov/pubmed/23865082
(4) http://www.ncbi.nlm.nih.gov/pubmed/23439792
(5) http://www.ncbi.nlm.nih.gov/pubmed/23436917
(6) http://www.ncbi.nlm.nih.gov/pubmed/22851994
(7) http://www.ncbi.nlm.nih.gov/pubmed/12145233
(8) http://www.ncbi.nlm.nih.gov/pubmed/19667753
(14) http://www.ncbi.nlm.nih.gov/pubmed/23767389
(15) http://www.ncbi.nlm.nih.gov/pubmed/23691379
(16) http://www.ncbi.nlm.nih.gov/pubmed/23663880
(17) http://www.ncbi.nlm.nih.gov/pubmed/23518829
(18) http://www.ncbi.nlm.nih.gov/pubmed/23306572
(19) http://www.ncbi.nlm.nih.gov/pubmed/22619157
(20) http://www.ncbi.nlm.nih.gov/pubmed/12508180
(21) http://www.ncbi.nlm.nih.gov/pubmed/11403259
(22) http://www.ncbi.nlm.nih.gov/pubmed/10349369
(22a) http://www.ncbi.nlm.nih.gov/pubmed/22090699
(23) http://www.ncbi.nlm.nih.gov/pubmed/2847097
(24) http://www.ncbi.nlm.nih.gov/pubmed/22090699
(25) http://www.ncbi.nlm.nih.gov/pubmed/20883174
(25a) http://www.ncbi.nlm.nih.gov/pubmed/21242171
(26) http://www.ncbi.nlm.nih.gov/pubmed/22530142
(27) http://www.ncbi.nlm.nih.gov/pubmed/12487769
(28) http://www.ncbi.nlm.nih.gov/pubmed/22951187
(29) http://www.ncbi.nlm.nih.gov/pubmed/21946130
(30) http://www.ncbi.nlm.nih.gov/pubmed/20801949
(31) http://www.ncbi.nlm.nih.gov/pubmed/23046013
(32) http://www.ncbi.nlm.nih.gov/pubmed/22876540
(33) http://www.ncbi.nlm.nih.gov/pubmed/22155461
(34) http://jcem.endojournals.org/content/90/8/4946.full
(35) http://www.ncbi.nlm.nih.gov/pubmed/?term=Hashimoto+thyroiditis+in+TCM
(37) http://www.ncbi.nlm.nih.gov/pubmed/2268942
(38) http://www.ncbi.nlm.nih.gov/pubmed/12466046
(39) http://www.ncbi.nlm.nih.gov/pubmed/22761185
(40) http://www.ncbi.nlm.nih.gov/pubmed/19467314
(41) http://www.ncbi.nlm.nih.gov/pubmed/1830846
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