Disease progression of hashimoto thyroiditis

There is no evidence to date that patients with Hashimoto's thyroiditis are at increased risk for a severe course of the disease if they become infected with the coronavirus. A good adjustment of the hormone dose is the best prerequisite for surviving an infection unharmed. Recent studies have shown the importance of thyroid hormones in protecting the lungs in COVID-19 infection. There have been isolated reports that patients with Hashimoto's thyroiditis have experienced a disease flare-up as a result of the Corona infection. the autoimmune disease of the thyroid gland has newly appeared due to the Covid-19 infection.

Corona vaccination in Hashimoto's thyroiditis

Autoimmune diseases such as Hashimoto's thyroiditis are not a contraindication to vaccination. On the contrary, a Corona vaccination not only reduces the risk of death and the risk of a severe course of the disease, but also the risk of a Hashimoto's flare-up, which can be triggered by a Corona infection. Patients with an autoimmune disease are less likely to have side effects such as fever or headache after a Corona vaccination. However, in rare cases, the immune response may be so attenuated that insufficient antibodies are produced against Covid-19. Initially, it was amed that the risk of insufficient vaccination protection would only exist in patients treated with immunomodulatory drugs such as cortisone or MTX. It is now known, however, that the underlying disease itself may also be the cause. Hashimoto patients have in principle a rather too strong immune defense, but some suffer from an additional dysregulation of the immune system due to the chronic inflammation. Fortunately, more than 90% of patients with Hashimoto's thyroiditis develop adequate vaccination protection. By measuring the antibody level two weeks after the complete vaccination, the vaccination protection can be checked at least approximately. Whether it makes sense to measure the strength of vaccination protection by determining neutralizing antibodies against covid-19 was initially controversial. In the meantime, however, there is much to suggest that it can be used to identify vaccinated patients with low or declining vaccine protection. A booster vaccination is recommended by the STIKO three months after the basic immunization, because the vaccination protection usually decreases strongly 3-4 months after the second vaccination.

Since the inflammation of the thyroid gland usually starts slowly, the symptoms and complaints of Hashimoto's thyroiditis are hardly noticed at first or other causes are suspected.

Hashimoto's thyroiditis, also known as chronic lymphocytic or autoimmune thyroiditis (AIT) is one of the most common autoimmune diseases. Non-specific symptoms such as fatigue, listlessness, sadness or weight gain gradually appear and those affected become accustomed to these changes. However, the actual cause, chronic thyroiditis is not diagnosed. Often there is already a latent hypothyroidism, which is not diagnosed by the use of outdated standard values for TSH (up to 4.0 is considered "high normal"). The symptoms of the patients are therefore usually not assigned to Hashimoto's thyroiditis by the doctors, which then unfortunately usually results in a long path of suffering from doctor to doctor for those affected.

The course of Hashimoto's thyroiditis generally begins barely noticeable. Many patients accept these symptoms as fated. Only after taking thyroid hormones on a trial basis do patients realize how well they might actually be doing. Even small doses of thyroid hormones often lead to a significant improvement in the general condition with a decrease in symptoms.

Since the different organs of our body absorb thyroid hormones differently, it is not uncommon for paradoxical symptoms and complaints of hyperfunction or. underactivity of the thyroid gland: Signs of both disorders can occur at the same time or alternate.

Basically, it should be taken into account that the production of thyroid hormones fluctuates, z.B. depending on the seasons: At the beginning of winter, hormone requirements are often increased, whereas at the beginning of summer, thyroid hormones are sometimes needed less. The body also needs more thyroid hormones during pregnancy, as well as when taking birth control pills.

We have also found that patients with high antibody titers (anti-TPO, anti-TG) have large fluctuations in their own thyroxine production, so that dose finding in this patient group often proves very difficult.

Hashimoto's relapse causes passive hyperthyroidism

At the onset of Hashimoto's thyroiditis, there can be an excessive production of thyroid hormones, so that there is a corresponding oversupply in the organism. This hyperthyroidism is called "Hashitoxicosis". In the further course of the disease, temporary symptoms of hyperthyroidism may also occur in phases of particularly high inflammatory activity, since the thyroid gland produces hormones in stock and these are then released uncontrollably due to the destruction of the thyroid cells. Typical symptoms of hyperthyroidism are:

Sweating, rapid heartbeat, high blood prere (hypertension), weight loss, diarrhea, increased anxiety, restlessness ("always in the fast lane"), trembling hands, muscle weakness, muscle tremors, insomnia, nervousness and ravenous appetite.

Symptoms such as sweating are often mistakenly classified as menopausal symptoms in menopausal women.

Therefore, even with such apparently typical complaints of other origin, a thyroid diagnosis should always be made to rule out Hashimoto's thyroiditis.

Tie destruction leads to hypothyroidism

The typical course of Hashimoto's thyroiditis is characterized by progressive destruction of the thyroid gland. Therefore, in the further course of the disease, the symptoms of an underactive thyroid gland (hypothyroidism) are in the foreground. Immunopathogenetically, the so-called CD4+ T cells and their differentiation into Th1, Th2, Th17 and Treg play a particularly important role.

Massive stimulation and production of B cells and plasma cells occurs, which form antibodies against the thyroid cells. In addition, lymphocytes, macrophages and cytokines such as interferon or TNF alpha are activated. This increases the autoimmune process. Destruction of the thyroid gland occurs.

Because almost all organs are affected by the thyroid hormones, the symptoms of hypothyroidism are also very varied.

Typical symptoms of hypofunction in Hashimoto's thyroiditis are:

Fatigue, memory and concentration disorders, general physical exhaustion, lack of resilience, lack of motivation, listlessness, weight gain, increased sensitivity to cold, depression, susceptibility to infections, compulsion to clear throat, cough, voice changes, tightness in the throat, globus sensation, sleep disorders, joint pain, hair loss, dry skin, brittle fingernails, flatulence, constipation, menstrual disorders in women, tingling and falling asleep of hands and forearms at night (carpal tunnel syndrome), loss of libido, depressive mood, muscle weakness, increase in blood lipids, cardiac arrhythmia, slow heartbeat, water retention, edema, hearing loss, muscle pain, rough voice, infertility, growth and development disorders in children.

The large number and variability of possible symptoms in Hashimoto's thyroiditis usually result in the diagnosis being made at a very late stage.

Hashimoto's thyroiditis and psyche

Patients with Hashimoto's thyroiditis often suffer from cognitive disorders in the areas of thinking, memory and concentration. In addition, affective disorders in the area of mood, emotion or social behavior also frequently occur.

The symptoms occur in varying degrees of severity. Sometimes the symptoms lead only to mild impairment, but sometimes to serious illnesses such as depression, panic attacks or pseudo-dementia.

It is not yet clear whether these symptoms are a direct result of thyroid dysfunction. Some thyroid specialists also blame thyroid antibodies themselves. Others see the cause of the psychological complaints so frequently occurring with Hashimoto thyroiditis in a superordinate immunological disease process in the brain.

The local distribution of thyroxine receptors in the brain probably also plays a significant role. It is also amed that a genetically determined variability of dejonidase in the brain, is the reason why some patients feel more comfortable with a combination therapy of T4 and T3 than with T4 monotherapy.

Therapy for Hashimoto's thyroiditis should have as its primary goal an improvement in the patient's quality of life. An exclusive orientation on the TSH value determined in the blood does not make sense, since this does not provide a reliable statement on the adequate thyroxine supply to the individual organs such as the brain. B. the brain is possible. Numerous international studies have been able to prove that even supposedly euthyroid (normal thyroid levels) patients with Hashimoto's thyroiditis benefit from thyroxine therapy. These patients with a TSH in the normal range also experienced a significant reduction in their psychological complaints as a result of hormone administration. In particular, symptoms such as poor thinking, lack of concentration, listlessness, sadness, fatigue or anxiety improve.

Children can also suffer from Hashimoto's thyroiditis

In children with Hashimoto's thyroiditis, hypothyroidism often manifests itself in a less characteristic way: lack of drive, concentration and attention deficits, as well as obesity can be signs.It is not uncommon for children with Hashimoto's thyroiditis to suffer from growth and developmental disorders. Learning disabilities are often noticeable at school. If there is an underlying thyroid dysfunction, it can be treated well and the symptoms usually disappear.

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