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What are the symptoms of Hashimoto's thyroiditis?


Hashimoto’s thyroiditis is an autoimmune disorder caused by antibodies  which attack the thyroid. It commonly runs in families and can be associated with a variety of symptoms .  Hashimoto’s thyroiditis cause symptoms  for a number of distinct reasons:


DESTRUCTION OF THE THYROID GLAND  by antibodies will cause hypothyroidism. This is the most common  cause of symptoms as the thyroid progressively shrivels up and stops working leading to tiredness, weight gain depression, muscle weakness and fibromyalgia. Hypothyroidism  can be readily treated by thyroxine replacement and symptoms generally resolve.


INFLAMMATION OF THE THYROID GLAND will cause  pressure on surrounding structures, leading to a sensation of choking, difficulty swallowing, trouble breathing or a persistent cough. Thyroxine may settle the symptoms but if they are severe, surgery to remove the thyroid may be required.


ASSOCIATED AUTOIMMUNE DISORDERS will cause symptoms in their own right. These include pernicious anaemia caused by Vit B12 deficiency (tiredness), Addison's disease or hypoadrenalism (weakness and fainting), vitiligo (white patches on the skin), and coeliac disease (gluten sensitivity). These associated disorders should be investigated and individually treated in all patients with Hashimoto’s thyroiditis.


HASHIMOTO’S ASSOCIATED SYNDROME is now recognised as a manifestation of the underlying autoimmune process which causes symptoms even when thyroid function is normal. Most patients present with fibromyalgia, tiredness, lethargy and depression. Treatment options are largely supportive, the most important contribution being to recognize the association and to exclude other causes of those symptoms.


TUMOURS OF THE THYROID occur more commonly in Hashimoto's thyroiditis. Whilst most of these are benign tumours (adenomas or hyerplastic nodules) thyroid cancer also occurs with increased frequency in this disorder.  The two most common types of Hashimoto's associated cancer are papillary thyroid cancer and thyroid lymphoma. Any significant lump or nodule detected in association with Hashimoto's thyroiditis should undergo a fine needle biopsy to exclude a cancer. 

TREATMENT should address specific aspects of Hashimoto's although selenium therapy and thyroidectomy have a role in patients with non-specific symptoms that do not resolve

Professor Leigh Delbridge thyroid surgeon Sydney Hashimoto's thyroiditis and fibromyalgia
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