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Madelyn LoPresti

Professor Sobocinski

English Composition 1201

26 March 2020

How Do Treatments for Hashimoto’s Disease Affect the Quality of Life of the Patients?

Hashimoto’s disease has changed the lives of fourteen million people in the United States

alone (Milas, 2014). I know firsthand that this disease can be detrimental to someone's life

because of the effect it has had on my life. I have suffered from this disease for years and it has

ultimately changed the way I am able to live. From constant hospital visits, to different treatment

plans, to a wide variety of painful symptoms, Hashimoto’s disease has taken a toll on my quality

of life. Although the disease itself is brutal, what made my quality of life decrease so

significantly was the treatment. Since there is no cure for the disease, doctors have to try their

best to find a treatment plan that will hopefully relieve you of your symptoms. This is usually a

long process of trial and error and during that process sometimes the patient suffers. Treatments

that are not right for the patient can cause an array of nasty side effects that make living with the

disease that much harder. Treatments for Hashimoto's disease, specifically hormone replacement,

decreases the quality of life of the patient because of the side effects.

Hashimoto’s disease is an autoimmune condition, this means that one’s immune system

is attacking its own body. In this case, one's immune system is attacking its thyroid gland. When

the thyroid gland is attacked, it becomes unable to produce thyroid hormones and eventually, the

function of the gland becomes weakened severely. Once the body is deprived of these hormones,

patients typically experience fatigue, difficulty concentrating, depression, weight gain, swelling,

bradycardia, and many more (Mayo Clinic Staff, 2020). These symptoms typically affect middle-
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aged women, but anyone can obtain the disease. It is thought that the disease typically affects

more women than men because of the connection to the endocrine system, which controls

hormones (Mayo Clinic Staff, 2020). Hashimoto’s disease has symptoms similar to a lot of other

diseases and can often be hard to diagnose. In order to diagnose the disease, your doctor will

order a hormone test and an antibody test (Mayo Clinic Staff, 2020). These tests will show if

your thyroid is underactive and therefore if you have the disease. Once you have tested positive,

the next step is formulating a treatment plan. There aren’t a ton of treatment options but the most

common is hormone replacement therapy. After the patient is put on medications the next step is

to meet with a nutritionist. These specialists can culminate a plan that usually consists of going

gluten-free, sugar-free, dairy-free, or perhaps all of them combined. Treatment plans often vary

depending on the severity of each patient's condition and what symptoms they are experiencing.

Fig. 1. A labeled close up visual of the thyroid gland (“A Diagram of the Thyroid Gland”).

A common issue found in patients is that their hormone replacement medication can help

their symptoms from Hashimoto’s disease but it also brings along its own side effects. The two

medications typically prescribed are Levothyroxine and Liothyronine. The two work to regulate
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the body and make up for the hormones the thyroid gland isn’t producing. Some doctors believe

that these drugs are usually successful in treating the disease. What isn’t as frequently talked

about is the horror stories that accompany these drugs. While reading “Cognitive functioning and

quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement,” it

states “Patients on long-term levothyroxine replacement show persistent impairments in both

cognitive functioning and general well-being"((Djurovic, 2018). The impairments that Djurovic

is referring to are the side effects of this drug. Some people experience anxiety, difficulty

breathing, chest pain, swelling, excessive sweating, and the list goes on. Liothyronine has similar

side effects to Levothyroxine with the most common being chest pain, tachycardia, headache,

tremor, excessive sweating, and more. Although many argue the drug does its job, the patients’

quality of life suffers tremendously.

Once treatment begins with these medications, they are taken for the rest of the patient’s

life. The thyroid gland is very slow to repair itself and even after your symptoms are gone you

must still remain on the medication. This is another reason why the patients’ quality of life

suffers. When I first got my diagnosis, my doctor decided to treat me with Armour Thyroid

instead of Levothyroxine. The main difference between the two is that Levothyroxine is man-

made and Armour Thyroid is a natural product because it is made from the glands of animals

(Mayo Clinic Staff, 2020). After being on Armour Thyroid for three months, I felt side effects

that I did not have before starting the medication. I was having bad anxiety, worse fatigue,

shortness of breath, and weight gain. The drug made my Hashimoto’s symptoms twice as worse

than they were, to begin with. I went back to the doctor and after a few tests were done, we

discovered my thyroid levels had actually gotten worse after taking the medication. I was then

taken off Armour Thyroid and turned to a different treatment plan. There is always a risk that
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comes with relying on medication to treat your symptoms. There are plenty of nerve-racking side

effects that accompany prescription drugs and no real guarantee you won’t experience them.

Overall, the medicinal route of treatment is one that gives a possibility of treating your

symptoms, but it doesn’t treat the decline in quality of life and general well-being. Hashimoto’s

disease is known to cause problems involving mental health, like anxiety and depression

(Djurovic, 2018). Taking drugs such as Levothyroxine and Liothyronine certainly doesn’t help

with this problem. Since the disease has a lot of symptoms that can be hard to treat, it is so

important to find the treatment plan that is specific to your condition. Some patients prefer

medicine because they notice an improvement in their condition, while others prefer more

natural routes of treatment. In many cases patients are given a medication that wasn’t right for

them. Because of this, they experience a number of side effects that could have been avoided.

Often times when patients have such a bad experience with medication, they turn to a more

natural way of treating their symptoms.

Many doctors recommend a change in diet for patients suffering from Hashimoto’s

disease. Some people are referred to a nutritionist while still taking their hormone replacement

medication and others use diet plans as their sole form of treatment. These nutritionists can help

a patient set up an elimination diet that is specified just for them. An elimination diet is a diet

where a patient is directed to avoid food, they are sensitive to (Woody, Sarah). Sometimes, the

patient knows what type of food are problems and other times it is a guess and check method.

Once you have figured out what foods you want to avoid, you restrict yourself from eating them

for a period of time. Eventually, when enough time has passed, you can reintroduce those foods.

Since the body has had time to heal itself, it can better handle the foods it is sensitive to. The

most common elimination diets are the gluten-free diet, dairy-free diet, soy-free diet, and sugar-
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free diet. In the “Dietary Intervention for Hashimoto’s Thyroiditis: Auto-immune Protocol”

Sarah Woody explains how these diets work for an autoimmune condition. She asserts, “by

eliminating inflammatory foods and allowing the gut to heal and restore, the body gets back to its

proper function and eventually foods can be reintroduced once the digestive system is healthy

and able to process these foods properly. There is evidence that gluten, however, should be

eliminated entirely for those with autoimmune conditions,” (Woody, Sarah). It has been proven

that inflammation leads to autoimmune disease because of the damage it causes long-term

(Woody, Sarah). An easy fix to this problem is eliminating the foods that often cause this

inflammation. A lot of patients struggle with these diets because they can be demanding.

Although many patients are uncertain how well these diets work, statistics say otherwise.

If you don’t cheat on the diet, they are proven to be extremely helpful in relieving symptoms.

They can reduce inflammation and swelling. Even though most elimination diets work, some

patients say they are unreasonable. I know from experience that it completely changes the way

you eat. I was told to cut out gluten, dairy, and sugar from my diet. I was unable to eat any of the

foods I enjoyed and it proved to be extremely difficult for me, as a teenager. It is nearly

impossible to find a menu item when you go out to eat with your friends. Despite all of this, I

decided to tough it out and continue with my diet. I noticed zero difference in my health except

for the fact that the diet had taken a toll on my quality of life. I wanted to be able to eat the foods

I enjoy without having to constantly worry if what I was eating had any of my sensitivities in it.

Once my doctor realized that my Hashimoto’s symptoms were not improving since beginning

the diet, we made alterations. I began the gluten-free diet, which was much more manageable.

The safest path for those with autoimmune conditions is to stay away from gluten. This treatment
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may be hard for younger patients, but it is almost always effective. Restoring a patient’s quality

of life is a lot easier once you have found a reasonable way to manage your symptoms.

Mental health plays a big role in Hashimoto’s disease. Anxiety and depression are known

to be very common in patients suffering from the disease. The Nigerian Tribune backs this up by

saying, “Hashimoto’s disease may cause mood changes, fatigue, memory problems and

depression,” (Tribune, 2019). One big way mental health becomes a problem often begins before

the diagnosis. Since Hashimoto’s can be difficult to diagnose, this places a lot of stress on the

patients and their families to find the right treatment. It took me two years and eleven doctors to

finally reach a correct diagnosis. For these years my mental health suffered because of a feeling

of hopelessness that always accompanied me. Staying optimistic is hard for patients especially if

they don’t know when they will find a treatment that will relieve their symptoms. Patients and

their families can become desperate to find relief that sometimes they are incorrectly diagnosed.

I was told I had chronic fatigue syndrome and depression before I finally found out that what I

really was suffering from was Hashimoto’s disease. Not knowing when you will feel normal

again can place a lot of strain on a patient and their family. Therefore, causing a major decrease

in their quality of life.

Another common reason for problems involving mental health occurs when treatment

does not work as it should. Sometimes thyroid replacement medication is not always effective

and after you have tried that there are not many more options. Patients can become depressed

when they feel they will never find a solution. Medication can also worsen your symptoms or

sometimes create new ones. Certain drugs can also contribute to problems with depression and

anxiety. The thyroid medication I was on only made my symptoms worse and for me, that was

an all-time low. I was being told I needed to be on a gluten-free diet and the medicine I was
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taking was making me anxious and depressed. The thought that all the things you are doing to try

to feel better (such as taking medicine, appointments with the doctor, elimination diets, and

more) are not working is very defeating. The feeling of knowing you have run out of options is

what makes becoming healthy that much harder. The quality of life of the patients suffers

tremendously when treatment is not relieving symptoms.

Although many people believe there are not many different ways to treat Hashimoto’s,

Trevor Angell disagrees. In the article, “Thyroidectomy Improves Quality of Life and Fatigue in

Patients with Hashimoto's Disease and Persistent Symptoms Compared to Adequate Thyroid

Hormone Replacement” Trevor makes an interesting conclusion. He finds that “In patients with

HT who had persistent thyroid-related symptoms despite achieving biochemical euthyroidism

while on thyroid hormone replacement, total thyroidectomy plus thyroid hormone replacement

resulted in significantly higher health-related quality-of-life scores and lower fatigue scores as

compared with continued thyroid hormone replacement therapy alone,” (Angell, 2019). He

believes that a total thyroidectomy along with thyroid hormone replacement is necessary for

overall improvement in patients. Patients experienced positive effects such as better quality of

life and low fatigue scores. Angell has a study to support his results but despite this, a lot of

people have a hard time accepting his way of treating patients. Jeffrey Garber is one of these

people, he uses Norway’s Telemark Hospital study to back up his claims. He argues in his

“Harvard Health” post that even though the study done to evaluate the benefits of a

thyroidectomy had promising results, the study itself is too small. He expresses this by saying,

“However, the study, while well done, is a relatively small one. We need longer-term follow up

and confirmation with additional studies done on diverse populations. It’s also important to

consider that thyroid surgery in patients with advanced Hashimoto’s thyroiditis is difficult,”
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(Garber, 2019). Even though a thyroidectomy seems to improve patients’ all-around quality of

life and reduces symptoms, it is a risk to use for treatment and it should definitely be tested

among a larger study to make sure it is effective before recommending to patients.

A disagreement that arose during my research surrounded the cause of the disease itself.

The Mayo Clinic explains how doctors do not know what causes the disease but there are a

number of factors involved (2020). Their website says, “Hashimoto's disease is an autoimmune

disorder in which your immune system creates antibodies that damage your thyroid gland.

Doctors don't know what causes your immune system to attack your thyroid gland. Some

scientists think a virus or bacterium might trigger the response, while others believe a genetic

flaw may be involved. A combination of factors — including heredity, sex and age — may

determine your likelihood of developing the disorder,” (Mayo Clinic Staff, 2020). After further

research, I found that a study from the south of China believed these were not the only factors

that contributed to the cause of the disease. The study concluded, “high iodine intake was likely

to lead to the occurrence of thyroid diseases, such as Hashimoto thyroiditis, nodular goiter, and

hyperthyroidism, through a long-term mechanism,” (Zhao, 2014). Although this source was

published in 2014, compared to the Mayo Clinic’s in 2020, I think it provides credible

information since there is a study with evidence to back up their claims. Since the results of the

study revealed that iodine has an impact on the likelihood of developing a thyroid condition it is

safe to say iodine intake plays a role in causing the disease. You can obtain high iodine levels by

eating foods that contain iodine, like seaweed or iodized salt for example. In order to control

your levels of iodine and possibly decrease your risk of getting a thyroid disease, a low iodine

diet is essential.
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The opposing side might argue that thyroid hormone replacement therapy is worth it to

ease one’s symptoms. It is argued that these hormones are a just a small change to have to make

to your life to ultimately eliminate symptoms completely. It is a small price to pay to take

medicine daily to hopefully become healthy. Hormone replacement therapy has proven to be

successful in normalizing thyroid levels in patients. The Mayo Clinic provides, “Levothyroxine

causes virtually no side effects when used in the appropriate dose and is relatively inexpensive,”

(Mayo Clinic Staff, 2020). Many doctors and other medical professionals support the use of

manmade thyroid hormone to treat Hashimoto’s disease. Medical professionals become skeptical

when patients are treated with hormones from the glands of animals. Armour Thyroid is an

example of medicine that contains hormones from the thyroid gland of a pig. Armour Thyroid is

not widely supported because the balance of T-4 and T-3 are different in humans than in animals

(Mayo Clinic Staff, 2020). Even though not all hormone replacement medications are always

successful, the most vastly supported is levothyroxine.

What opposing viewpoints fail to mention is the fact that once someone is put on these

medications; they are on them for the rest of their life. Although there are success stories, there

are just as many cases where hormone replacement therapy worsened symptoms. In my opinion,

a patient’s quality of life and mental health should always come first. Sometimes this can be

difficult because of the many obstacles that surround Hashimoto’s. Since Hashimoto’s has no

cure, going through the unpleasant treatments aren’t always worth it. If there was a way to ensure

patients that their suffering would come to an end, it would be easier for them to persevere.

Unfortunately, this is impossible for any doctor to promise. This is why I believe that a patient’s

quality of life should be equally as important as their physical health. Some treatments, like

hormone replacement, can jeopardize this.

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Getting diagnosed with Hashimoto’s disease at a young age is never easy. Since it is rare

to be diagnosed young, it made treating my symptoms that much harder. Having this disease has

changed my whole life around, I am unable to do many of the things that I enjoy the most. After

doing thorough research about Hashimoto’s, it has helped me learn a lot. Mainly I have proven

that treatments for Hashimoto's disease, specifically hormone replacement, decrease the quality

of life of the patient because of the side effects. This disease can be difficult to treat but

researching what kind of treatment will relieve your symptoms most effectively while still

maintaining your quality of life will provide you with the most relief.

Works Cited

Angell, Trevor. “Thyroidectomy Improves Quality of Life and Fatigue in Patients with

Hashimoto's Disease and Persistent Symptoms Compared to Adequate Thyroid Hormone

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Replacement.” Mary Ann Liebert Inc. Publishers, 8 May 2019,

www.liebertpub.com/doi/10.1089/ct.2019%3B31.178-181. Accessed 28 February 2020.

BERBEROĞLU, Kıvanç Kudret and GÖRKER, Işık. “Assessment of Psychiatric

Disorders Accompanying Hashimoto’s Thyroiditis in Children and Adolescents.” Anatolian

Journal of Psychiatry / Anadolu Psikiyatri Dergisi, vol. 20, no. 2, April 2019, pp. 189–195.

EBSCOhost, doi:10.5455/apd.5216. Accessed 28 February 2020.

Djurovic, Marina. “Cognitive Functioning and Quality of Life in Patients with Hashimoto

Thyroiditis on Long-Term Levothyroxine Replacement.” Endocrine, U.S. National Library of

Medicine, October 2018, www.ncbi.nlm.nih.gov/pubmed/29959689. Accessed 27 February

2020.

“A Diagram of the Thyroid Gland.” The Pantagraph, 7 June 2018, www.pantagraph.com/what-

is-hashimoto-s-disease/article_d7dd9605-61e9-57cd-92d0-abb2e2c7aefe.html. Accessed

31 March 2020.

Garber, Jeffrey. “Is There a Role for Surgery in Treating Hashimoto's Thyroiditis?”

Harvard Health Blog, 31 July 2019, www.health.harvard.edu/blog/is-there-a-role-for-surgery-in-

treating-hashimotos-thyroiditis-2019081217443. Accessed 28 February 2020.

Hadleigh-West, Maggie, director. Sick to Death! Sick to Death, 2018,

www.sick2death.com/screen-the-film/. Accessed 27 February 2020.

LoPresti, Madelyn G. “Hashimoto's Patient's Quality of Life from a Parent's Perspective.”

27 Feb. 2020. Accessed 27 February 2020.

Mayo Clinic Staff. “Hashimoto's Disease.” Mayo Clinic, Mayo Foundation for Medical

Education and Research, 11 February 2020, www.mayoclinic.org/diseases-

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conditions/hashimotos-disease/symptoms-causes/syc-20351855?page=0&citems=10. Accessed

26 February 2020.

Milas, Kresimira. “Hashimoto's Thyroiditis Facts and Tips.” EndocrineWeb, 2014,

www.endocrineweb.com/conditions/hashimotos-thyroiditis/hashimotos-thyroiditis-facts-

tips. Accessed 6 April 2020.

Online, Tribune. “Hashimoto's Disease Deprives Human Body of Hormones for Healthy

Function - Endocrinologist.” Nigerian Tribune, 22 August 2019. Accessed 27 February 2020.

Ryan, Marc. How to Heal Hashimoto’s: An Integrative Road Map to Remission. 1st Hay

House edition, Hay House, Inc., 2017. EBSCOhost, search.ebscohost.com/login.aspx?

direct=true&db=cat01128a&AN=scc.b1975003&site=eds-live. Accessed 28 February 2020.

Woody, Sarah. “Dietary Intervention for Hashimoto’s Thyroiditis: Auto-Immune

Protocol.” Running Head: DIET FOR HASHIMOTO’S THYROIDITIS,

achs.edu/resource/theses-and-capstone-projects/woody.pdf. Accessed 20 March 2020.

Zhao, Hengqiang. “Correlation Between Iodine Intake and Thyroid Disorders: A Cross-

Sectional Study from the South of China.” Biological Trace Element Research, vol. 162, no. 1–3,

Dec. 2014, pp. 87–94. EBSCOhost, doi:10.1007/s12011-014-0102-9. Accessed 28 February

2020.