Camelia Bhattacharyya, Amity University Kolkata
The immune system is the body’s defense system on which the entire functionality of an individual depends; but what if the frontline warriors are corrupted and conspires against the territory (here the body)? The entire kingdom (the organ systems) will crash and be ruined right? That’s exactly what happens in the case of an autoimmune disorder. While each type of such conspiracy (types of autoimmune diseases) act against particular parts of the kingdom (the tissues) due to the differentiation in their activity level and their distribution from within (the receptors, enzymes, mechanisms, pathways, and metabolism), there are other soldiers of the body that tries to act against the conspiracy and sometimes other soldiers are hired to do so (treatments, drugs, and therapies). Hashimoto’s Thyroiditis is one such disorder discovered by a Japanese surgeon, Hakaru Hashimoto back in 1912 and is known to be mostly found in North America, Australia, and Africa due to genetic history, other disorders (mostly digestive ones), stress, packed food, etc.
Region of action: The immune system of the patient suffering from Hashimoto’s disease, attacks the small gland present below Adam’s apple and at the backward side of the neck, i.e., the thyroid gland. Since this gland is a part of the endocrine system and is largely responsible for several major functions of the body like growth, metabolism, and development, the irregularity or reverse functioning of the immune system interferes with the other bodily activities and might at times be accompanied by other diseases like hypothyroidism, loss of memory, obesity, etc.
Gender bias? The study reveals that the disease affects women more than men. The ratio of patients is 8:1 (women to men). Why? Well, women are the ones who give birth to offspring and thus have additional hormonal balance completely absent in men. The menstrual cycle on which the release of the ovum depends is, in turn, dependent on the hormonal balance, the thyroid hormone is one of them. The regularity of the menstrual flow depends largely on the release of these hormones and thus any hindrance to normal functioning can lead to other diseases related to the entire thyroid gland. The major problems causing the interference are infertility and miscarriage. The artificial manipulation of the menstrual cycle through birth control pills containing estrogen and progesterone can also manipulate the functioning of the thyroid, these hormones being interdependent. When speaking of hormones and the menstrual cycle, the Polycystic Ovary Disease (PCOD) and the Polycystic Ovary Syndrome (PCOS) also come to our minds. A study has proved that women with PCOS and PCOD are more likely to get Hashimoto’s disease due to improper hormonal balance and an irregular menstrual cycle leading to improper functioning of the Thyroid gland.
Symptoms: Dryness and roughness of skin, thinning of the hairline, fatigue, enlarged goiter, depression, weight gain, slow heart rate, etc.
The biochemistry: Thyroid peroxidases and Thyroglobulin are the most common markers of this disease. Other genes and hormones involved include cytotoxic T lymphocyte antigen-4, protein tyrosine phosphatase nonreceptor type 22, thyroglobulin, vitamin D receptor, and cytokines. Excess intake of iodine and several infections might send a signal to the body directing towards a high level of antigen. To this, the body replies with T-helper type-1 (Th1) and T-helper type-17 (Th17) responses which finally leads to the destruction of the gland and hypothyroidism. The lymphocytic infiltration is carried out by the thyroid autoantibodies (TAbs). These antibodies work against the thyroid peroxidase (TPO), an antigen involved in synthesizing the thyroid hormone, catalyzing the oxidation of iodine, iodinating tyrosine residues in thyroglobulin (Tg), and coupling the iodothyrosines into thyroxine (T4) and triiodothyronine (T3). Since Tg, a glycoprotein on which the thyroid hormone is synthesized and stored is also affected, the hormone suffers more hindrance. The main TAbs are the TPOAbs and the TgAbs (antibodies named after the antigen for which they show their affinity). All these might lead to severe dysfunction of the thyroid gland needing rapid control to manage the antibodies and to neutralize the effects by increasing the hormones and the antigens.
Diagnosis: The most common diagnostic tests include the levels of the thyroid hormone and the thyroid-stimulating hormones (TSH) in the blood thus checking the functioning of the thyroid and the pituitary glands. Other tests under recent practice are the TPOAbs and TgAbs levels. The dosage of medication is dependent on the level of these tested biomolecules.
Treatment: Most times the disease might not lead to hypothyroidism thus not needing immediate treatment. But in cases where the diagnosis shows a drastic imbalance in the body, drugs like Levoxyl, Synthroid, and others containing thyroid hormone levothyroxine are used. These are identical to thyroxine. In case of the presence of other diseases, mostly severe hypothyroidism, the dosage of this medication should be checked and handled with utmost care. In addition to that, iron and calcium supplements, Cholestyramine, Sucralfate, and other drugs which support the activity of the thyroid hormone levothyroxine and the normal functioning of the body are also provided. Surgery is the last option that a doctor might try. At times the T3 and T4 supplements are also provided before as well as after the surgery.
New methods for the detection as well as the treatment of the disease are under the question to date and might take medical science a way forward someday.
Also read: Use of animals in the perfume industry
References:
- Zaletel K., Gaberšček S. “Hashimoto’s Thyroiditis: From Genes to the Disease”. (2011) 12(8):576-588. Curr Genomics. doi:http://10.2174/138920211798120763.
- Arason GJ, Jorgensen GH, Ludviksson BR. Primary immunodeficiency and autoimmunity: lessons from human diseases.(2010) 71(5):317-28.Scand J Immunol. doi: http://10.1111/j.1365-3083.2010.02386.x.
- Mincer DL, Jialal I. Hashimoto Thyroiditis. (2021) Treasure Island (FL): StatPearls Publishing. NBK459262.
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the thyroid gland work? 2010 Nov 17.
- Kubala J. “Hashimoto Diet: Overview, Foods, Supplements, and Tips”. (2020) Nutrition:Healthline.
- Carteron N. “Hashimoto’s Thyroiditis”. (2019) Health.
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