Hashimoto’s thyroiditis is a disorder of the immune system, which affects the function of the thyroid gland. There are many findings about the relationship between other autoimmune diseases and Hashimoto’s. The immune system can also mistakenly target any other part of the body causing it to malfunction. In Hashimoto’s disease in addition to thyroid antibodies patients can have antibodies to other tissues or enzymes as well that puts them at a higher risk to develop another autoimmune condition.
There are more than 100 autoimmune diseases and any of them could appear in individuals with Hashimoto’s thyroiditis before or after its onset. The association between most of them tends to occur within the family indicating a genetic predisposition to autoimmune diseases.
Hashimoto’s disease patients have an increased risk in developing the following disorders and autoimmune diseases:
- Anemia is a disorder when the number of red blood cells is decreased and oxygen supply to the body tissues is impaired. Anemia can occur due to a low thyroid hormone level and could possibly correct itself when the hypothyroidism is adequately treated.
- Pernicious anemia is an autoimmune condition when the cells of the stomach lining fail to absorb B12 from the food. Vitamin B12 is essential for producing red blood cells and its deficiency causes anemia and neurological problems.
- Dysbiosis is a deficiency or absence of good bacteria in the intestinal flora that can also lead to an abnormally high level of bacterial infections in the small intestine such candida overgrowth. Both this conditions can trigger increased thyroid autoimmunity and result in Hashimoto’s, impaired T4 to T3 conversion and multiple hypothyroid symptoms in women.
- Addison’s disease is an adrenal failure that occurs through damage to the adrenal gland due to an autoimmune attack. In this condition, the adrenal glands are unable to produce enough cortisol and aldosterone steroid hormones. Statistically, the complete adrenal failure is an uncommon condition occurring in only four to six individuals per 100,000 of population.
- Adrenal insufficiency is a more common adrenal disorder that profoundly affects the efficiency and action of other hormones including thyroid. This condition develops mostly due to continuous stress or chronic illness and requires hormone replacement.
- Alopecia areata is patchy loss of hair anywhere on the body including the scalp, eyebrows, extremities and facial area. This condition can be permanent or temporary independent of the thyroid hormone levels.
- Celiac disease is an intestinal disorder that causes the body to have an immune reaction to gluten, which is a type of protein found in grains such as wheat, barley, corn and rye. The antibodies create an inflammatory process that destroys the surface of the intestinal wall leading to nutritional deficiencies, multiple symptoms and also can trigger Hashimoto’s thyroiditis.
- Dermatitis herpetiformis is a gluten induced extremely itchy and blistering rash. About 25% of patients with Hashimoto’s thyroiditis have dermatitis herpetiformis.
- Non-celiac gluten sensitivity develops in people who have specific antibodies against gluten but do not show intestinal damage.
- Vitiligo is a patchy loss of skin pigmentation due to immune system attack on the skin cells, which maintain pigment production. The blanched areas on the skin may be limited to small spots or may affect multiple areas of the skin throughout the body.
- Type 1 Diabetes Mellitus is an autoimmune condition when antibodies and lymphocytes attack the pancreatic cells. The inability to produce insulin makes the patient susceptible to wide fluctuations in the blood glucose levels and requires insulin injections.
- Polygrandular syndrome type II or Schmidt’s syndrome is an autoimmune disorder of the endocrine glands resulting in failure of multiple glands to produce their hormones. Most often the disorder is a combination of adrenal insufficiency, thyroiditis and type 1 diabetes mellitus.
- Polygrandular syndrome type III is an autoimmune condition without the presence of adrenal insufficiency. There are three subcategories: IIIA – autoimmune thyroiditis with type 1 diabetes mellitus, IIIB – autoimmune thyroiditis with pernicious anemia, IIIC – autoimmune thyroiditis with vitiligo and/or alopecia and/or other organ specific autoimmune disease.
- Sjorgen syndrome is an autoimmune disease when the inflammation of the salivary, tear and mucous glands prevents lubrication and moisture production resulting in dryness and irritation of the mouth, eye and vagina.
- Arthritis is a tendon and joint inflammation that in most cases relates to undertreated or untreated hypothyroidism. Low thyroid function may cause fluid accumulation and tissue thickening around the joints and tendons resulting in muscle pain, joint stiffness and nerve compression.
- Carpal tunnel syndrome caused by a compression of the meridian nerve due to swelling and inflammation in the wrist area. The person has nerve and muscle pain in the arms, wrists under the armpits. People with carpal tunnel syndrome also have hypothyroidism that can be the underlying cause of most their symptoms. They respond very well to adding T3 thyroid hormone to their treatments that can make the symptoms of carpal tunnel syndrome disappear completely.
- Rheumatoid arthritis is an autoimmune joint disease that can cause inflammation of many joints in the body. The patient experiences pain and stiffness, especially in the morning. Sometimes the symptoms can improve when the hypothyroidism is corrected.
- Fibromyalgia is a chronic condition characterized by widespread pain in the muscles, ligaments and tendons. Fatigue is common and multiple tender points on the body causes pain when slightly pressed.
- Polycystic Ovary Syndrome (PCOS) is a hormonal and metabolic disorder. Studies show that PCOS can trigger Hashimoto’s disease and is the most common cause of infertility.
- Premature ovarian failure or oophoritis is a painless autoimmune inflammation of the ovaries resulting in premature menopause before age forty with a loss of fertility and ovary hormonal function. The incidence of this autoimmune condition is higher in women with Hashimoto’s disease. However, about half of the patients show intermittent estrogen production and could ovulate. The pregnancy could occur after diagnosis is made.
- Autoimmune hepatitis is a condition in which the immune system attacks the liver cells causing inflammation that can lead to liver damage, fibrosis and cirrhosis. The disease is chronic and the patient often shows symptoms of acute hepatitis.
- Easy bruising is a platelet disorders that prevents the blood to clot normally. If the number and function of platelets decreases the person may experience easy bruising. This condition may get worse if the individual uses pain medication such as aspirin or ibuprofen.
- Thrombocytopenic purpura is a bleeding disorder due to inadequate platelets in the blood. The autoimmune process destroys large numbers of platelets causing red or blue bruises to appear on the skin, especially on the legs.
- Lupus erythematosus is a systemic autoimmune disease that involves multiple organs and glands such as skin, lymph glands, heart, lungs, kidneys. When the antibodies act against an antigen that is shared by multiple tissue sites, multiple organs or glands are affected. Patients with lupus often test positive for thyroid antibodies.
- Mitral valve prolapse is characterized by a deformed mitral heart valve, which doesn’t close properly and may leak.
- Thyroid eye disease is an autoimmune inflammatory disorder that is associated with positive thyrotropin receptor antibody (TRAb). About 3% of people with Hashimoto’s get diagnosed with severe thyroid orbitopathy. However, eye and eyelid abnormalities such as mild upper lid retraction are very common and were found in 34% of the Hashimoto’s patients according to one recent study.
Above listed diseases have increased prevalence in patients with autoimmune thyroiditis. Hashimoto’s disease could also develop after any of these conditions have been previously diagnosed. According to a study at the University of Birmingham, UK the frequency of another autoimmune disorder was 14.3% in 495 patients with Hashimoto’s thyroiditis. Rheumatoid arthritis was the most common coexisting autoimmune disorder found 4.24% of Hashimoto’s thyroiditis cases.
Impaired metabolism affects people in different ways, resulting in a variety of overlapping symptoms that often could be mistaken for different diseases. Hashimoto’s thyroiditis requires an experienced physician or a specialist who is familiar and has knowledge of this disease and its related conditions.
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