Wednesday, April 24, 2019

Thyroidectomy Seems to Improve Quality of Life in Hashimoto Disease

Total thyroidectomy appears to improve quality of life in patients with Hashimoto disease, according to a study in the Annals of Internal Medicine.

Roughly 150 adults with Hashimoto-related symptoms despite adequate hormone substitution were randomized to receive either total thyroidectomy with standard medical therapy or medical therapy alone. All had serum antithyroid peroxidase (anti-TPO) antibody titers above 1000 IU/mL at baseline.

At 18 months, surgery patients had significantly better health-related quality-of-life scores than did controls. Surgery patients also had improved fatigue scores, and their serum anti-TPO antibody levels were significantly lower.

My Take:
Hashimoto’s disease is an autoimmune disease of the thyroid gland. It is estimated that a third of all patients suffering from hypothyroidism have Hashimoto’s.

The condition often goes undiagnosed as the confirmatory tests – thyroid peroxidase and thyroid autoantibodies – are seldom performed. However, there is renewed interest in Hashimoto’s as evidenced by this study.

Traditional treatment of Hashimoto’s disease is limited to hormone replacement therapy using Synthroid. There is no medical approach to treat the underlying autoimmune disease. Even in this extreme treatment where the thyroid gland is surgically removed, the underlying disease is not addressed.

Autoimmune disease is progressive in nature. Although the errant immune system may initially target the thyroid gland, over time other tissues of the body are affected.

To complicate matters, the lab tests can be transient. I have a patient that was tested every three months for three years before her lab tests confirmed her diagnosis of Hashimoto’s disease.

Autoimmune disease is triggered by a foreign substance in the blood stream. Low grade viral infections, especially EBV (Epstein-Barr virus) have been implicated as the trigger in a third of patients with Hashimoto’s, MS or RA. However, any protein complex consisting of five or more amino acids will precipitate an immune response. The same is true of any sugar larger than a monosaccharide. So, food particles that are not fully digested are also suspect.

Increased intestinal permeability (leaky gut) is the predisposing factor allowing these larger chemical compounds to enter the blood stream. Once identified, the immune system attacks these compounds. As the immune system targets this sequence of amino acids or sugars, it looks and finds this pattern in our tissues as well and the self-attack begins. The disease is named for the initial tissue under siege but the process is the same.

Bottom Line:
While patients with Hashimoto’s thyroiditis may show some improvement in symptoms following thyroidectomy, surgery is not the answer. Treat the underlying autoimmune disease – modulate the immune system and repair the leaky gut.

Source: March 12, 2019 New England Journal of Medicine

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