RESEARCH PAPER
Associations between serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3) and clinical symptoms in patients diagnosed with Hashimoto’s thyroiditis
Karol Wiśniewski 1  
,   Monika Bełej 2  
,   Joanna Wojtkiewicz 1  
 
More details
Hide details
1
Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Wamia and Mazury in Olsztyn, Poland
2
Advanced Materials Engineering and Modelling Group, Faculty of Chemistry, Wroclaw University of Science and Technology, Poland
CORRESPONDING AUTHOR
Joanna Wojtkiewicz   

Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Wamia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland.
Submission date: 2019-11-14
Final revision date: 2020-05-18
Acceptance date: 2020-05-18
Online publication date: 2020-10-15
 
Pol. Ann. Med. 2020;27(2):96–102
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Hashimoto’s thyroiditis (HT), with prevalence of about 0.8%, is one of the most common autoimmune disorders in the world. Due to the fact that HT affects level of thyroid hormones, symptoms of HT are from almost every body system.

Aim:
The aim of this study was to estimate the correlations between symptoms reported by patients with HT and the level of TSH, fT3 and fT4 and also to check the frequency of reporting each symptom at presentation and to estimate the frequency of other co-existing with HT autoimmune diseases.

Material and methods:
This study included 65 patients with HT who decided to complete the online survey.

Results and discussion:
The most common among the reported symptoms were fatigue (77%), sleepiness (60%) and weak concentration (57%). The results also showed higher prevalence of: rheumatoid arthritis, coeliac disease, systemic lupus erythematous, diabetes mellitus type 1, inflammatory bowel disease and atopic dermatitis than in general population. Significant correlations were found between TSH level and the symptoms including: weak concentration (P = 0.0002), easy freezing (P = 0.02) and body weight gain (P = 0.02). There was also a correlation between level of fT3 and physical exercise (P = 0.02).

Conclusions:
The findings in this study suggest that there is a higher relative risk for some autoimmune disorders (especially rheumatoid arthritis, coeliac disease and systemic lupus erythematous) for people with HT. The findings also suggest that some symptoms of HT correlate with the level of thyroid parameters.

CONFLICT OF INTEREST
None declared.
FUNDING
None declared.
 
REFERENCES (38)
1.
Jenkins RC, Weetman AP. Disease associations with autoimmune thyroid disease. Thyroid. 2002;12(11):977–988. https://doi.org/10.1089/105072....
 
2.
Caturegli P, Remigis AD, Rose N. Hashimoto thyroiditis: Clinical and diagnostic criteria. Autoimmun Rev. 2014;13(4–5):391–397. https://doi.org/10.1016/j.autr....
 
3.
Berghi N. Immunological mechanisms implicated in the pathogenesis of chronic urticaria and Hashimoto thyroiditis. Iran J Allergy Asthma Immunol. 2017;16(4):358–366.
 
4.
Pyzik A, Grywalska E, Matyjaszek-Matuszek B, Roliński J. Immune disorders in Hashimoto’s thyroiditis: What do we know so far? J Immunol Res. 2015;2015:1–8. https://doi.org/10.1155/2015/9....
 
5.
Popko K, Górska E. The role of natural killer cells in pathogenesis of autoimmune diseases. Cent Eur J Immunol. 2015;40(4):470–476. https://doi.org/10.5114/ceji.2....
 
6.
Czarnocka B. Thyroperoxidase, thyroglobulin, Na+/I– symporter, pendrin in thyroid autoimmunity. Front Biosci. 2011;16(1):783–802. https://doi.org/10.2741/3720.
 
7.
Dong YH, Fu DG. Autoimmune thyroid disease: mechanism, genetics and current knowledge. Eur Rev Med Pharmacol Sci. 2014;18(23):3611–3618.
 
8.
Mcleod DSA, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012;42(2):252–265. https://doi.org/10.1007/s12020....
 
9.
Schomburg L. Selenium, selenoproteins and the thyroid gland: interactions in health and disease. Nat Rev Endocrinol. 2011;8(3):160–171. https://doi.org/10.1038/nrendo....
 
10.
Negro R, Greco G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab. 2007;92(4):1263–1268. https://doi.org/10.1210/jc.200....
 
11.
Janegova A, Janega P, Rychly B, Kuracinova K, Babal P. The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases. Endokrynol Pol. 2015;66(2):132–136. https://doi.org/10.5603/ep.201....
 
12.
Caselli E, Zatelli MC, Rizzo R, et al. Virologic and immunologic evidence supporting an association between HHV-6 and Hashimotos thyroiditis. PLoS Pathogens. 2012;8(10): e1002951. https://dx.doi.org/10.1371%2Fj....
 
13.
Brix TH. A population-based study of chronic autoimmune hypothyroidism in Danish twins. J Clin Endocrinol Metab. 2000;85(2):536–539. https://doi.org/10.1210/jcem.8....
 
14.
Caturegli P, Remigis AD, Chuang K, Dembele M, Iwama A, Iwama S. Hashimotos thyroiditis: Celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid. 2013;23(2):142–150. https://doi.org/10.1089/thy.20....
 
15.
Li Y, Bai Y, Liu Z, et al. Immunohistochemistry of IgG4 can help subclassify Hashimoto’s autoimmune thyroiditis. Pathol Int. 2009;59(9):636–641. https://doi.org/10.1111/j.1440....
 
16.
Luca FD, Santucci S, Corica D, Pitrolo E, Romeo M, Aversa T. Hashimoto’s thyroiditis in childhood: presentation modes and evolution over time. Riv Ital Pediatr. 2013;39(1):8. https://dx.doi.org/10.1186%2F1....
 
17.
Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012;97(2):334–342. https://doi.org/10.1210/jc.201....
 
18.
Corsello SM, Barnabei A, Marchetti P, Vecchis LD, Salvatori R, Torino F. Endocrine side effects induced by immune checkpoint inhibitors. J Clin Endocrinol Metab. 2013;98(4):1361–1375. https://doi.org/10.1210/jc.201....
 
19.
Vita R, Guarneri F, Agah R, Benvenga S. Autoimmune thyroid disease elicited by NY-ESO-1 vaccination. Thyroid. 2014;24(2):390–394. https://dx.doi.org/10.1089%2Ft....
 
20.
Mandac JC, Chaudhry S, Sherman KE, Tomer Y. The clinical and physiological spectrum of interferon-alpha induced thyroiditis: Toward a new classification. Hepatology. 2006;43(4):661–672. https://doi.org/10.1002/hep.21....
 
21.
Radetti G. Clinical aspects of Hashimoto’s thyroiditis. In: Szinnai G, ed. Paediatric Thyroidology. Basel: Karger. 2014;26:158–170. https://doi.org/10.1159/000363....
 
22.
Wu G. Ultrasonography in diagnosis of Hashimoto’s thyroiditis. Front Biosci (Landmark Ed). 2016;21:1006–1012. https://doi.org/10.2741/4437.
 
23.
Reinhardt W, Luster M, Rudorff K, et al. Effect of small doses of iodine on thyroid function in patients with Hashimoto’s thyroiditis residing in an area of mild iodine deficiency. Eur J Endocrinol. 1998;139:23–28. https://doi.org/10.1530/eje.0.....
 
24.
Tajiri J. Radioactive iodine therapy for goitrous Hashimoto’s thyroiditis. J Clin Endocrinol Metab. 2006;91(11):4497–4500. https://doi.org/10.1210/jc.200....
 
25.
Acharya UR, Sree SV, Krishnan MMR, et al. Computer-aided diagnostic system for detection of Hashimoto thyroiditis on ultrasound images from a Polish population. J Ultrasound Med. 2014;33(2):245–253. https://doi.org/10.7863/ultra.....
 
26.
Bousquet J, Schunemann HJ, Fonseca J, et al. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): The new generation guideline implementation. Allergy. 2015;70(11):1372–1392. doi:10.1111/all.12686.
 
27.
Arduc A, Dogan BA, Bilmez S, et al. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: Does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015;40(4):204–210. https://doi.org/10.3109/074358....
 
28.
Kowalczyk K, Franik G, Kowalczyk D, Pluta D, Blukacz Ł, Madej P. Thyroid disorders in polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2017;21(2):346–360.
 
29.
Boelaert K, Newby PR, Simmonds MJ, et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med. 2010;123(2):183.e1–9. https://doi.org/10.1016/j.amjm....
 
30.
Tuhan H, Işık S, Abacı A, et al. Celiac disease in children and adolescents with Hashimoto thyroiditis. Turk Pediatri Ars. 2016;51(2):100–105. https://dx.doi.org/10.5152%2FT....
 
31.
Posselt RT, Coelho VN, Skare TL. Hashimoto thyroiditis, anti-thyroid antibodies and systemic lupus erythematosus. Int J Rheum Dis. 2017;21(1):186–193. https://doi.org/10.1111/1756-1....
 
32.
Shizuma T. Concomitant thyroid disorders and inflammatory bowel disease: A literature review. Biomed Res Int. 2016;2016:5187061. https://doi.org/10.1155/2016/5....
 
33.
Sybilski AJ, Raciborski F, Lipiec A, et al. Epidemiology of atopic dermatitis in Poland according to the Epidemiology of Allergic Disorders in Poland (ECAP) study. J Dermatol. 2014;42(2):140–147. https://doi.org/10.1111/1346-8....
 
34.
Zalewska M, Furmańczyk K, Jaworski S, Niemiro W, Samoliński B. The prevalence of asthma and declared asthma in Poland on the basis of ECAP survey using correspondence analysis. Comput Math Methods Med. 2013;2013:597845. https://dx.doi.org/10.1155%2F2....
 
35.
Rutkowski M, Bandosz P, Czupryniak L, et al. Prevalence of diabetes and impaired fasting glucose in Poland – the NATPOL 2011 Study. Diabet Med. 2014;31(12):1568–1571. https://doi.org/10.1111/dme.12....
 
36.
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: A systematic review. J Hypertens. 2004;22(1):11–19. https://doi.org/10.1097/000048....
 
37.
Niklas A, Flotyńska A, Puch-Walczak A, et al. Prevalence, awareness, treatment and control of hypertension in the adult Polish population – Multi-center National Population Health Examination Surveys – WOBASZ studies. Arch Med Sci. 2018;14(5):951–961. https://doi.org/10.5114/aoms.2....
 
38.
Özen S, Berk Ö, Şimşek DG, Darcan S. Clinical course of Hashimoto’s thyroiditis and effects of levothyroxine therapy on the clinical course of the disease in children and adolescents. J Clin Res Pediatr Endocrinol. 2011;3(4):192–197. https://dx.doi.org/10.4274%2Fj....