Hashimoto's Disease
Hashimoto's Disease is an autoimmune disease that affects the thyroid. It is the most common cause of hypothyroidism in people over 6 years old in the United States. Hashimoto's is the most common cause of spontaneous hypothyroidism in areas of adequate iodine intake. It affects women 10-15 times more than men. It is estimated that it affects 3.5 women per 1000 per year and 0.8 men per 1000 per year. The most commonly affected age range is 30-50 years old.
What is Hashimoto’s Disease?
Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's functions.
Inflammation from Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism. It primarily affects middle-aged women but can also occur in men and women of any age and in children. Doctors test your thyroid function to help detect Hashimoto's disease. Treatment of Hashimoto's disease with thyroid hormone replacement usually is simple and effective.
What are the symptoms of Hashimoto’s disease?
You might not notice signs or symptoms of Hashimoto's disease at first, or you may notice a swelling at the front of your throat (goiter). Hashimoto's disease typically progresses slowly over years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels in your blood. The signs and symptoms are mainly those of an underactive thyroid gland (hypothyroidism). Signs and symptoms of hypothyroidism include:
• Fatigue and sluggishness
• Increased sensitivity to cold
• Constipation
• Pale, dry skin
• A puffy face
• Brittle nails
• Hair loss
• Enlargement of the tongue
• Unexplained weight gain
• Muscle aches, tenderness and stiffness
• Joint pain and stiffness
• Muscle weakness
• Excessive or prolonged menstrual bleeding
• Depression
• Memory lapses
What causes Hashimoto’s disease?
Hashimoto's disease is an autoimmune disorder in which your immune system creates antibodies that damage your thyroid gland. Doctors don't know what causes your immune system to attack your thyroid gland. Some scientists think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. A combination of factors including heredity, sex and age may determine your likelihood of developing the disorder.
What are the risk factors for Hashimoto’s disease?
These factors may contribute to your risk of developing Hashimoto's disease:
• Sex – Women are much more likely to get Hashimoto's disease.
• Age – Hashimoto's disease can occur at any age but more commonly occurs during middle age.
• Heredity – You're at higher risk for Hashimoto's disease if others in your family have thyroid or other autoimmune diseases.
• Other autoimmune disease – Having another autoimmune disease such as rheumatoid arthritis, type 1 diabetes or lupus increases your risk of developing Hashimoto's disease.
• Radiation exposure – People exposed to excessive levels of environmental radiation are more prone to Hashimoto's disease.
What are the complications of Hashimoto's Disease?
Left untreated, an underactive thyroid gland (hypothyroidism) caused by Hashimoto's disease can lead to a number of health problems:
• Goiter - Constant stimulation of your thyroid to release more hormones may cause the gland to become enlarged, a condition known as a goiter. Hypothyroidism is one of the most common causes of goiters. It's generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing.
• Heart problems - Hashimoto's disease may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol the "bad" cholesterol can occur in people with an underactive thyroid gland (hypothyroidism). If left untreated, hypothyroidism can lead to an enlarged heart and, possibly, heart failure.
• Mental health issues - Depression may occur early in Hashimoto's disease and may become more severe over time. Hashimoto's disease can also cause sexual desire (libido) to decrease in both men and women and can lead to slowed mental functioning.
• Myxedema - This rare, life-threatening condition can develop due to long-term severe hypothyroidism as a result of untreated Hashimoto's disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.
• Birth defects - Babies born to women with untreated hypothyroidism due to Hashimoto's disease may have a higher risk of birth defects than do babies born
to healthy mothers. Doctors have long known that these children are more prone to intellectual and developmental problems. There may be a link between hypothyroid pregnancies and birth defects, such as a cleft palate. A connection also exists between hypothyroid pregnancies and heart, brain and kidney problems
in infants. If you're planning to get pregnant or if you're in early pregnancy, be sure to have your thyroid level checked.
What are the treatments for Hashimoto's Disease?
Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life.
What medications are used to treat Hashimoto's Disease?
• Synthetic Hormones - If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others).
Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism.
Another option for synthetic hormones is using a combination of levothyroxine (t4) and liothyronine (T3) in an effort to mimic our natural thyroid physiology. However, a literature review found that out of 9 controlled clinical trials, only 1 indicated that combined therapy seemed to improve the mood, quality of life, and psychometric performance of patients more than did levothyroxine alone.
Image Credit: https://pubchem.ncbi.nlm.nih.gov/compound/Levothyroxine
• Low Dose Naltrexone (LDN) - In patients with Hashimoto's, LDN is used as a supportive therapy to synthetic thyroid hormone supplementation. LDN has anti-inflammatory properties and increased endorphin function which helps modulate the immune system. By decreasing inflammatory cytokine concentration, it is thought that LDN can improve thyroid function effects both in the pituitary gland and in the body’s peripheral cells. These physiological mechanisms have been shown to further improve T4 conversion into active T3. Moreover, LDN has been shown to inhibit cells that cause the autoimmune process.
What is Low Dose Naltrexone?
LDN is a prescription drug that helps to regulate a dysfunctional immune
system. It reduces pain and fights inflammation. It is not a narcotic or a
controlled substance. It is an opioid receptor antagonist that is taken orally to block opioid receptors. An antagonist is a chemical that acts within the body to reduce the physiological activity of another chemical substance.
Naltrexone was approved by the FDA in 1984 for the treatment of opioid addiction, usually at a dose of 50-100mg a day. It blocks the receptors that opioids like oxycodone bind to negating the euphoric effect. However, at much lower doses, naltrexone has been used for autoimmune disorders like
Hashimoto’s disease as well as chronic pain.
For more information on how LDN works, please click here.
Image Credit: https://pubchem.ncbi.nlm.nih.gov/compound/Naltrexone
What does the research show?
A large number of studies show that LDN can reduce abnormal inflammation and cytokine production and effectively normalize immune abnormalities in many autoimmune diseases. Clinical trials looking specifically at LDN and Hashimoto’s are virtually non-existent, the likely explanation for this is that the drug companies don’t have a lot to gain from funding this type of research as LDN is an old generic drug and it’s relatively cheap.
For a list of other LDN studies, please click here.
What dosage forms are available?
LDN is available by prescription only from compounding pharmacies. It is available as an immediate-release oral capsule or a liquid. LDN is typically prescribed at doses from 0.001mg-16mg with the most common dose of 4.5 mg.
Ask your doctor or one of our compounding pharmacists if LDN is right for you.
Sources:
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
https://emedicine.medscape.com/article/120937-overview
https://emedicine.medscape.com/article/120937-overview#a5
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/diagnosis-treatment/drc-20351860.
https://emedicine.medscape.com/article/120937-treatment
https://ldnresearchtrust.org/hashimoto-thyroiditis-and-low-dose-naltrexone-ldn-paula-johnson