Hashimoto's Thyroiditis and Its Impact on Thyroid Enlargement

Regarding thyroid enlargement caused by Hashimoto's thyroiditis?

Hello, Doctor.
I was diagnosed with Hashimoto's thyroiditis earlier this month after experiencing thyroid enlargement.
I underwent an ultrasound and blood tests at the hospital.
My outpatient physician informed me that I have no tumors or bleeding as per the ultrasound, but my blood test results indicate hypothyroidism (high antibodies, normal T3, and T4 around 3).
I was prescribed Levothyroxine (50 mcg) to take every morning on an empty stomach.
I have been on the medication for 10 days, but the swelling of my thyroid fluctuates.
It is generally not swollen when I first wake up, but by 2 to 3 PM, it becomes enlarged (I even feel pressure on my esophagus and airway).
When swollen, I experience slight pain in the lower part of my neck and a persistent urge to cough, along with difficulty breathing.
Recently, the pain has intensified (to the point where my entire neck hurts).
Should I return for a follow-up appointment? Additionally, my doctor did not specifically advise me on any dietary restrictions, but I found online that foods high in iodine should be avoided, which leaves me uncertain about what to do.
I hope you can clarify this for me.
Thank you.

Liu Xiao Yue, 20~29 year old female. Ask Date: 2016/10/14

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I am not an endocrinologist, so I can only provide a general response.
Ultimately, your question should be discussed with your physician during your clinic visit.
From what I understand, Hashimoto's thyroiditis can lead to either hyperthyroidism or hypothyroidism.
The fact that your doctor has prescribed levothyroxine suggests that your current condition may be hypothyroid, in which case consuming iodine-rich foods should not pose significant issues.
However, if someone has hyperthyroidism, additional iodine intake could be problematic.

Moreover, as the name suggests, Hashimoto's thyroiditis is an inflammatory condition, which can sometimes cause swelling and pain in the thyroid gland.
This inflammation may also irritate the upper respiratory tract, leading to symptoms such as coughing and difficulty breathing.
Therefore, if necessary, anti-inflammatory medications can be considered to alleviate the inflammatory pain.
You should discuss this aspect with your physician.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2016/10/14

More Info

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that leads to inflammation of the thyroid gland. This condition is characterized by the immune system mistakenly attacking the thyroid, which can result in hypothyroidism (underactive thyroid) over time. The thyroid gland may become enlarged, a condition known as goiter, due to the inflammation and the body's attempt to compensate for the reduced hormone production.

In your case, the ultrasound findings indicating no tumors or bleeding, along with elevated antibodies and low T4 levels, confirm the diagnosis of Hashimoto's thyroiditis. The treatment you are receiving, Levothyroxine (often referred to by its brand name, Eltroxin), is a synthetic form of the thyroid hormone thyroxine (T4) that helps to normalize hormone levels and alleviate symptoms associated with hypothyroidism.

The symptoms you are experiencing, such as the fluctuation in thyroid size, pressure on the esophagus and airway, and discomfort in the neck, are not uncommon in Hashimoto's thyroiditis. The thyroid gland can swell due to inflammation, leading to a sensation of tightness or pressure in the throat. This can also cause difficulty swallowing or breathing, especially when the gland is more inflamed later in the day, as you described.

It is essential to monitor your symptoms closely. If the pain in your neck becomes more severe, or if you experience significant difficulty breathing or swallowing, you should seek medical attention promptly. It is also advisable to return to your healthcare provider for a follow-up appointment to discuss your symptoms, the effectiveness of your current medication, and any necessary adjustments to your treatment plan.

Regarding dietary considerations, there is some debate about the role of iodine in Hashimoto's thyroiditis. While iodine is essential for thyroid hormone production, excessive iodine intake can exacerbate thyroid dysfunction in some individuals with autoimmune thyroid disease. Therefore, it is often recommended that individuals with Hashimoto's avoid high-iodine foods, such as seaweed, iodized salt, and certain seafood, particularly if they have been advised to do so by their healthcare provider.

However, dietary restrictions should be personalized. It is crucial to have a conversation with your doctor or a registered dietitian who specializes in thyroid disorders to determine the best dietary approach for your specific situation. They can provide guidance on what foods to include or avoid based on your individual health needs and thyroid function.

In summary, Hashimoto's thyroiditis can lead to thyroid enlargement and associated symptoms due to inflammation. Your current treatment with Levothyroxine is appropriate for managing hypothyroidism, but ongoing monitoring and communication with your healthcare provider are vital. If you have concerns about your symptoms or dietary restrictions, do not hesitate to reach out to your doctor for further clarification and support.

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