Are You At Risk For Autoimmune Hashimoto’s Disease?

Hashimoto's disease risk

Autoimmune thyroiditis affects between 2% and 5% of the general population in Western countries. A combination of heredity, gender and age are the main contributing factor to the occurrence of this disease.

Heredity

There is a genetic predisposition for the development of Hashimoto’s thyroiditis. If some of your second degree relatives such as grandmother had any thyroid disease you are at an increased risk to develop Hashimoto’s. Up to 5% of first degree relatives of patients with Hashimoto’s thyroiditis may test positive for thyroid antibodies.

Thyroid disease might often skip generations. For example, someone with an underactive thyroid may have healthy parents, but could have had grandparents with thyroid issues. Studies show that a combination of multiple factors causes autoimmune diseases. Certain people inherit a tendency for thyroid problems, however never develop a disease, while others struggle with debilitating symptoms, and progressing illness.

Gender

The incidence of Hashimoto’s thyroiditis in women is six times greater than in males. The female endocrine system shows wide swings in the sex, adrenal and thyroid hormones due to puberty, fertility cycles, pregnancy and menopause. Hormonal imbalances and diseases affecting endocrine system develop more often in women and possibly trigger an autoimmune response more often than in men.

Hormone balance is altered among patients with autoimmune disease. The evidence shows that estrogen and progesterone levels affect thyroid function. While progesterone has a supporting role, excess of estrogen causes low thyroid.

Age

Hypothyroidism in elderly

Hashimoto’s thyroiditis can occur at any age, however it is most common in women of child bearing age, during menopause and in the elderly.

Hashimoto’s thyroiditis is the most common thyroid disease that develops during pregnancy. A woman is under the increased risk in the first three months of pregnancy and in the first six to twelve months after delivery.

The incidence of hypothyroidism has a tendency to increase with age. However, the signs of Hashimoto’s disease and thyroid dysfunction can be masked by perimenopausal and menopausal symptoms making a diagnosis more difficult. At the same time, hypothyroidism contributes to worsening symptoms of menopause and general well-being.

The hypothyroidism and  subclinical hypothyroid state are most likely to occur in menopause women (up to 4 and 10%, respectively). Furthermore, chronic autoimmune thyroiditis is the major risk factor for the development of hypothyroid disease in menopause women. It is important to get tested for major hormones and restore the hormonal levels in order to prevent diseases and minimize the symptoms of menopause.

During menopause, levels of major hormones drop and many women are on hormone replacement therapy with bio-identical estrogen, progesterone, testosteron and DHEA. The incidence of Hashimoto’s disease increases around menopause and is strongly associated with hormonal changes. Besides, women who use estrogen replacement show higher thyroid hormone requirements and normally need to increase their thyroid medication dosage.

Studies on the relationship between sex and thyroid autoimmunity in elderly people have shown that the age related prevalence of thyroid antibodies is greater in women older than 60 years. In the elderly population the occurrence of Tg antibodies increases up to 6.8% versus 2.9% in younger individuals. The levels of the TPO antibodies raise up to 13.3% in older people versus 2.9% in younger. In addition, an increased incidence of hypothyroidism has been documented in the elderly population.

There is also a high prevalence of autoimmune thyroid disease in patients with Alzheimer’s disease and chromosomal disorders including Turner’s, Klinefelter’s and Down syndromes. Around 40% of Turner syndrome patients have TPO antibodies and 15% become hypothyroid.

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Triggers of autoimmune thyroiditis. Part 1. Genetics

Triggers of autoimmune thyroiditis. Part 2. Environmental factors

References:

1.The autoimmune diseases by Ian R. Mackay, Academic Press, 2006

2. Molecular pathology of endocrine diseasesby Jennifer L. Hunt, Springer, 2010

3. The Thyroid and Autoimmunity: Proceedings Merck European Thyroid Symposium, June 2006 by Wilmar Wiersinga, Thieme, 2007

4. Thyroid disease in the elderly: sex-related differences in clinical expression. J Endocrinol Invest. 2005;28(11 Suppl Proceedings):101-4

5. Anti-Helicobacter Pylori, anti-thyroid peroxidase, anti-thyroglobulin and anti-gastric parietal cells antibodies in Czech population. Physiol Res. 2008;57 Suppl 1:S135-41. Epub 2008 Feb 13