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Autoimmune Diseases Associated with Hashimoto’s Thyroiditis.

Hashimoto’s thyroiditis, an autoimmune disease that targets the thyroid gland, is often associated with other autoimmune conditions due to the shared underlying mechanisms of immune dysregulation and genetic predisposition. In today’s article, I will explain some of the most common autoimmune diseases associated with Hashimoto’s that we see in the clinic.

Autoimmune diseases occur when rare cells in our immune system evade normal checkpoints and attack healthy parts of our body, instead of fighting infectious invaders. There are more than 100 autoimmune diseases, spanning all age groups in the community and affecting around 10% of the population collectively.

Common autoimmune disease associated with Hashimoto's thyroiditis

Some of the most common autoimmune diseases associated with Hashimoto’s thyroiditis include:

1. Graves’ Disease:

Hashimoto’s thyroiditis and Graves’ disease are both autoimmune disorders that affect the thyroid gland. While there are distinct differences between these two conditions, there is an association between the two.

Hashimoto’s thyroiditis is characterized by an underactive thyroid gland due to the autoimmune destruction of thyroid cells by the immune system. In contrast, Graves’ disease is an autoimmune disorder that leads to an overactive thyroid, resulting in hyperthyroidism.

The immune response in Graves’ disease involves the production of antibodies, specifically thyroid-stimulating immunoglobulins (TSIs), which overstimulate the thyroid and cause excessive hormone production.

Despite this opposite thyroid dysfunction, individuals can sometimes develop both Hashimoto’s and Graves’ disease, known as autoimmune overlap syndrome.

In some cases, individuals with Hashimoto’s thyroiditis may go on to develop Graves’ disease, or vice versa. This transformation from one condition to another is known as the “Hashitoxicosis” phenomenon.

Hashitoxicosis occurs when the immune response shifts from destructive autoantibodies (Hashimoto’s) to stimulating autoantibodies (Graves’).

Hashimoto’s thyroiditis initially causes hypothyroidism, leading to symptoms such as fatigue, weight gain, and depression. On the other hand, Graves’ disease results in hyperthyroidism, leading to symptoms like weight loss, rapid heartbeat, and irritability. It’s important to get the proper testing if you experience both hyperthyroid and hypothyroid symptoms.

Auto immune diseases associated with Hashimoto’s Thyroiditis_Type 1 Diabetes

2. Type 1 Diabetes:

Another Autoimmune disease associated with Hashimoto’s thyroiditis is Type I Diabetes.

Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin-producing beta cells in the pancreas.

Individuals with Hashimoto’s thyroiditis have an increased risk of developing type 1 diabetes compared to the general population, indicating a common genetic susceptibility to autoimmune conditions.

Both conditions share an autoimmune basis, wherein the immune system mistakenly targets and damages the body’s own tissues.

Certain genes, such as human leukocyte antigen (HLA) genes, have been associated with an increased risk for both conditions.

Furthermore, certain autoimmune Triggers, such as viral infections, Inflammation, Leaky gut, and food sensitivities, may trigger autoimmune responses in genetically susceptible individuals.

Hashimoto’s thyroiditis and type 1 diabetes are two of the conditions included in autoimmune polyglandular syndrome (APS) type 3, also known as autoimmune polyendocrine syndrome type 3. Autoimmune polyglandular syndrome is characterized by the presence of multiple autoimmune endocrine disorders within the same individual.(*)

Other conditions that may be associated with autoimmune polyglandular syndrome type 3 include Addison’s disease and pernicious anemia.(*)

Auto immune diseases associated with Hashimoto’s Thyroiditis_Rheumatoid Arthritis

3. Rheumatoid Arthritis (RA):

Hashimoto’s thyroiditis and rheumatoid arthritis (RA) are both autoimmune diseases, and here again, there is evidence of an association between Hashimoto’s and rheumatoid arthritis.

Both Hashimoto’s thyroiditis and rheumatoid arthritis are characterized by an autoimmune response, where the immune system mistakenly attacks the body’s tissues.

In Rheumatoid arthritis the immune system directs an attack that primarily affects the joints, causing chronic inflammation and tissue damage.

Studies have shown an increased prevalence of thyroid autoimmunity, including Hashimoto’s, in individuals with rheumatoid arthritis compared to the general population. Likewise, there is a higher incidence of rheumatoid arthritis in individuals with Hashimoto’s thyroiditis.

These findings suggest an important association between the two conditions. Environmental factors, such as intestinal dysbiosis, Leaky gut, infections, or hormonal changes, may also play a role in triggering autoimmune responses in susceptible individuals.

Both Hashimoto’s and rheumatoid arthritis involve dysregulation of the immune system and chronic inflammation. Inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), play a role in the cause of both conditions. This shared inflammatory pathway might contribute to the association observed between Hashimoto’s and rheumatoid arthritis.

Autoimmune Diseases associated with Hashimotos_Celiac Disease

4. Celiac Disease:

There is a well-established association between Celiac disease and Hashimoto’s thyroiditis. Celiac disease is an autoimmune disorder where the immune system reacts to gluten, a protein found in wheat, barley, and rye, leading to inflammation and damage to the small intestine.

Patients with Hashimoto’s thyroiditis are at an elevated risk of having Celiac disease, and vice versa, indicating an important association between these autoimmune conditions.

Several studies have observed a higher incidence of Celiac disease in individuals with Hashimoto’s thyroiditis, and vice versa, compared to the general population. The coexistence of these conditions suggests a common genetic predisposition or shared environmental triggers that contribute to their development.

Studies have identified certain human leukocyte antigen (HLA) variants, particularly HLA-DQ2 and HLA-DQ8, that are associated with an increased risk of both Celiac disease and Hashimoto’s thyroiditis. These shared genetic factors further support the association between both Hashimoto’s and Celiac disease.

Individuals with Celiac disease or Hashimoto’s may present with elevated levels of specific autoantibodies. In Celiac disease, tissue transglutaminase antibodies (tTG-IgA) and anti-endomysial antibodies (EMA) are commonly detected, while in Hashimoto’s, thyroid peroxidase antibodies (TPO) and Thyroglobulin antibodies (TGB)  are frequently found.

Some individuals may have positive antibodies suggestive of both conditions. Additionally, both celiac disease and Hashimoto’s may share symptoms such as fatigue, weight changes, gastrointestinal disturbances, and nutrient deficiencies.

Considering the association between celiac disease and Hashimoto’s thyroiditis, individuals with one condition might benefit from screening for the other. Diagnosis typically involves a combination of medical history assessment, genetic testing, and antibody testing.

Autoimmune Diseases associated with Hashimoto_Vitiligo

5. Vitiligo:

Another autoimmune association with Hashimoto’s is vitiligo.

Vitiligo is a skin condition characterized by the loss of melanin-producing cells, resulting in depigmentation patches on the skin.

Studies have found a higher prevalence of vitiligo in individuals with Hashimoto’s thyroiditis and vice versa. The coexistence suggests a genetic predisposition or shared environmental triggers that contribute to the development of both conditions.

A family history of autoimmune diseases, including vitiligo and Hashimoto’s, can also increase the risk of developing either condition.

Autoimmune Diseases associated with Hashimotos_Atrophic Gastritis

6. Autoimmune Gastritis:

Autoimmune gastritis is another associated autoimmune disease seen in patients with Hashimoto’s.

In the early stages, gastric mucosal atrophy usually does not show any abnormal symptoms in the body, so few people can detect it early. However, if not treated in time, this condition can cause many serious complications such as stomach ulcers, and stomach cancer.

Autoimmune gastritis is characterized by the immune system attacking the cells that line the stomach, leading to the progressive destruction of the stomach lining and reduced production of intrinsic factor.

Intrinsic factor is a protein produced by the cells of the stomach lining, particularly in the gastric parietal cells. Its primary function is to aid in the absorption of vitamin B12 in the small intestine.

The association between autoimmune gastritis and Hashimoto’s suggests underlying shared autoimmune factors or genetic predispositions.

Studies have shown that individuals with Hashimoto’s thyroiditis are at an increased risk of developing autoimmune gastritis, and vice versa.

This co-occurrence suggests a common underlying immune dysregulation or genetic susceptibility that predisposes individuals to develop both conditions.

The presence of certain autoantibodies, such as thyroid peroxidase (TPO) antibodies and parietal cell antibodies, may be seen in individuals with both autoimmune gastritis and Hashimoto’s, further supporting the association.

Autoimmune gastritis is an immune-mediated condition targeting the stomach lining, leading to reduced production of gastric acid and intrinsic factor. Individuals with Hashimoto’s thyroiditis have an increased risk of autoimmune gastritis, impacting their digestive health and nutrient absorption.

Autoimmune gastritis and Hashimoto’s may share symptoms such as fatigue, gastrointestinal discomfort, and nutrient deficiencies.

Additionally, individuals with autoimmune gastritis may exhibit laboratory findings like those seen in Hashimoto’s, including the presence of antibodies against the thyroid (TPO antibodies) and abnormalities in thyroid hormone levels.

Autoimmune Diseases associated with Hashimotos_Lupus

7. Systemic Lupus Erythematosus (SLE):

Systemic lupus erythematosus or just Lupus is a multisystem autoimmune disorder that can affect various organs and tissues. Studies have reported an association between Hashimoto’s thyroiditis and systemic lupus erythematosus, suggesting a potential link between these autoimmune diseases. Studies show that patients with Hashimotos have a (*)

Hashimoto’s and lupus share several common risk factors, including female gender, genetic predisposition, hormonal imbalances, and environmental triggers. These shared factors suggest a potential overlap in the underlying mechanisms or pathways involved in autoimmune processes.

An individual can have both Hashimoto’s and lupus. Coexistence of these conditions can complicate diagnosis and management, as the symptoms can overlap.

Both Lupus and Hashimoto’s present with fatigue, joint pain, and inflammation, making it essential for healthcare professionals to consider a comprehensive evaluation and provide appropriate treatment.

Autoimmune diseases associated with Hashimotos_Pernicious Anemia

8. Pernicious Anemia-

Pernicious Anemia (PA) a condition caused by vitamin B12 deficiency, has been observed together. Pernicious Anemia itself is often an autoimmune disorder, and the presence of Hashimoto’s can further increase the risk.

Pernicious Anemia is strongly associated with a personal history of autoimmune thyroid diseases, and it is a part of autoimmune polyglandular syndrome (APS). PA is also encountered with other Autoimmune diseases such as type 1 diabetes, rheumatoid arthritis, vitiligo, and Addison’s disease.

Pernicious anemia results from the deficiency of intrinsic factor, a protein required for the absorption of vitamin B12. Without adequate vitamin B12, red blood cell production is impaired, leading to anemia. Pernicious anemia is often caused by an autoimmune response targeting cells that produce intrinsic factor in the stomach lining. It can manifest in symptoms like fatigue, weakness, pale skin, and tingling or numbness in the hands and feet.

Diagnosing Pernicious Anemia. 

Pernicious anemia doesn’t always impact the tongue. However, tongue-related symptoms are often one of the first things people notice when they have the condition, and it is the signal that leads people to visit their doctor in search of answers.

Complete Blood Count (CBC): A CBC measures the levels of red blood cells, white blood cells, hemoglobin, and platelets. In pernicious anemia, red blood cell counts are typically low, and the cells may appear large and immature (macrocytic anemia).

Serum Vitamin B12 Level: Measuring the level of vitamin B12 in the blood is essential. Low levels of vitamin B12 indicate deficiency, which is often seen in pernicious anemia.

Intrinsic Factor Antibodies: Testing for antibodies against intrinsic factor, a protein essential for absorbing vitamin B12, can help confirm or support the diagnosis of pernicious anemia. Positive intrinsic factor antibodies often suggest an autoimmune cause of the condition.

Homocysteine and Methylmalonic Acid (MMA) are tests that can and should be run. Elevated levels of these substances may indicate a vitamin B12 deficiency before anemia develops and can aid in early diagnosis.

Implications and Management Strategies

Given the common occurrence of multiple autoimmune diseases in individuals with Hashimoto’s thyroiditis, comprehensive evaluation, monitoring, and management are essential to address the complexities of autoimmune conditions.

Healthcare providers may recommend the following strategies for individuals with Hashimoto’s and associated autoimmune diseases:

  1. Multidisciplinary Care: Collaborative management involving endocrinologists, rheumatologists, gastroenterologists, dermatologists, and Functional Medicine Practitioners can provide comprehensive care for individuals with Hashimoto’s and concomitant autoimmune conditions, ensuring integrated treatment and holistic support.
  2. Regular Monitoring: Routine monitoring of thyroid function, autoimmune markers, and symptom assessment is crucial for early identification of disease progression, treatment adjustments, and optimization of care for individuals with Hashimoto’s and related autoimmune diseases.
  3. Personalized Treatment: Tailored treatment approaches, lifestyle modifications, dietary interventions, and stress reduction techniques, can help address autoimmune symptoms, manage inflammation, and support overall health in individuals with multiple autoimmune conditions.
  4. Predictive Antibody Testing. Predictive antibodies, also known as biomarker antibodies, are antibodies that can indicate the likelihood of an individual developing a specific disease or condition in the future. These antibodies are present in the bloodstream and can be detected years before diagnosis.

By recognizing the common autoimmune diseases associated with Hashimoto’s thyroiditis and implementing collaborative, patient-centered care, individuals can navigate the challenges of managing multiple autoimmune conditions effectively.

It’s important to note that the presence of predictive antibodies does not guarantee that an individual will develop the associated disease.

However, their presence can serve as a warning sign, prompting further medical evaluation, monitoring, and potentially preventive measures.

Predictive antibody testing can help individuals take proactive steps toward managing their health and enable healthcare providers to offer tailored interventions based on individual risk profiles.

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