Analyzing the Hashimoto Thyroiditis Research Paper

Hashimoto Thyroiditis

ACRONYMS

TSH Thyroid Stimulating Hormone

T3 Triiodothyronine

T4 Thyroxine

Hashimoto Thyroiditis

The condition, Hashimoto's Thyroiditis, is named after Hakaru Hashimoto, a Japanese scientist, who uncovered the disease in the year 1912. Amino, DeGroot, and Akamizu (2013) write that Hashimoto explained the conditions of four types of individuals having a chronic thyroid disorder, that he labeled as "struma lymphomatosa." These individuals' thyroid glands had diffused lymphocytic infiltration, parenchymal atrophy, fibrosis, and eosinophilic acinar-cell change. Pathological as well as clinical researches of Hashimoto Thyroiditis have been conducted frequently since Hashimoto first described the affliction.

Hashimoto's Thyroiditis, is an autoimmune syndrome wherein a person's immune system attacks body tissues, organs and cells. Persons suffering from this affliction have a thyroid malfunction, a condition known as hypothyroidism, wherein the thyroid gland ceases to secrete sufficient hormones to meet the needs of the body. This gland, situated at the anterior part of the neck, produces hormones is responsible for controlling metabolism, including one's heart rate as well as the rate with which one's body burns up calories from the food consumed. Hashimoto's Thyroiditis inflames a patient's thyroid gland. In other words, the body's immune system attacks the person's thyroid gland, as though it were some foreign tissue. Scholars in the field are yet to ascertain the exact cause of this autoimmune process (WebMD, 2005-2016).

Goiter, i.e., a thyroid enlargement, is among the foremost symptoms of the condition of Hashimoto Thyroiditis. Enlargement in the thyroid may cause the sufferer's neck to appear swollen. This may even result in difficulties in swallowing and breathing. With continued damage to one's thyroid, the gland may shrink with time; the goiter might disappear eventually. Other symptoms and signs that arise from underactive thyroid gland might include trouble losing weight (or weight gain issues), excessive fatigue or tiredness, dry, thin hair, constipation, slow heart rate, and muscle or joint pain. Individuals suffering from this disorder might also be characterized by paleness and puffiness of the face, and might feel unnaturally cold . Among women who are affected by the condition, the problem of conceiving children and irregular or heavy menstrual periods may arise. Furthermore, those with thyroid hormone shortage may also suffer depression and difficulty in concentrating (Genetics Home Reference, 2016).

Incidence and Prevalence

Gaberscek and Zaletel (2011) state that Hashimoto's condition is among the most widespread autoimmune ailments triggered in genetically vulnerable people, by numerous triggers, which include gender (female), changes to immune system following delivery, iodine intake, fetal microchimerism, and environmental factors. Researchers have found that Hashimoto's Thyroiditis is a lot more prevalent in females than in males. While the condition is typically supposed to arise in teens or young adults, one can see it more commonly among women aged from 30 to 50 years. Estimates reveal that no less 20 million people in the U.S. suffer from one or another type of thyroid issue, with approximately 60% of individuals not knowing that they are suffering from the condition. One out of eight females will be affected by some thyroid disorder in her life. Hypothyroidism represents one among the most widely occurring thyroid disorders. A recent analysis indicated that as far as 10% of females aged above 60 years have subclinical or clinical hypothyroidism. Furthermore, the condition appears to be hereditary. Researchers in the field are endeavoring to detect the gene(s) responsible for transmitting this disease from generation to generation (Kresser, 2010).

Research scholars have, for instance, discovered that consumption of excessive amounts of iodine can inhibit the production of thyroid hormone among vulnerable people. Pesticides and other chemicals released in the environment, together with specific drugs and viral infections can bring about autoimmune thyroid problems as well. A number of susceptibility genes might be involved, when it comes to Thyroiditis development, of which some are common to other autoimmune disorders, whereas others are thyroid-specific.

Basic Pathophysiology

DeGroot, Akamizu, and Amino (2013) clarify that Hashimoto's condition is clinically characterized as a pain-free, widely occurring, diffused thyroid gland enlargement chiefly appearing among middle-aged females. While patients are usually euthyroid, hypothyroidism might arise. A fibrotic reaction and lymphocytic infiltrate may diffusely replace the parenchyma of the thyroid gland. Normally, one can see lymphoid germinal follicles. Focus has been upon this process, owing to the manifestation of autoimmune conditions in a majority of patients. Those suffering from Hashimoto's Thyroiditis possess serum antibodies that react with thyroid peroxidase and thyroglobulin, while reacting against an unknown protein found in colloid. Moreover, several patients are characterized by cell-mediated immunity which is against the antigens of thyroid which can be demonstrated by numerous techniques. The thyroid hormone has a direct impact on one's brain, bone metabolism, the gastrointestinal tract, liver and gall bladder function, cardiovascular system, RBC (red blood cells) metabolism, glucose metabolism, steroid hormone secretion, protein metabolism, body temperature control, and cholesterol and lipid metabolism.

Clinical Implication

Kresser (2010) explains that among the greatest challenges faced by people having hypothyroidism is that care standards for thyroid gland-related diseases in alternative as well as conventional medicine are very inadequate. Thyroid disorder patients, as well as their practitioners, seek a remedy capable of magically reversing the disease's course. For conventional healthcare providers, such a solution is bio-identical or synthetic thyroid hormone, whereas for alternative medicine practitioners, the solution is iodine. In most cases, unfortunately, neither of these two approaches work. Patients might get short-term relief, but ultimately the disease grows further or the symptoms reappear.

Diagnosis

According to the National Institute of Diabetes and Digestive and Kidney Disease (2013), diagnosis of Hashimoto Thyroiditis's is conducted in stages. It starts with an analysis of medical history and a physical examination. A goiter, growths, or nodules, might be uncovered during physical examinations, and symptoms might indicate hypothyroidism. Doctors will subsequently conduct blood tests for confirming this diagnosis. Blood tests entail drawing of blood at some clinic or commercial facility, followed by directing the blood sample to some clinical laboratory for testing. Diagnostic tests can include;

TSH test. This ultrasensitive test is the first step in most cases. Even if the sample contains small traces of TSH, they can be detected. This test produces the most precise measure of activity of the thyroid gland. Normally, an above-normal TSH reading implies that an individual suffers from hypothyroidism. T4 test is another thyroid test. It gauges the true quantity of thyroxine present in the patient's blood. In case of hypothyroidism, T4 level in the patient's blood is below normal. Yet another test -- Antithyroid antibody exam -- seeks auto- thyroid-antibodies, or molecules that are created within an individual's body, which attack the person's own tissues inadvertendly. Two main kinds of antibodies acting against the thyroid gland are 1) anti-thyroglobulin that attacks the thyroglobulin protein present within the thyroid gland, and 2) anti-thyroperoxidase that attacks the thyroperoxidase enzyme present in thyroid gland cells; this enzyme catalyzes T4's conversion to T3. The presence of thyroperoxidase auto-antibodies within the blood implies the person's immune system has previously attacked his/her thyroid tissue. A majority of sufferers of the condition carries the antibodies in their blood stream, but those in whom other conditions cause hypothyroidism do not (National Institute of Diabetes and Digestive and Kidney Diseases, 2013).

A doctor may also order imaging tests, which include CT scans (i.e., computerized tomography scans) and ultrasounds. The latter employs a transducer -- a device by which painless, safe sound waves bounce off the patient's organs, creating images of their respective structures. Specialized technicians in outpatient facilities, doctor's offices, or hospitals carry out this procedure. The interpretation of these images requires a radiologist; one does not require anesthesia while undergoing this process. The images generated will be able to show the thyroid's texture and size, in addition to a typical pattern of autoimmune inflammation, which aids the doctor in confirming Hashimoto's disease. Further, the images display growths or nodules within the thyroid gland, indicating the presence of some malignant tumor. Meanwhile, a CT scan combines computer technology and x-rays for image creation. The patient is required to consume a special solution, and injected with contrast medium -- a special dye. The patient is made to lie down on a sliding table, which moves into the tunnel-shaped instrument in which x-rays of the desired area are obtained. In hospitals and outpatient healthcare facilities, the procedure is carried out by x-ray technicians and interpretation of images is done by a radiologist. The patient need not be anesthetized. In certain Hashimoto's disease cases, CT scans are employed for assessing large goiters' extent and placement, together with its impact on structures surrounding it (National Institute of Diabetes and Digestive and Kidney Diseases, 2013).

Treatment

The preferred treatment for Hashimoto's Thyroiditis is replacement of thyroid hormone. Typically, patients are recommended lifelong use of levothyroxine sodium, administered orally. This is the care standard for the condition: merely waiting till ample amounts of the thyroid tissue are destroyed by one's immune system, and one gets classified as suffering from "hypothyroidism," followed by receiving replacement for the thyroid hormone. Levothyroxine sodium dosage is customized and titrated…