Your blood values are OK, but you still feel tired and exhausted? What’s really behind the symptoms, what can help, and when is surgery the best option?

Hashimoto's disease is an autoimmune disorder that causes inflammation and reduced hormone production in the thyroid gland. Diagnosis involves measuring thyroid hormone levels and specific antibodies, such as thyroid peroxidase antibodies, which may impact more than just the thyroid. The standard treatment is synthetic T4 hormone replacement, but some patients continue to experience symptoms despite normal blood values. Supplementary therapies like selenium and iodine have been explored, but current evidence does not support their routine use. In rare and severe cases where medication is ineffective, surgical removal of the thyroid may be considered, which can alleviate symptoms by halting the autoimmune response.

Hashimoto's disease — reducing thyroid damage

The thyroid is a relatively small organ that produces T3 and T4 hormones. They regulate a range of processes in the body, influencing your heartbeat, metabolic rate and mental health. If the thyroid fails to produce enough of the hormones, it can throw off the body's balance in a big way. Hormone expert Saskia Momberger is familiar with the full range of potential symptoms caused by the autoimmune disease Hashimoto's thyroiditis. It triggers a kind of inflammatory reaction that impairs the thyroid's function and leads to reduced hormone production. And thyroid hormones are needed throughout the body. Autoimmune diseases involve malfunctions in the body's natural defence system. In the case of Hashimoto's disease, it mistakenly identifies thyroid cells as a danger and attacks them. That causes the organ to grow chronically inflamed and produce fewer hormones. Blurred values can reveal whether the thyroid is still functioning, and if so, how well. The concentration of freely circulating T3 and T4 hormones is a key indicator. Special antibodies are also analysed, such as thyroid peroxidase antibodies or TPOs. This is very important for diagnosis, because if antibody levels are higher, I know why. It's in black and white. And the specific antibodies connected to Hashimoto's have a greater impact on the body than previously thought, says endocrine surgeon Volker Fendrich. Recent studies are increasingly showing that these TPO antibodies don't just target the thyroid. They can also be found in many other organs and bodily fluids, such as the synovial fluid in joints. There are no specific drugs for treating Hashimoto's disease. To compensate for the insufficient hormone production and provide symptom relief, patients are prescribed tablets containing synthetic T4 hormone. The problem is, while blood values, thanks to the tablets, then appear normal, many patients, like Johanna Olenska, still don't feel any better. They say the blood values are fine and within the normal range. And then my doctor says there's nothing more he can do for me. For years now, a range of supplementary therapies have been under consideration for treating Hashimoto's. One is the trace element selenium, taken as a dietary supplement. Selenium was recommended a few years ago because it was thought to have a generally positive effect on inflammation, especially with Hashimoto's. But those initial studies haven't really been replicable and we no longer recommend it in our department. For a long time, it was thought the trace element iodine might aggravate Hashimoto's or even trigger it. That was based on a study from Asia, where it appeared that high iodine intake led to a greater prevalence of Hashimoto's. But this hasn't really been confirmed, over here in Western Europe at least. Experts now agree that consuming iodine via a reasonable amount of table salt is fine, but not as an extra dietary supplement. What's also clear is that the thyroid changes over the course of the disease, growing smaller and more fragile, and in many cases developing dark spots. But it doesn't waste away completely. A few cells can be enough to sustain the autoimmune process, and 100% of the thyroid is never completely dead and providing no stimuli for the body. As is also shown by a study in Norway. Hashimoto's patients who had their thyroids removed felt better than those only on medication, especially when it came to symptoms like fatigue and exhaustion. The researchers concluded that removing the thyroid stops the autoimmune process, because the body no longer receives the stimulus to continue producing these antibodies. Surgery, however, is still more the exception than the rule. Removing the organ is only recommended in very severe cases, where medication simply doesn't help.

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