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What is Hashimoto’s disease?
Hashimoto’s disease is an autoimmune disease that affects the thyroid gland. Your thyroid is a small gland at the base of your neck. Your thyroid gland makes hormones that control many activities in your body, including how fast your heart beats and how fast you burn calories.

In people with Hashimoto’s disease, the immune system makes antibodies that attack the thyroid gland. This damages your thyroid gland, so it does not make enough thyroid hormone. Hashimoto’s disease often leads to hypothyroidism. Hypothyroidism, when severe, can cause your metabolism to slow down, which can lead to weight gain, fatigue, and other symptoms.

Who gets Hashimoto’s disease?
Hashimoto’s disease affects more women than men. It can happen in teens and young women, but it most often appears between ages 40 and 60. Hashimoto’s disease often runs in families.

Your risk of getting Hashimoto’s disease is higher if you have another autoimmune desease, such as rheumatoid arthritis, celiac disease, type 1 diabetes, pernicious anemia (vitamin B12 deficiency anemia), or lupus.

What are the symptoms of Hashimoto’s disease?
You may not have any symptoms of Hashimoto’s disease for years. The first sign is often an enlarged thyroid, called a goiter. The goiter may cause the front of your neck to look swollen. You may feel it in your throat, or it may be hard to swallow. But most people don’t have any symptoms, and goiters rarely cause pain.

Some women with Hashimoto’s disease have problems getting pregnant.

Hashimoto’s disease often leads to an under active thyroid gland (hypothyroidism). Symptoms of an under active thyroid include feeling tired, feeling cold when others do not, constipation, weight gain, and heavier-than-normal menstrual periods.

What causes Hashimoto’s disease?
Researchers aren’t sure exactly what causes Hashimoto’s disease. Studies show that it is more common in women than men.

Your risk is higher if you
Have a family history: Hashimoto’s disease may run in families. Researchers are working to find the gene or genes involved
Recently had a baby: Some women have thyroid problems after having a baby, called postpartum thyroiditis. The thyroid often returns to normal within 12 to 18 months after symptoms start. But if you have a history of postpartum thyroiditis, your risk is higher for developing permanent hypothyroidism.

How does Hashimoto’s disease affect women?
Women are more likely than men to get Hashimoto’s disease. It also affects women differently than men. Most problems from Hashimoto’s disease happen when women develop hypothyroidism. Hypothyroidism can cause:

Problems with your menstrual cycle: Your thyroid hormone can affect your menstrual cycle. Too little thyroid hormone can lead to irregular menstrual cycles or periods that are heavier than normal.
Problems getting pregnant: Irregular menstrual cycles can make it harder for women with Hashimoto’s to get pregnant. Studies show that almost half of women with hypothyroidism due to Hashimoto’s disease had problems getting pregnant. Most of these women were recently diagnosed with hypothyroidism or had not yet started treatment for hypothyroidism.
Problems during pregnancy: The unborn baby’s brain and nervous system need thyroid hormone to develop. Untreated or poorly treated, Hashimoto’s disease can lead to miscarriage, birth defects, or other problems.

How is Hashimoto’s disease diagnosed?
If you have symptoms of hypothyroidism, your doctor or nurse will do an exam and order one or more tests. Tests used to find out whether you have hypothyroidism and Hashimoto’s disease include:

Thyroid function test: This blood test tells whether your body has the right amounts of thyroid stimulating hormone (TSH) and thyroid hormone. A high level of TSH is a sign of an underactive thyroid. When the thyroid begins to fail, the pituitary gland makes more TSH to trigger the thyroid to make more thyroid hormone. When the damaged thyroid can no longer keep up, your thyroid hormone levels drop below normal.

Antibody test: This blood test tells whether you have the antibodies that suggest Hashimoto’s disease. More than one in 10 people have the antibodies but have normal thyroid function. Having only the antibodies does not cause hypothyroidism.

How is Hashimoto’s disease treated?
Hashimoto’s disease can be treated with Western medicine but for a natural alternative, Hashimoto’s disease can also be addressed with a combination of acupuncture and a Chinese Herbal Thyroid Balance medicine.

What can happen if hypothyroidism from Hashimoto’s disease is not treated?
If left untreated, hypothyroidism from Hashimoto’s disease can cause other health problems, including:

– Infertility
– Miscarriage
– Giving birth to a baby with birth defects
– High cholesterol

Very rarely, severe under active thyroid, called myxedema, can lead to:

– Heart failure
– Seizures
– Coma
– Death

Untreated or poorly treated hypothyroidism can lead to problems during pregnancy, such as:

– Preclampsia
– Anemia
– Miscarriage
– Placental abruption
– Postpartum bleeding

It also can lead to serious problems for your baby, such as:

– Premature birth
– Low birth weight
– Stillbirth
– Birth defects
– Thyroid problems

Symptoms of normal pregnancy, like fatigue and weight gain, can make it easy to overlook thyroid problems in pregnancy. If you have symptoms of an underactive thyroid or notice a goiter, it’s important to tell your doctor or nurse.

Some women develop thyroid problems in the first year after giving birth. This is called postpartum thyroiditis. It often begins with mild symptoms of an overactive thyroid, which last two to four months. Most women then develop symptoms of an under active thyroid, which can last up to a year and requires treatment. Most often, thyroid function returns to normal as the thyroid heals.

Sourses

1. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Hashimoto’s Disease.
2. Zaletel, K., & Gaberšček, S. (2011). Hashimoto’s thyroiditis: From genes to the disease. Current Genomics, 12(8), 576–588.
3. Lazarus, J. H., (2011). The continuing saga of postpartum thyroiditis. Journal of Clinical Endocrinology and Metabolism, 96(3), 614–616.
4. Quintono-Moro, A., Zantut-Wittmann, D., Tambascia, M., da Costa Machado, H., & Fernandes, A. (2014). High prevalence of infertility among women with Graves’ disease and Hashimoto’s thyroiditis. (link is external)International Journal of Endocrinology, 2014 (982705). doi:10.1155/2014/982705.
5. DailyMed. (2016). Levothyroxine sodium. National Library of Medicine.

Depression describes a group of disorders characterized by sadness, despondency, rumination, inability to experience pleasure, and feelings of hopelessness and inadequacy that are severe or persistent enough to interfere with normal function, interest in life and family and social interaction. Depressed patients experience a range of symptoms in addition to the mood component, and it is helpful to think of depression as a disorder that interferes with the basic aspects of life: the energy for activity, appetite, sex drive and sleep.

Typical symptoms for depression include reduced sex drive, decreased appetite and weight loss (although increased appetite and weight gain can occur), constant fatigue, poor concentration, withdrawal from social situations and activities, and thoughts of death or suicide. Sleep disturbance, insomnia, waking in the early hours of the morning, or somnolence are common. Patients may report headaches, vague aches and pains and digestive problems. Symptoms can vary during the day but are usually worse upon waking in the morning.

True depression should be distinguished from the low mood that results from disappointment or loss, which may be better described as demoralization. The negative feelings of demoralization, unlike those of depression, usually abate when circumstances improve; the duration of the low mood lasts days rather than weeks or months, and suicidal ideation and loss of function are less likely.

Patients with a depressed mood can be classified into two groups: those with low mood as a response to specific circumstances, and those in which no specific trigger can be identified. These distinctions are clinically important, because if a cause can identified, the probability of a satisfactory outcome is increased. Demoralization as a result of distressing or stressful stimuli can be a normal and appropriate response to the circumstances and will abate with time. In some cases, the response to the distressing event may be exaggerated, pathological, and indistinguishable from major depression (below). In both cases, Chinese Medicine, in conjunction with counseling, lifestyle modification, and other appropriate interventions, can be of significant benefit, helping the patients to move through the process, while supporting healthy organ system function and maintaining qi and blood flow. Depression without an identifiable cause is more complex condition. It will usually be diagnosed as a major depression, with the pathology a mix of constitutional factors, life habits and diet, and an exaggerated response to chronic stress, routine difficulties and setbacks. This type of depression can be difficult to manage effectively with a single therapeutic strategy, and may require a multi factorial approach, especially when suicide is a possibility. Practitioners should not be reluctant to harness the relatively fast acting pharmacotherapeutic approach of psychiatry, with the awareness building of cognitive behavioral therapy, and the supportive, strengthening and qi and blood mobilizing effects of Chines Medicine.

From a psychiatric point of view, there are three groups of depression; minor, major and masked.

Minor depression: Minor depression is a mood disturbance of at least two weeks duration, with two to four of the DSM-IV criteria, including number 1 or 2. There are no delusions, and suicidal thoughts, if present are fleeting and not seriously entertained. Minor depression is usually a form of demoralization.

Major depression: Major depression is a disabling condition which adversely affects all aspects of the patient’s life, and is characterized by the presence of a severely depressed state that persists for at least two weeks. The diagnostic criteria for major depression are shown in box 3.2. Episodes may be isolated or recurrent, and occur without identifiable trigger events. Patients with major depression may contemplate and attempt suicide, and occasionally suffer delusions or hallucinations.

Masked depression: Masked depression is a depressed state characterized by the prominence of physical symptoms. Patients may not complain of depression, or may deny it. They usually present with multiple minor physical complaints. The mood component is hidden beneath tiredness, menstrual disorders, unusual sensations in the head and body, breathing difficulties and sleep problems. Masked depression is relatively common, and is influenced by cultural factors and perceptions of depression as a sign of weakness and social stigma.

Diagnostic Criteria for Depression:

Five of the following, with number 1 or 2 essential, are necessary for the diagnosis of major depression.

1. Pervasive depressed mood
2. Marked loss of interest or pleasure
3. Appetite change (poor apatite most common); weight loss or weight gain
4. Insomnia or somnolence
5. Fatigue, lack of energy every day
6. Feelings of worthlessness or excessive guilt
7. Impaired thinking or concentration, indecisiveness
8. Suicidal thoughts

Depression in Chinese Medicine: Mental or physical health is a product of the quality, volume and uninhibited movement of qi and blood. All mental disorders are due to disruption of one or more of the internal organ systems and their mental components, the shen, hun, po, yi and zhi (henceforth collectively known as the anima), by insufficient or constrained qi and blood.

In Chinese, depression is yu zheng. In the context of medicine, the word yu conveys the meaning of restraining action on the flow of qi, which we render as constraint. Qi flows through the surface layers can be constrained by the ‘freezing and constricting’ nature of cold. Qi flow can also be constrained in various organ systems by repression of emotion. The term constraint is used to distinguish it from other forms of stagnation due to factors not related to emotion. In the context of depression, constraint is most commonly applied to the effect of emotional repression on the Liver, but can also apply to the Heart and Lungs, and Spleen and stomach. Different emotions cause constraint in different organs, with different expressions of the depressed mood. Constraint of qi, however, is not the only cause of a depressed mood. Even though the term yu implies that constraint of some type is at work in depression, this is not always the case. Both deficiency and excess factors can influence the anima and produce depression. Constraint interferes with the expression and activity of the anima by restricting their movement, which in turn produces a particular shade of mood disorder. The anima can also be destabilized and scattered by a deficiency of qi, blood, yin and yang, with a different tone to the depressed state.