Hashimoto's vs Hypothyroidism: The difference

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Hashimoto's vs. Hypothyroidism: What's the Difference?

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http://thyroid.about.com/cs/hypothyroidism/a/hashivshypo.htm

A Look at Autoimmune Thyroid Disease and Underactive Thyroid

Conditions

by J. Shomon

February 2002 -- Hashimoto's disease is a disease, and

hypothyroidism is a condition. Hypothyroidism is most commonly

caused by Hashimoto's disease, but the two terms are not

interchangeable.

Hashimoto's Disease

Hashimoto's disease, sometimes known as Hashimoto's thyroiditis,

autoimmune thyroiditis, or chronic lymphocytic thyroiditis, is an

autoimmune disease. In Hashimoto's, antibodies are reacting against

proteins in the thyroid, causing gradual destruction of the gland

itself, and its ability to produce the thyroid hormones the body

needs.

Hashimoto's disease is typically diagnosed by one or more of the

following means:

Enlargement of the thyroid, known as a goiter

High levels of antibodies against thyroglobulin (TG) and thyroid

peroxidase (TPO), detected via blood test

Fine needle aspiration of the thyroid (also known as a needle

biopsy), which shows lymphocytes and macrophages

A radioactive uptake scan, which would show diffuse uptake in an

enlarged thyroid gland

Ultrasound, which would show an enlarged thyroid gland

Typically, in Hashimoto's, the thyroid does become enlarged, a

condition known as a goiter.

In some Hashimoto's patients, the goiter will be very small, and

they will have no symptoms. Some of these patients require no

treatment.

Some people with a goiter will feel discomfort in the neck area. If

the goiter causes difficulty swallowing or breathing, or is a

cosmetic problem, then thyroid hormone drugs such as levothyroxine

or natural desiccated thyroid will usually be given to help shrink

the thyroid.

In many cases, however, the onset of Hashimoto's and elevation of

antibodies will be accompanied by a variety of symptoms, including

fatigue, weight changes, depression, hair loss, muscle/joint aches

and pains, infertility, and recurrent miscarriages, among others.

Many conventional endocrinologists will not, however, treat

Hashimoto's disease if the thyroid function tests (i.e., TSH, T4,

T3) are in the normal range, despite these symptoms.

Usually, however, Hashimoto's involves a slow but steady destruction

of the gland that eventually results in the thyroid's inability to

produce sufficient thyroid hormone -- the condition known as

hypothyroidism. Along the way, however, there can be periods where

the thyroid sputters back to life, even causing temporary

hyperthyroidism, then a return to hypothyroidism. This cycling back

and forth between hypothyroidism and hyperthyroidism is

characteristic of Hashimoto's disease.

Ultimately, however, the thyroid slowly becomes less able to

function, and when hypothyroidism itself can be measured by blood

tests, many practitioners will finally treat with thyroid hormone

replacement drugs.

There are, however, some endocrinologists, as well as holistic MDs,

osteopaths and other practitioners, who believe that Hashimoto's

disease -- as confirmed by the presence of thyroid antibodies --

along with symptoms, are enough to warrant treatment with small

amounts of thyroid hormone.

The practice of treating patients who have Hashimoto's thyroiditis

but normal range thyroid function tests is supported by a study,

reported on in the March 2001 issue of the journal Thyroid. In this

study, German researchers reported that use of levothyroxine

treatment for cases of Hashimoto's autoimmune thyroiditis where TSH

had not yet elevated beyond normal range (people who were

considered " euthyroid " ) could reduce the incidence and degree of

autoimmune disease progression.

In the study of 21 patients with euthyroid Hashimoto's Thyroiditis

(normal range TSH, but elevated antibodies), half of the patients

were treated with levothyroxine for a year, the other half were not

treated. After 1 year of therapy with levothyroxine, the antibody

levels and lymphocytes (evidence of inflammation) decreased

significantly only in the group receiving the medication. Among the

untreated group, the antibody levels rose or remained the same.

The researchers concluded that preventative treatment of normal TSH

range patients with Hashimoto's disease reduced the various markers

of autoimmune thyroiditis, and speculated that that such treatment

might even be able to stop the progression of Hashimoto's disease,

or perhaps even prevent development of the hypothyroidism.

Autoimmune Thyroiditis Atttacks

In some cases, the thyroid becomes particularly inflamed, known as a

thyroiditis attack. Dr. Langer, author of " Solved: The Riddle

of Illness, " refers to thyroiditis as like an " arthritis of the

thyroid. " He explains that just as arthritis attacks the joints with

pain and inflammation, thyroiditis can mean pain and inflammation in

the thyroid for some sufferers. And in particular, during a

thyroiditis attack, common symptoms are anxiety, panic attacks,

heart palpitations, swelling in the thyroid area, problems

swallowing, and frequently, problems sleeping.

" Thyroiditis attacks classically happen in the middle of the night, "

says Dr. Langer, which can be particularly troublesome in terms of

the ability to sleep.

Dr. Langer suggests taking some calcium/magnesium, which are

nutrients that have a sedative effect, along with a pain reliever to

relieve inflammation -- buffered aspirin or ibuprofen -- before you

go to bed, this might help. He's found that this helps about two-

thirds of his patients suffering from nighttime thyroiditis

symptoms.

Reducing swelling is a key aspect of dealing with thyroiditis

attacks, according to Dr. Langer. " Just as with arthritis, an anti-

inflammatory pain reliever doesn't cure the problem, but it

temporarily ameliorates the symptoms. "

Hypothyroidism

Many people with Hashimoto's disease end up hypothyroid, the

situation where the thyroid is either underactive or totally unable

to function.

Hashimoto's disease is actually the leading cause of hypothyroidism,

but other causes of hypothyroidism include:

surgical removal of all or part of the thyroid as treatment for

nodules, goiter, hyperthyroidism, Graves' disease, or thyroid cancer

radioactive iodine treatment (RAI) given as a hyperthyroidism or

Graves' disease treatment

use of antithyroid drugs (such as Tapazole or PTU) to reduce thyroid

activity, in response to as hyperthyroidism or Graves' disease

use of certain drugs, such as lithium

Reference Source: Thyroid, 2001 Mar;11(3):249-55, " One-year

prophylactic treatment of euthyroid Hashimoto's thyroiditis patients

with levothyroxine: is there a benefit? "