Hashimoto: is thyroid surgery a solution
Hashimoto's thyroiditis is an autoimmune disease first described as early as 1912 by Japanese doctor Haruko Hashimoto. The disease is also called chronic lymphocytic thyroiditis or autoimmune thyroiditis.
Translation: Rositsa Tashkova, Master of Molecular Biology and Microbiology
Hashimoto's thyroiditis [ref. 1] is an autoimmune disease first described as early as 1912 by Japanese doctor Haruko Hashimoto.
As with any autoimmune disease, in this case too the immune system attacks by mistake its own cells, considering them foreign and dangerous. With Hashimoto thyroids, the immune system attacks thyroid cells, and the disease is the most common cause of hypothyroidism (decreased thyroid function) in the world, as well as the most common autoimmune disease.
Women more often suffer from Hashimoto than men, although the condition can affect both sexes. It usually occurs for the first time at a later age and is often conditioned by a genetic predisposition to thyroid diseases or even other autoimmune diseases.
What are the functions of the thyroid gland
The thyroid gland is part of the endocrine system - it secretes hormones that control our metabolism, that is, it controls the speed and efficiency at which our cells convert nutrients into energy. It regulates many of the vital functions of our body, including the functions of the heart, brain, bones, muscles, digestive system, skin. All this is evidence of the importance of both this organ and the disease. Therefore, timely diagnosis is of particular importance for preserving the good quality of life of Hashimoto sufferers.
What are the signs that we may have Hashimoto?
The first signs of the disease may include decreased levels of thyroid hormones, its enlargement, as well as repeated miscarriages that have no other explanation. Over time, the disease can cause more serious damage to the gland and this can lead to the already mentioned hypothyroidism, in which the organ fails to synthesize the amount of hormones required by the body. This leads to delayed metabolism, fatigue, loss of appetite, dry skin, hair loss, weight gain, cold intolerance, constipation, high cholesterol and a heavier menstrual cycle in women.
Thyroid tissue of a patient with Hashimoto thyroiditis. Photo by Patho on Wikipedia
An increase in the thyroid gland is also called "goiter" - the gland becomes visible to the naked eye and can cause difficulty swallowing. In these cases, usually the patient undergoes surgical surgery to remove part or all of the gland.
The diagnosis of Hashimoto is usually confirmed by a blood test, which proves the presence of specific antibodies against the thyroid gland.
Treatment of Hashimoto thyroiditis and what is the importance of surgical intervention
When it is established or suspects that a patient suffers from Hashimoto's thyroiditis, usually the condition is simply monitored, but if hypothyroidism develops, treatment begins with the intake of synthetic thyroid hormones. This is especially important in pregnant women, and therefore it is good to have gland hormones examined even before the planned pregnancy, even if there are no signs of disease to avoid potential complications or miscarriage, which is always a traumatic event.
A 2019 study [ref. 2] conducted at Telemark Hospital in Norway tracked the condition of Patients with Hashimoto, with one group undergoing surgery to remove the thyroid gland and the other remaining only for medical treatment.
The patients were between the ages of 18 and 79, and although their hormone levels were normal, probably due to medication, they still had unpleasant symptoms of the disease - fatigue, low vitality, emotional and mental health problems, deteriorated physical and social functions and pain. In these patients, thyroid antibody levels were 10 or more times higher than the upper limit of normal.
Half of the participants underwent surgical treatment, and according to this study, the results were very impressive - antibody levels dropped to normal and quality of life improved, fatigue was also already as in healthy people.
Another study [ref. 3], published in 2015 in the International Journal of Surgery, also showed that quality of life improves after surgical removal of the gland in sufferers of both Hashimoto's thyroiditis and goiter.
What are the negative side effects of surgical removal of the thyroid gland
This study demonstrated the potential of surgical treatment of Hashimoto in patients who did not respond well to drug treatment, but it did not cover a sufficiently large group of people - the total number of study participants was 147 and the undergoing surgery were 73 of them.
More research is needed to cover a larger number of people and more heterogeneous populations. [ref. 4]
A lifetime intake of synthetic hormones will also be needed if the gland is removed. Therefore, for now, such an operation is applied only in patients where the thyroid gland is so enlarged that it prevents swallowing, but we will be interested in monitoring developments in this regard, since medical treatment does not seem to improve the quality of life of anyone suffering from Hashimoto's thyroiditis, a disease that affects more and more people.
Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms. A Randomized Trial. Annals Of Internal Medicine. 2019
Quality of life improvement in patients with Hashimoto thyroiditis and other goiters after surgery: A prospective cohort study. International Journal of Surgery. 2015
Is there a role for surgery in treating Hashimoto's thyroiditis? Jeffrey Garber, MD, FACP, FACE. www.health.harvard.edu
👩 🔬 Rositsa Tashkova-Kacharova has a Bachelor degree in Molecular Biology and a Master's degree in Microbiology and Microbiological Control. She completed her Master's thesis at the University of Nantes, France. At that time she painted a Christmas tree of bacteria and inspired the announcement of the first competition for drawing with microorganisms Agar Art. For 3 years she was the editor of the journal Bulgarian Science and continues to write about science and medicine.