Hashimoto’s Disease The amount of diseases that are present in the world today are more than one person can handle. It is hard enough with even one disease attacking the body, depending on the severity of it. Having multiple diseases, it seems like it has become normal in our society today. There are multiple diseases one can have and a various amount of treatments to help balance it out. Unfortunately, there are still many diseases out there that have yet to be discovered and diseases that have not had any cures for it. Luckily, Hashimoto’s disease is treatable and can be controlled. Hashimoto’s disease is an autoimmune disease which roots from the Thyroid gland that under produces thyroid hormones. The thyroid gland is responsible to control hormone stimulation which regulates the process of metabolism in the body. (Huether & McCance) Hashimoto’s disease is the commonly cause of hypothyroidism. This disease generally occurs in females between the ages of 40-60 years of age. (National Institute of Diabetes and Digestive and Kidney Diseases, Hashimoto’s disease, par 4-5) Genetic markers that may influence the rise of this disease would be based on inheriting it from one’s parents, Fetuin-A levels, and/or other associated diseases that may influence the thyroid to be dysfunctional. There are specific proteins that are also associated with Hashimoto’s disease such as the thyroid gland proteins (Thyroxine and Triiodothyronine) and Thyroid antibodies (Immunoglobin G class, Thyroid Peroxide and Thyroglobulin). (National Center for Biotechnology Information, Fetuin A & National Library of Medicine, Hasimoto thyroiditis) Current treatments for Hashimoto thyroiditis are the use of Levothyroxine which is used to replace the depleted levels of Thyroxine. (American Thyroid Association, Thyroid Hormone Treatment) Fortunately, there are new treatments being considered such as the use of Pentoxifylline which is supposed to inhibit the destruction of the thyroid itself. (OMICS international, Pentoxifylline explores new horizons in treatment of Hashimoto Thyroiditis) To elaborate on the disease itself, Hashimoto’s disease is indeed an autoimmune disease. An autoimmune disease is when a person’s immune system is unable to recognize from normal tissue and foreign tissue. When this happens, the body then reacts and starts attacking healthy tissue. Basically, it is the body attacking itself. (Medline plus, Autoimmune disorders.) In this case, Hashimoto’s disease is when the thyroid gland is being attacked by the body’s antibodies which inhibits production of thyroid hormones. When the body does not have enough thyroid proteins in circulation, then the body’s metabolism suffers. Hashimoto’s disease is the common cause of Hypothyroidism. Symptoms of hypothyroidism can consist of being tired more often, gaining weight, having a puffy face, sensitive to cold temperatures, pain in the muscles and joints, being constipated, having drier skin than normal, thinning of the hair, a slower heart rate, decreased sweat gland activity, irregular menstrual periods, and depression. (Medline Plus, Hypothyroidism) There are number of factors that can lead to Hashimoto’s disease. A person’s age, gender, socioeconomic status, or where one is living are all factor’s that play a role relating to Hashimoto’s disease. Hashimoto’s disease occurs in people between the ages of 40 to 60. (National Institute of Diabetes and Digestive and Kidney Disease, Hashimoto’s Disease) As people age, so do their immune system. Aging takes a toll in one’s immune system and with all things and time, it may start to break down. As one grows older, their immune system may start to slow down and their ability to heal may take longer than usual. This would be a perfect opportunity for an autoimmune disease to occur as the immune system would have trouble identifying what normal cells and foreign cells are. (Medline plus, Aging changes immunity) Another factor would be gender. Females are more prone to having Hashimoto’s disease than males. According to the National Academy of Hypothyroidism, “It’s also noted that during transitory times in women’s reproductive status I when the risk of hypothyroidism is highest.” Females going through a change in hormones have a higher risk of having Hashimoto’s disease. In experience, I have worked as a pre-operative nurse who have seen many 40-50-year-old women having hysterectomies where a women’s uterus and/or fallopian tubes, and ovaries are surgically removed. With this procedure, reproductive hormones are imbalanced and may need to be replaced. This may cause women to have a higher risk in having Hashimoto’s disease because of hormonal imbalance. (ELABORATE MORE??) Another factor could be one’s socioeconomic status. One may have trouble staying healthy if they are unable to afford the nutrition necessary. We have multiple fast food restaurants that are not health conscious about what is being served. These fast food companies provide low quality foods for a cheaper price. When families are not making enough to support healthy diets, their immune system may take a toll. This too can introduce many diseases into the body like our very own, Hashimoto’s disease. Our environment can affect our health as well. When the quality of our air, water, and food is low, our body responds to this as well. Our immunity becomes weak and the risk of introducing disease increase. “…Hashimoto’s is caused by a combination of nutrition depletions, food sensitivities, an impaired stress response, and impaired ability to handle toxins as well as chronic low-grade infections.” (Dr. Wentz) As these factors have an effect on our immunity, it is more likely for Hashimoto’s disease to occur. Genetics are another reason a person’s risk increases of having Hashimoto’s disease. There are a group of genes that belong to the human leukocyte antigen complex. This complex helps the body to determine whether cells are self-cells or foreign cells. This complex can alter because of genetic alterations that have been passed down by family members. (National Center for Advancing Transitional Sciences, Hashimoto’s syndrome) Hashimoto’s disease can be caused by altering certain genes such as CTLA4, HLA-DRB1, PTPN22, SLC26A4, & TG. These genes might look like a mixture of letters and numbers mixed all in one, but they each have a different role that may alter one’s Thyroid. The CTLA4 gene is responsible for stopping over production of T-Cells. The gene called HLA-DRB1 is in charge of making instructions for making other proteins which identifies the different cell types present in the body. The PTPN22 gene also makes instructions but this gene takes the role for assisting the nucleus of a cell to grow and multiply. The SLC26A gene helps produce a protein called pendrin. Pendrin will move ions in and out of a cell’s membrane. The TG gene is responsible for making Thyroglobulin. Thyroglobulin with iodine are broken down to eventually make thyroid hormones. (Genetics Home Reference, CTLA4, HLA-DRB1, PTPN22, SLC26A4, TG) Altering these genes will increase the chances of a person having Hashimoto’s disease. Proteins, enzymes, and cell structures certainly play a role in Hashimoto’s disease. Proteins that are made by the Thyroid gland are Thyroxine (T4) and Triiodothyronine (T3). These 2 proteins help the body maintain its metabolism. The functions of T4 & T3 are regulating cell protein, fat, carbohydrates, metabolic rate, and to produce body heat. T3 & T4 help balance the secretion of the growth hormone, development of bone, heart and gastrointestinal health. T4 & T3 can affect the development of the central nervous system and the production of red blood cells. (Huether and Mccanece) If the Thyroid gland becomes dysfunctional and is unable to secrete enough T3 and T4, then it can very much affect the body. This is what happens when Hashimoto’s disease is not controlled. The whole body becomes imbalanced and would lead to hypothyroidism. Other proteins that may be associated with Hashimoto’s disease are the thyroid antibodies. Thyroid antibodies are part of the Immunoglobulin G class. In the body, there are 5 classes of Immunoglobulins (IgG, IgA, IgM, IgE, and IgD). These antibodies help fight against specific antigens that may harm the body. IgG is associated with Hashimoto’s disease. IgG accounts for 80-85% of immunoglobulins circulating in the blood. IgG class protects against unrecognizable antigens. Thyroid antibodies such as Thyroid peroxide (TPO) and Thyroglobulin (TG) are elevated when the thyroid is starting to breakdown. Now a person may have normal levels of thyroid stimulating hormones (TSH) years before knowing that there is a problem with their thyroid. Testing for TSH is a common lab to diagnose Hashimoto’s disease, but it may be too late. In Hashimoto’s disease, TPO and TG are increased in the thyroid because it has been altered. With this being said, this is when the body is attacking itself. TPO and TG levels in the thyroid are elevated years prior to TSH levels becoming noticeable. (Dr. Wentz) If we are able to test for our thyroid antibody levels early on, then we may catch our body’s sign before developing Hashimoto’s disease. There are no exact treatments for Hashimoto’s disease. But there are treatments if Hashimoto’s disease develops into hypothyroidism. Hypothyroidism is when the thyroid gland is not producing enough hormones to keep up with the body. In this case, there is a treatment for this stage of the disease. As stated previously, thyroid hormones that are produced in the thyroid are T4 & T3. The medication to replace this hormone is Levothyroxine. Levothyroxine is identical to the hormones that are produced by the thyroid gland. With this hormone replacement, it may need to be adjusted prior to having a set amount off the bat. Just like with any other medication, the doctor must find what dosage works best for the person. In order to determine the correct dosage, the provider may give you the lowest dose to start off with. After taking the medication for about 6-8 weeks or depending on the prescriber, the provider will then test your blood. By testing your blood, the provider will assess if your hormone levels are within normal ranges. Once normal ranges are achieved, blood tests are usually performed yearly to monitor thyroid hormone levels. Other treatments would be considering one’s diet. People who have Hashimoto’s disease should avoid a large amount of Iodine. Iodine is essential for the body, but in this case, intaking a large amount of Iodine can further damage the thyroid. Avoiding foods high in iodine will help. Iodine rich foods may include seaweed, kelp, fish, milk, yogurt, cheese, grains, fruits and vegetables treated with fertilizer, iodized salt, etc. (National Institutes of Health Office of Dietary Supplements, Iodine) Women who are pregnant will need more iodine than the typical person. Consequences for an increased amount of iodine in a pregnant woman could result in the baby developing a goiter. The recommended course of action would be to consult a provider for a safe dosage while pregnant. (National Institute of Diabetes and Digestive and Kidney Diseases, Hashimoto’s Disease) Nutrition is very important whether one may have a disease or not. With Hashimoto’s disease developing into hypothyroidism, nutrition can help with decreasing the symptoms that come with the disease. There has not been a set diet for Hashimoto’s disease because everyone is different. What may work for one may not work for others. Animal proteins help the body but eating meats and fat alone could put the body in an acidic nature. Balancing vegetables and meats would optimize nutrition and help the body gain control once again. (Dr. Wentz) With the combination of nutrition and medication, one can decrease seeing symptoms of hypothyroidism. There are upcoming treatments that have yet to be discovered. One treatment that is currently being developed is a chemical called Pentoxifylline. Currently, Pentoxifylline is FDA approved to treat peripheral arterial disease. As for Hashimoto’s disease, it has not been approved. Pentoxifylline has been hypothesized to decrease the rate of the destruction of the thyrocytes in the thyroid gland. With this being said, Pentoxifylline could potentially lower the damage to thyrocytes by inhibiting the cell immune response against the thyroid gland. Pentoxifylline has also been hypothesized to act as an immune system regulator, an antioxidant, a TSH sensitizer, and an anti-fibrotic agent. Pentoxifylline acting as an immune system regulator would consist of it balancing t-helper cell reactions. Another way that Pentoxifylline could play a role as a regulator of the immune system by increasing interleukin-10 production. (Azimi) Interleukin-10 stops the growth of other lymphocytes and proinflammatory cytokines. (Huether & McCance) In Hashimoto’s disease, since the body is attacking it-self by it’s own immunity, Pentoxifylline could potentially stop that process from happening. Pentoxifylline acting as an antioxidant by relieving the damage caused by oxidative stress in the thyroid. Pentoxifylline can also act as a TSH sensitizer by increasing the sensitivity to a similar protein called follicle stimulating hormone. It has been expressed by Azimi, “As PTX increases the sensitivity to FSH, considering the issue that TSH and FSH are structurally similar to each other, it is hypothesized that PTX may do the same…” This only means by having Pentoxifylline change the effect of one protein, TSH could very well be affected as well because TSH and FSH are similar enough. Pentoxifylline could also be an anti-fibrotic agent. When Hashimoto’s disease has fully developed in the thyroid, the thyroid itself may become fibrotic. Pentoxifylline would be able to lower the creation of collagen and fibrosis. (Azimi) This treatment has not been approved for curing Hashimoto’s disease quite yet but could very well be in the future. All these alterations that Pentoxifylline could potentially make would be life changing for those who have Hashimoto’s disease and hypothyroidism. Hashimoto’s disease can cause an uproar in our bodies. People who are between the ages of 40-60 years of age and mostly women who are effected by Hashimoto’s disease. As research has shown, mainly women who are going through a transitional time with hormones are more prone to having Hashimoto’s disease occur. It also matters where a person lives and how the person lives. Chances of having Hashimoto’s disease increase in populations with lower nutrition and where pollution is more prominent. Genetics plays a role as well. Having family members with the trait can increase one’s risk in having Hashimoto’s disease develop. Alterations in thyroid antibodies can lead to Hashimoto’s disease as this is where the body attacks itself. Current treatments have controlled the signs and symptoms of hypothyroidism which results from Hashimoto’s disease. Although, there is no cure for Hashimoto’s disease at the moment. Developing treatments like Pentoxifylline are still yet to be approved. Hashimoto’s disease is just one of many other diseases. The more we can find out what treatments are awaiting for us in the future, the better we are able to keep it from destroying us.