Hashimoto’s Hypothyroidism Manifestations, Risk Factors and Co-morbidity

Hashimoto’s Hypothyroidism (HH) is an autoimmune condition in which progressive and gradual thyroid failure occurs (Ledesma & Lawson, 2018). In Australia, approximately five percent of the adult populace has Hashimoto’s hypothyroidism with a greater prevalence in women than men (Walsh, 2016). Globally the Hashimoto’s hypothyroidism occurrence rate is three to five reports for every ten thousand people yearly (Ekambaram, Kumar, Chowdhury, Siddaraju, & Kumar, 2010). There is no specific literature in relation to the burden of cost for Hashimoto’s hypothyroidism in Australia, but certainly, any burden of Hashimoto’s hypothyroidism can be reduced by controlling risk factors that trigger the disease. This paper will discuss about pathophysiology, clinical manifestations, risk factors and one co-morbidity of Hashimoto’s hypothyroidism. Also, this paper will discuss about impact of Hashimoto’s hypothyroidism on the patient and their immediate family. Furthermore, a model of care will be selected for management, treatment and prevention of the disease. Subsequently, role of multidisciplinary team will be discussed. Lastly, available resources about Hashimoto’s hypothyroidism in the community will be explored.

 

Pathophysiology:

Hashimoto’s is a disease of the endocrine system in which the thyroid gland is compromised (Crisafulli et al., 2018). The thyroid gland is located at the front of the neck and underneath the larynx (Stuss, Michalska-Kasiczak, & Sewerynek, 2017). It consists of two lobes on sides of the trachea (Stuss et al., 2017). The thyroid gland is responsible for the production of hormones, which aid in running the metabolic processes of the body (Stuss et al., 2017). Also, the hormones are responsible for digestive functions, brain growth, and different body functions (Chi, Chen, Tsai, Tsai, & Lin, 2013). As Hashimoto’s disease is an autoimmune disease, the immune system starts destroying thyroid gland and limits the ability to maintain an adequate supply of thyroid hormones (Ledesma & Lawson, 2018). The low production of hormones from thyroid gland is referred to as hypothyroidism (Valea & Georgescu, 2018). According to a study, the most common cause of hypothyroidism is Hashimoto disease (Caturegli, De Remigis, & Rose, 2014). The exact pathophysiology of Hashimoto’s hypothyroidism is still not clear (Caturegli et al., 2014). Hashimoto is a slow, gradual and progressive disease (Caturegli et al., 2014). It often takes years to detect any initial symptoms of Hashimoto’s disease (Caturegli et al., 2014). Some physical symptoms like weight gain, muscle soreness, and enlarged thyroid can prompt a patient for further diagnostic investigation (Stern & Shamus, 2015).  Some of the tests which can be performed for diagnosis of the diseases are sonography of the thyroid, thyroid function test, family history of autoimmune diseases, blood tests and physical examination (Stern & Shamus, 2015).

The clinical manifestation of Hashimoto’s hypothyroidism will be described according to the different systems of the body. For instance, the signs of HH in the central nervous system can be sleepiness, depression and slow discourse (Stern & Shamus, 2015). The signs of HH in the skin can be a swollen face, enlarged thyroid gland which is known as goiter, hair loss, cold intolerance, and thickened tongue (Yoo & Chung, 2016). According to a study, findings in the cardiovascular system related to HH can be low cardiac output and bradycardia (Grais & Sowers, 2014). Also, muscle fatigue, dry skin, weight gain, constipation is one of the initial symptoms a patient with HH can experience (Grais & Sowers, 2014). Due to the compensatory mechanism, the early diagnostic test may not reveal any diagnosis of HH (Ledesma & Lawson, 2018). Furthermore, as thyroid hormones are necessary for neurological and physical development, lack of thyroid hormones before birth can affect the physical and mental growth of a baby throughout his life if not treated (Hage & Azar, 2012). All of the above clinical manifestations may also be present in patients who have no thyroid disease (Hage & Azar, 2012). Hence, it is crucial to visit a general practitioner on a regular basis to seek advice if the above symptoms persist.

There are several factors which can increase the risk or worsen the condition of Hashimoto’s hypothyroidism. The main factor which can elevate the risk of having Hashimoto’s hypothyroidism is having an existing autoimmune disease such as lupus, type one diabetes or rheumatoid arthritis (Pyzik, Grywalska, Matyjaszek-Matuszek, & Roliński, 2015). Patient with HH produces fewer thyroid hormones and countries where there is a deficiency of iodine can worsen hypothyroidism (Sun, Shan, & Teng, 2014). Iodine intake is a key element for the healthy human body, as Iodine is essential for the manufacturing of thyroid hormone (Sun et al., 2014). According to a study, Human DNA plays a crucial part in increasing risk for HH in siblings of a person who has Hashimoto’s hypothyroidism (Hubalewska-Dydejczyk, 2013). Subsequently, any damage to the brain due to surgery, radiation or a tumour may affect the pituitary gland (Guaraldi et al., 2012). Pituitary gland is responsible for signaling thyroid gland to produce thyroid hormones (Guaraldi et al., 2012). Hence, if pituitary is not working then the thyroid gland can be compromised. Thus further worsening the condition. Also, HH is more common in middle-aged people as compared to other age groups (Stern & Shamus, 2015). Lastly, if a family member has HH, it likely increases the risk of HH in their offspring (Hubalewska-Dydejczyk, 2013).

There are many comorbidities linked to Hashimoto’s hypothyroidism such as depression, obesity, and arthritis (Stern & Shamus, 2015). This paper will briefly discuss the linkage between obesity and  Hashimoto’s hypothyroidism. Most people with HH also suffer from obesity and weight gain (Walsh, 2016). One of the symptoms of HH is weight gain due to the weak metabolism and low production of thyroid hormones (Sanyal & Raychaudhuri, 2016). Hence, if the patient’s weight is increased and the BMI jumps to 30 or above the patient is considered to be obese (Sanyal & Raychaudhuri, 2016). A study suggests that obesity itself can play a crucial role in leading to thyroid imbalances (Longhi & Radetti, 2013). In order to decrease the worsening of the HH condition, it is crucial to seek help from appropriate health team member. A nutritionist is the best choice for obese patients to seek help (“Overweight and obesity among women: analysis of demographic and health survey data from 32 Sub-Saharan African Countries,” 2016). A nutritionist can help in selecting healthy food depending on their occupation, age, and gender. Regardless of the diet, a nutritionist will also emphasize on exercises, to be an important factor in maintaining weight and leading a healthy life.

Impact:

Impact of any disease on the patient and their family member is enormous. According to a study, after treating Hashimoto’s hypothyroidism it can still decrease the quality of life (Bektas Uysal & Ayhan, 2016). It means that even after treating the condition there still be some remaining symptoms which can hinder the healthy lifestyle. Patient and their family members often go through feelings of worry, stress, and frustration. Subsequently, pressure on family members mount up due to financial burden and to adjust work life. Also, there is no time for family members to take a vacation or take care of their health due to meeting the needs of the patient.  According to a study, family members are more affected emotionally as compared to the patient (Wittenberg, Saada, & Prosser, 2013). The reason behind this is that the social life of family members might be affected and leisure activities might be diminished (Wittenberg et al., 2013). One study shows that family members mostly neglect their own medical conditions due to caring for their loved one (Rosland, Heisler, & Piette, 2012). Thus, worsening their own health condition which can lead to further complications. In addition, the patient may experience a sense of guilt as they are a burden on their family. The patient is usually dependent on family members for needs such as physical needs, assistance with cooking, eating, showering and shopping. Looking after a patient can be challenging both mentally and physically. Thus, It is crucial to understand the impact of disease on family members of the patient. As the health of the family can directly affect the health of the patient.

Prevention/Management/Treatment:

Hashimoto’s hypothyroidism can never be fully prevented but risk factors and symptoms can be decreased to increase the quality of life (Laurberg, Andersen, Pedersen, Knudsen, & Carlé, 2013). Patients with thyroid disorders and symptoms of Hashimoto’s should consult a doctor for further investigation if any symptom arises. The three most common diagnostic test to detect Hashimoto’s hypothyroidism are Thyroid-stimulating Hormone Test, Anti-thyroid Antibodies Tests, and Free T4 Test (Ledesma & Lawson, 2018). Thus, early detection of the disease will prevent the patient’s condition to deteriorate further. After diagnosis of Hashimoto’s hypothyroidism, the doctor may initiate the treatment based on the case. This paper will use integrated chronic disease management (ICDM) model for treating and managing a patient with Hashimoto’s hypothyroidism. ICDM model is a shared care which involves people with chronic disease along with the multidisciplinary team involved (Mahomed, Asmall, & Voce, 2016). The purpose of this model is to increase the quality of life for people with chronic disease by delivering person-centered care (Mahomed et al., 2016).

Treatment for Hashimoto’s hypothyroidism is usually medication and hormone replacement therapy with synthetic thyroid hormone (Caturegli et al., 2014). The name of synthetic thyroid hormone is levothyroxine and it is used daily to keep the body in the normal metabolic state for rest of the life (Caturegli et al., 2014). Special care should be taken while taking this hormone as excessive amounts of thyroid hormone can create further complications such as arrhythmias and coronary disorders (McAninch & Bianco, 2016). To avoid further complications, the doctor may suggest for routine blood tests to check if the patient is consuming the right strength according to his condition (McAninch & Bianco, 2016). Also, it is crucial to listen to the patient and the history they provide. As it would be crucial in the further management of their disease. Patient with Hashimoto’s hypothyroidism has usually several other comorbidities. Hence, according to the ICDM model, different health professionals should be included into the care.

Multidisciplinary Team:

One of the main health members which should be included is a general practitioner (GP) initially. A GP can initially investigate symptoms and refer to another health member such as an endocrinologist. An endocrinologist who specializes in hormonal conditions can manage a patient with Hashimoto’s hypothyroidism much effectively (Hepp, Wyne, Manthena, Wang, & Gossain, 2018). An endocrinologist should inform the patient about the importance of compliance of medication and the thyroid hormone replacement therapy (Hepp et al., 2018). Also, to report any symptoms during the treatment. As one of the comorbidities discussed is obesity, hence a Nutritionist or Dietician can be included in the care. A nutritionist can help the patient in finding any nutritional deficiencies caused by Hashimoto’s Hypothyroidism (Sanyal & Raychaudhuri, 2016). Also, can provide the information about food which can increase the risk of obesity. Hence, to avoid certain foods and intake of healthy foods such as corn, eggs, dairy, and legumes. Subsequently, a Social Worker can help the patient in his daily life activities and can play a role of liaison between other health professionals. If the condition of a patient with Hashimoto’s Hypothyroidism is severe then a Personal care attendant can be included to help with cooking, showering and shopping. Furthermore, a Physiotherapist is also a  key member, which can help in mobility and exercises. As exercise is very important in maintaining a healthy lifestyle. Lastly, a Psychologist can be included in care, for finding any mental health problems. According to a study, depression is a common symptom of Hashimoto’s Hypothyroidism (Hage & Azar, 2012). Hence, a psychologist can teach de-stress techniques and provide reassurance to calm the patient (Hage & Azar, 2012).

Resources:

Patient with Hashimoto’s Hypothyroidism can live a happy and healthy life if all the resources are utilized appropriately. There are several resources in the community which can help the patient with thyroid disorders and can help ease the symptoms. Thus, enhancing the quality of life. One of the top resource is Australian Thyroid Foundation (ATF, 2018). This foundation can help patients and their family members in accessing a wide range of information about the disease and their symptoms (ATF, 2018). Australian thyroid Foundation has been a great resource for patients as it decreases the frustration which can increase from lack of information to manage their Hashimoto’s Hypothyroidism. Also, on a broader level, there is The Endocrine Society of Australia (ESA) (ESA, 2018). ESA is an organization where scientists with the help of research bring innovations and best treatment for endocrine-related disorders such as Hashimoto’s Hypothyroidism (ESA, 2018). Subsequently, Hashimoto’s Hypothyroidism has multiple comorbidities such as depression and obesity. Therefore, symptoms related resources should be utilized to enhance the quality of life. In regards to obesity, the Victorian Government has initiated several measures such as The Obesity Policy Coalition (OPC) and live lighter (OPC, 2018). OPC is a special program which influences government policy in preventing obesity in Australian children (OPC, 2018). All these resources can have a positive impact on a patient with Hashimoto’s Hypothyroidism.

Conclusion:

Hashimoto’s Hypothyroidism is a great challenge for the world. However, people with HH can live a healthier lives because of early detection and management services available in place. This paper has discussed the pathophysiology, clinical manifestation, risk factors and one comorbidity of HH. Also, the impact of HH on patient and family has also been discussed. Furthermore, a model of care was chosen for the management and prevention of HH. Subsequently, the role of different health professionals was also discussed. Finally, this paper also shed light on available resources in the community for Hashimoto’s hypothyroidism to help the patients live their life happy and healthy