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Constipated? Check your neck

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C. A. V. Nogueira, M.D. ▼ | October 31, 2014
Hashimoto disease
Hashimoto disease   Symptoms of chronic thyroiditis may lead in the wrong direction

Hashimoto disease or chronic thyroiditis is a common thyroid gland disorder that can hit at any age but the problem is that its symptoms can easily point to another direction and wrong diagnosis.

Now, take a look at these symptoms: constipation, difficulty thinking, unable to stay focused, dry skin, fatigue, hair loss, intolerance to cold. So far they look innocent and like something we all can experience at some points in our lives. But if we add weight gain and enlarged neck or goiter, then we must suspect that Hashimoto disease is around the corner.

Hashimoto disease is caused by inflammation of the thyroid gland and this is an autoimmune disease. That's bad news by itself: that means the body is attacking the thyroid gland as if it was some foreign tissue. We can't say what's the cause of that be we know that the condition tends to occur in families so the family history will be the first thing the doctor will ask you if there are signs that point to Hashimoto. We also know that Hashimoto disease can be connected with type 1 diabetes or celiac disease, also autoimmune diseases.

Bad news for women is that it is 5 to 10 times more common in women than in men. Bad news for both sexes is that the condition begins slowly and it may take months or even years for it to be detected. It most often starts in adults but when symptoms are visible, the disease can be already well-developed.

How it works? T lymphocytes, a type of blood cells involved in the inflammation process, invade the thyroid gland and they cause painless inflammation that destroys it. At the end the patient produces very little or no thyroid hormone at all. That leads us to the test: blood test can confirm is it about Hashimoto because it reveals an increased number of antibodies against thyroid-specific proteins. But how to detect it early?

When the condition is still young, the levels of thyroid hormones (T3 and T4) may be normal. So, no use of that. But if we measure TSH (thyroid stimulating hormone) in the blood, we are onto something: the increase in TSH can precede the fall of thyroid hormone to low levels by years.

There are more complications that may include an enlarged thyroid gland that can interfere with breathing or swallowing, emotional problems and depression, loss of will for sex, extreme sensitivity to cool temperatures and various other cardiac conditions.

If we keep in mind symptoms and add a slowing of the heart rate, lower body temperature, and puffiness around the eyes, we know Hashimoto is going stronger. Then, heart failure may occur and the patient may fell in coma. So, if left untreated, this condition is very dangerous.

And now the good news: we said "may" twice and with a reason. If the patient's thyroid is functioning normally and there is no evidence of hormone deficiency, the doctor will just regularly check the state and that's it. If the patient experience thyroid hormone deficiency, it's logical to get replacement therapy with thyroid hormone.

If that's the case, the therapy is here to stay for the whole life but pills restore hormone levels and reverse all the symptoms of hypothyroidism. As the time is passing by, the doctor will check the dosage and adapt it if needed.

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