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Hashimoto's thyroiditis (hypothyroidism)
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[[File:MECFS comorbid autoimmune.jpg|alt=Hashimoto's thyroiditis & ME/CFS|thumb|Hashimoto's thyroiditis found in 17-20% of ME/CFS patients<ref name="Castro2018" /> Source: Sotzny et al (2018), [[EUROMENE]] project. ]]'''Hashimoto's thyroiditis''' or '''Hashimoto's disease''' (also known as '''chronic lymphocytic thyroiditis''') is an [[autoimmune disease]] affecting [[thyroid]] function, where the body's [[immune system]] creates antibodies that attack and inflame the thyroid. Hashimoto's thyroiditis is the most common cause of '''hypothyroidism''' (or underactive thyroid or low thyroid) in the United States. Hypothyroidism is an [[endocrine]] disorder in which the [[thyroid gland]] does not produce enough [[thyroid hormone]] called T4 (thyroxine), which is used to help the body use energy as well help maintain function of the brain, heart, muscle, and other organs.<ref name="amthyass">{{Cite web | url=https://www.thyroid.org/hashimotos-thyroiditis/ | title = Hashimoto’s Thyroiditis|website=American Thyroid Association|language=en-US|access-date=2020-08-26}}</ref><ref name="niddk">{{Cite web | url=https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism | title = Hypothyroidism (Underactive Thyroid) {{!}} NIDDK|website=National Institute of Diabetes and Digestive and Kidney Diseases|language=en-US|access-date=2020-08-26}}</ref> Hashimoto's thyroiditis is found in an estimated 17% - 20% of ME/CFS patients.<ref name="Castro2018" /><ref name="Castro2017"/> ==Signs and symptoms== [[File:Signs_and_symptoms_of_hypothyroidism.png|right|alt=Human female body labeled with signs and symptoms of hypothyroidism|source: Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014".]] Symptoms of an underactive thyroid (hypothyroidism) due to Hashimoto's include: * [[Weight gain]] * [[Hair loss]] (or thinning) * [[Fatigue]] * [[Body temperature|Sensitivity to cold]] * [[Constipation]] * [[arthralgia|Joint pain]] and [[myalgia|muscle pain]] * Excessive or prolonged [[menstrual period|menstrual bleeding]] * [[Depression]] == Causes == There are many risk factors and potential causes for thyroid disease. Hashimoto's is the number one cause of hypothyroidism in the United States.<ref name="amthyass" /> Causes of hypothyroidism include: *[[Hashimoto's thyroiditis]], which is an acquired form of thyroiditis * Congenital hypothyroidism, which is when a person is born with hypothyroidism * Thyroid surgery that removes all or part of the thyroid * Past radiation treatment of the thyroid * Other causes include certain medicines, too much or too little [[iodine]] in the diet, or pituitary disease (which is another endocrine disease).<ref name="niddk"/> === Hashimoto's thyroiditis=== The exact cause of Hashimoto's thyroiditis is unknown. Many researchers and physicians believe genetics and/or a virus could play a role in the development of this autoimmune disease.<ref name="niddk"/> == Cellular hypothyroidism == Some patients may exhibit Hashimoto's hypothyroid symptoms, yet display normal ranges in their thyroid blood tests. This could be an indication of “''cellular or peripheral hypothyroidism''”, where there's a deficiency at the cellular level. While thyroid hormone production may be functioning properly, the transportation of thyroid hormone into cells will be hindered if there is mitochondrial dysfunction.<ref>{{Cite journal | last = Kelly | first = Tammas | date = Dec 2016 | title = A hypothesis on the mechanism of action of high-dose thyroid in refractory mood disorders| url = https://pubmed.ncbi.nlm.nih.gov/27876122/|journal=Medical Hypotheses|volume=97 | pages = 16–21|doi=10.1016/j.mehy.2016.09.022|issn=1532-2777|pmid=27876122}}</ref> [[Mitochondria dysfunction|Mitochondrial dysfunction]] has been implicated countless times, not only as a contributor to, but often cited as the immediate cause of ME/CFS symptoms.<ref>{{Cite journal | last = Myhill | first = Sarah | last2 = Booth | first2 = Norman E. | last3 = McLaren-Howard | first3 = John | date = 2009-01-15 | title = Chronic fatigue syndrome and mitochondrial dysfunction | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680051/|journal=International Journal of Clinical and Experimental Medicine|volume=2|issue=1 | pages = 1–16|issn=1940-5901|pmc=2680051|pmid=19436827}}</ref><ref>{{Cite journal | last = Tomas | first = Cara | last2 = Brown | first2 = Audrey E. | last3 = Newton | first3 = Julia L. | last4 = Elson | first4 = Joanna L. | date = 2019-03-01 | title = Mitochondrial complex activity in permeabilised cells of chronic fatigue syndrome patients using two cell types| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398432/|journal=PeerJ|volume=7|doi=10.7717/peerj.6500|issn=2167-8359|pmc=6398432|pmid=30847260}}</ref><ref>{{Cite journal | last = Venter | first = Marianne | last2 = Tomas | first2 = Cara | last3 = Pienaar | first3 = Ilse S. | last4 = Strassheim | first4 = Victoria | last5 = Erasmus | first5 = Elardus | last6 = Ng | first6 = Wan-Fai | last7 = Howell | first7 = Neil | last8 = Newton | first8 = Julia L. | last9 = Van der Westhuizen | first9 = Francois H. | date = 2019-02-27 | title = MtDNA population variation in Myalgic encephalomyelitis/Chronic fatigue syndrome in two populations: a study of mildly deleterious variants| url = https://www.nature.com/articles/s41598-019-39060-1|journal=Scientific Reports|language=en|volume=9|issue=1 | pages = 2914|doi=10.1038/s41598-019-39060-1|issn=2045-2322}}</ref> == Viral triggers == [[Virus]]es are common triggers of Hashimoto's thyroiditis, and hypothyroidism. [[Epstein-Barr virus|Epstein-Barr virus (EBV)]] and [[Human herpesvirus 6|Human Herpesvirus 6 (HHV-6)]] are perhaps two of the most common viral triggers for Hashimoto. Others include [[Herpes simplex virus|Herpes Simplex 1 and 2 (HSV)]], [[Cytomegalovirus|Cytomegalovirus (CMV)]], [[Enterovirus]], and [[Parvovirus B19]]. ==ME/CFS == An estimated 17%-20% of ME/CFS patients are believed to also have Hashimoto's thyroiditis.<ref name="Castro2018">{{Cite journal | date = 2018-06-01 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease| url = https://www.sciencedirect.com/science/article/pii/S1568997218300880|journal=Autoimmunity Reviews|language=en|volume=17|issue=6 | pages = 601–609|doi=10.1016/j.autrev.2018.01.009|issn=1568-9972}}</ref><ref name="Castro2017">{{Cite journal | last = Castro-Marrero | first = Jesús | last2 = Faro | first2 = Mónica | last3 = Aliste | first3 = Luisa | last4 = Sáez-Francàs | first4 = Naia | last5 = Calvo | first5 = Natalia | last6 = Martínez-Martínez | first6 = Alba | last7 = de Sevilla | first7 = Tomás Fernández | last8 = Alegre | first8 = Jose | date = Sep 2017 | title = Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Nationwide Population-Based Cohort Study| url = https://pubmed.ncbi.nlm.nih.gov/28596045/|journal=Psychosomatics|volume=58|issue=5 | pages = 533–543|doi=10.1016/j.psym.2017.04.010|issn=1545-7206|pmid=28596045}}</ref> A 2001 Swedish study of 219 chronic fatigue patients (90% women), used fine-needle aspiration (FNA) cytology to test thyroid function. 87 of 219 (40%) were diagnosed with cytological lymphocytic thyroiditis.<ref>{{Cite journal | last = Wikland | first = B. | last2 = Löwhagen | first2 = T. | last3 = Sandberg | first3 = P.O. | date = 2001-03-24 | title = Fine-needle aspiration cytology of the thyroid in chronic fatigue| url = https://pubmed.ncbi.nlm.nih.gov/11289370/|journal=Lancet (London, England)|volume=357|issue=9260 | pages = 956–957|doi=10.1016/s0140-6736(05)71654-8|issn=0140-6736|pmid=11289370}}</ref> ===Studies linking viruses to Hashimoto's and ME/CFS=== Studies suggesting a viral trigger for Hashimoto's thyroiditis and autoimmune thyroiditis (AIT) that are also viruses commonly associated with ME/CFS. {| class="wikitable" |'''Epstein-Barr virus serology in patients with autoimmune thyroiditis''' J Vrbikova, I Janatkova, V Zamrazil, F Tomiska, T Fucikova<ref>{{Cite journal | last = Vrbikova | first = J. | last2 = Janatkova | first2 = I. | last3 = Zamrazil | first3 = V. | last4 = Tomiska | first4 = F. | last5 = Fucikova | first5 = T. | date = 1996 | title = Epstein-Barr virus serology in patients with autoimmune thyroiditis| url = https://pubmed.ncbi.nlm.nih.gov/8750577/|journal=Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association|volume=104|issue=1 | pages = 89–92|doi=10.1055/s-0029-1211428|issn=0947-7349|pmid=8750577}}</ref> |1996 |Endocrinology study shows significantly higher presence of active Epstein-Barr virus (EBV) in those with autoimmune thyroiditis compared to healthy controls. 7 of 22 (32%) patients were positive for EBV early antigen (EA-D) antibodies, versus 2 of 35 (6%) controls. |- |'''Virologic and Immunologic Evidence Supporting an Association between HHV-6 and Hashimoto's Thyroiditis''' Elisabetta Caselli, Maria Chiara Zatelli, Roberta Rizzo, Sabrina Benedetti, Debora Martorelli, Giorgio Trasforini, Enzo Cassai, Ettore C. degli Uberti, Dario Di Luca, Riccardo Dolcetti<ref name="Caselli2012">{{Cite journal | last = Caselli | first = Elisabetta | last2 = Zatelli | first2 = Maria Chiara | last3 = Rizzo | first3 = Roberta | last4 = Benedetti | first4 = Sabrina | last5 = Martorelli | first5 = Debora | last6 = Trasforini | first6 = Giorgio | last7 = Cassai | first7 = Enzo | last8 = degli Uberti | first8 = Ettore C. | last9 = Di Luca | first9 = Dario | date = 2012-10-04 | title = Virologic and Immunologic Evidence Supporting an Association between HHV-6 and Hashimoto's Thyroiditis| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464215/|journal=PLoS Pathogens|volume=8|issue=10|doi=10.1371/journal.ppat.1002951|issn=1553-7366|pmc=3464215|pmid=23055929}}</ref> |2012 |Study using fine needle aspirates (FNA) thyroid biopsies found HHV-6 DNA in 28 of 34 (82%) Hashimoto's thyroiditis patients and 3 of 28 (10%) controls. |- |'''Inflammation and Increased Myxovirus Resistance Protein A Expression in Thyroid Tissue in the Early Stages of Hashimoto's Thyroiditis''' Sara Salehi Hammerstad, Frode Lars Jahnsen, Sisko Tauriainen, Heikki Hyöty, Trond Paulsen, Ingrid Norheim, and Knut Dahl-Jørgensen<ref>{{Cite journal | last = Hammerstad | first = Sara Salehi | last2 = Jahnsen | first2 = Frode Lars | last3 = Tauriainen | first3 = Sisko | last4 = Hyöty | first4 = Heikki | last5 = Paulsen | first5 = Trond | last6 = Norheim | first6 = Ingrid | last7 = Dahl-Jørgensen | first7 = Knut | date = Mar 2013 | title = Inflammation and Increased Myxovirus Resistance Protein A Expression in Thyroid Tissue in the Early Stages of Hashimoto's Thyroiditis| url = https://www.liebertpub.com/doi/full/10.1089/thy.2012.0264|journal=Thyroid|volume=23|issue=3 | pages = 334–341|doi=10.1089/thy.2012.0264|issn=1050-7256}}</ref> |2013 |Study found Enterovirus RNA in 11% of Hashimoto's thyroiditis (HT) patients, versus 0% of controls. |- |'''The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases''' Andrea Janegova, Pavol Janega, Boris Rychly, Kristina Kuracinova, Pavel Babal<ref>{{Cite journal | last = Janegova | first = Andrea | last2 = Janega | first2 = Pavol | last3 = Rychly | first3 = Boris | last4 = Kuracinova | first4 = Kristina | last5 = Babal | first5 = Pavel | date = 2015 | title=The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases| url = https://pubmed.ncbi.nlm.nih.gov/25931043/|journal=Endokrynologia Polska|volume=66|issue=2 | pages = 132–136|doi=10.5603/EP.2015.0020|issn=2299-8306|pmid=25931043}}</ref> |2015 |Graves' and Hashimoto's disease specimens were used in this study, finding a high prevalence of EBV infection. ''"We assume that high prevalence of EBV infection in cases of Hashimoto's and Graves' diseases imply a potential aetiological role of EBV in autoimmune thyroiditis"'' |- |'''Association of active human herpesvirus-6 (HHV-6) infection with autoimmune thyroid gland diseases''' A Sultanova, M Cistjakovs, S Gravelsina, S Chapenko, S Roga, E Cunskis, [[Zaiga Nora-Krukle|Z Nora-Krukle]], V Groma, I Ventina, [[Modra Murovska|M Murovska]]<ref name="Sultanova">{{Cite journal | last = Sultanova | first = A. | last2 = Cistjakovs | first2 = M. | last3 = Gravelsina | first3 = S. | last4 = Chapenko | first4 = S. | last5 = Roga | first5 = S. | last6 = Cunskis | first6 = E. | last7 = Nora-Krukle | first7 = Z. | authorlink7 = Zaiga Nora-Krukle | last8 = Groma | first8 = V. | last9 = Ventina | first9 = I. | last10 = Murovska | first10 = M. | authorlink10=Modra Murovska | date = Jan 2017 | title = Association of active human herpesvirus-6 (HHV-6) infection with autoimmune thyroid gland diseases| url = https://pubmed.ncbi.nlm.nih.gov/27693656/|journal=Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases|volume=23|issue=1 | pages = 50.e1–50.e5|doi=10.1016/j.cmi.2016.09.023|issn=1469-0691|pmid=27693656}}</ref> |2017 |A study comparing the involvement of HHV-6 infection between autoimmune thyroiditis (AIT) patients and healthy controls. Thyroid gland biopsies confirmed active persistent HHV-6 infection in 18 of 44 (41%) AIT patients and 1 of 17 (6%) healthy controls. |- |'''Human herpesvirus 6A active infection in patients with autoimmune Hashimoto's thyroiditis''' Noorossadat Seyyedi, Gholamreza Rafiei Dehbidi, Mozhgan Karimi, Amir Asgari, Babak Esmaeili, Farahnaz Zare, Ali Farhadi, Mohammad Hossein Dabbaghmanesh, Forough Saki, Abbas Behzad-Behbahani<ref>{{Cite journal | last = Seyyedi | first = Noorossadat | last2 = Dehbidi | first2 = Gholamreza Rafiei | last3 = Karimi | first3 = Mozhgan | last4 = Asgari | first4 = Amir | last5 = Esmaeili | first5 = Babak | last6 = Zare | first6 = Farahnaz | last7 = Farhadi | first7 = Ali | last8 = Dabbaghmanesh | first8 = Mohammad Hossein | last9 = Saki | first9 = Forough | date = Nov 2019 | title = Human herpesvirus 6A active infection in patients with autoimmune Hashimoto's thyroiditis| url = https://pubmed.ncbi.nlm.nih.gov/31751524/|journal=The Brazilian Journal of Infectious Diseases: An Official Publication of the Brazilian Society of Infectious Diseases|volume=23|issue=6 | pages = 435–440|doi=10.1016/j.bjid.2019.10.004|issn=1678-4391|pmid=31751524}}</ref> |2019 |In this study, 38% of patients with Hashimoto’s disease had active HHV-6A infections. |- |'''Study of Epstein–Barr virus serological profile in Egyptian patients with Hashimoto’s thyroiditis: A case-control study''' Samir Naeim Assaad, Marwa Ahmed Meheissen, Eman Tayae Elsayed, Saher N. Alnakhal, Tarek M. Salema<ref name="Assaad">{{Cite journal | last = Assaad | first = Samir Naeim | last2 = Meheissen | first2 = Marwa Ahmed | last3 = Elsayed | first3 = Eman Tayae | last4 = Alnakhal | first4 = Saher N. | last5 = Salem | first5 = Tarek M. | date = 2020-03-12 | title = Study of Epstein–Barr virus serological profile in Egyptian patients with Hashimoto’s thyroiditis: A case-control study| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090364/|journal=Journal of Clinical & Translational Endocrinology|volume=20|doi=10.1016/j.jcte.2020.100222|issn=2214-6237|pmc=7090364|pmid=32215255}}</ref> |2020 |This study included 60 Hashimoto's thyroiditis patients and 60 healthy controls. Epstein-Barr virus (EBV) Early Antigen (EA) was positive in 20 of 60 (33%) HT patients and 4 of 60 (7%) healthy controls, indicating a higher prevalence of active EBV in Hashimoto patients. |- |'''HHV-6 Infection and Chemokine RANTES Signaling Pathway Disturbance in Patients with Autoimmune Thyroiditis''' Alina Sultanova, Maksims Cistjakovs, Liba Sokolovska, Katerina Todorova, Egils Cunskis, Modra Murovska<ref name="Sultanova2020">{{Cite journal | last = Sultanova | first = Alina | last2 = Cistjakovs | first2 = Maksims | last3 = Sokolovska | first3 = Liba | last4 = Todorova | first4 = Katerina | last5 = Cunskis | first5 = Egils | last6 = Murovska | first6 = Modra | date = Jun 26, 2020 | title = HHV-6 Infection and Chemokine RANTES Signaling Pathway Disturbance in Patients with Autoimmune Thyroiditis| url = https://pubmed.ncbi.nlm.nih.gov/32604892/|journal=Viruses|volume=12|issue=6|doi=10.3390/v12060689|issn=1999-4915|pmc=7354462|pmid=32604892}}</ref> |2020 |Markers of active HHV-6 infection were predominantly found in patients with autoimmune thyroiditis (AIT). 56% of AIT patients (vs. 6% controls) were found to have active HHV-6 infection in thyroid gland tissue. |} == Sleep apnea == Hashimoto's thyroiditis (HT) and sleep apnea can both result in extreme fatigue. New evidence suggests a connection between Hashimoto's and obstructive sleep apnea (OSA). In fact, the association could be bi-directional, where either condition could potentially develop as a consequence of the other.<ref name="Xerfan2019">{{Cite journal | last = Xerfan | first = Ellen M.S. | last2 = Facina | first2 = Anamaria S. | last3 = Andersen | first3 = Monica L. | last4 = Tufik | first4 = Sergio | last5 = Tomimori | first5 = Jane | date = 2019-11-15 | title = Hashimoto Thyroiditis as a Cause or Consequence of Obstructive Sleep Apnea| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853408/|journal=Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine|volume=15|issue=11 | pages = 1703|doi=10.5664/jcsm.8054|issn=1550-9389|pmc=6853408|pmid=31739867}}</ref> ==HLA risk alleles== Variations in several human leukocyte antigen (HLA) complex family of genes have been studied as possible risk factors for Hashimoto thyroiditis. Associations have been found between Hashimoto's disease and the following HLA alleles:<ref>{{Cite web | url=https://selfdecode.com/blog/article/hla-drb1-thyroid-autoimmunity-92/ | title = SelfDecode {{!}} Blog|website=selfdecode.com|access-date=2020-08-26}}</ref><ref>{{Cite journal | last = Tashiro | first = Ryosuke | last2 = Niizuma | first2 = Kuniyasu | last3 = Khor | first3 = Seik-Soon | last4 = Tokunaga | first4 = Katsushi | last5 = Fujimura | first5 = Miki | last6 = Sakata | first6 = Hiroyuki | last7 = Endo | first7 = Hidenori | last8 = Inoko | first8 = Hidetoshi | last9 = Ogasawara | first9 = Koetsu | date = 2019-08-14 | title = Identification of HLA-DRB1*04:10 allele as risk allele for Japanese moyamoya disease and its association with autoimmune thyroid disease: A case-control study| url = https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220858|journal=PLOS ONE|language=en|volume=14|issue=8| pages = e0220858|doi=10.1371/journal.pone.0220858|issn=1932-6203|pmc = 6693760|pmid=31412073}}</ref><ref name="Lande">{{Cite journal | last = Lande | first = Asgeir | last2 = Fluge | first2 = Øystein | last3 = Strand | first3 = Elin B. | last4 = Flåm | first4 = Siri T. | last5 = Sosa | first5 = DaysiD. | last6 = Mella | first6 = Olav | last7 = Egeland | first7 = Torstein | last8 = Saugstad | first8 = OlaD. | last9 = Lie | first9 = Benedicte A. | date = 2020-03-24 | title = Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)| url = https://www.nature.com/articles/s41598-020-62157-x|journal=Scientific Reports|language=en|volume=10|issue=1 | pages = 5267|doi=10.1038/s41598-020-62157-x|issn=2045-2322}}</ref> * C*07:04 * DQB1*03:03 * DRB1 * DRB1*04:10 === ME/CFS and Hashimoto's genetics=== In a large 2020 study, CFS patients with [[Human leukocyte antigen genes|Human Leukocyte Antigen]] (HLA) risk alleles ('''C*07:04''' and '''DQB1*03:03''') were found to share the following [[Autoimmune disease|autoimmune diseases]], ordered by frequency:<ref name="Lande" /> # [[Hashimoto's thyroiditis]] # Psoriasis # [[Rheumatoid arthritis]] # Alopecia areata # Crohn’s disease or [[ulcerative colitis]] ==Diagnosis== Hashimoto's thyroiditis is usually diagnosed based on multiple examinations, often beginning with hypothyroid symptom evaluation. This can be accompanied by blood tests and ultrasound. Blood tests indicating Hashimoto's disease include elevated levels of thyroperoxidase antibodies (TPO), and elevated levels of thyroid stimulating hormone (TSH). Other lab testing can include Thyroglobulin antibodies (Tg), Free thyroxine (T4), or Free triiodothyronine (T3). This might be followed by an ultrasound to confirm an enlarged thyroid gland, and other features of Hashimoto's thyroiditis.<ref name="amthyass"/> == Treatments == === Hormone Replacement === [[Levothyroxine]] - If you are found to have a thyroid hormone deficiency, resulting in elevated TSH levels, your doctor might prescribe hormone replacement therapy. Levothyroxine is a synthetic thyroid hormone used to normalize TSH and hormone levels, leading to hypothyroid symptom improvement.<ref name="mayo">{{Cite web | url=https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/diagnosis-treatment/drc-20351860 | title = Hashimoto's disease - Diagnosis and treatment - Mayo Clinic|website=Mayo Clinic|access-date=2020-10-18}}</ref> === Target Infection === [[Antiviral|Antivirals]] - If your Hashimoto's was triggered by a bacterial or viral infection, then suppressing the infection using antiviral treatment might improve symptoms. * [[Epstein-Barr virus#Treatment|Epstein-Barr virus treatment]] * [[Human herpesvirus 6#Antivirals|HHV-6 treatment]] === Supplementation === [[Selenium]] - Selenium has been shown to decrease thyroperoxidase (TPO) antibody levels and improve overall symptoms associated with Hashimoto's Thyroiditis.<ref>{{Cite journal | last = Ventura | first = Mara | last2 = Melo | first2 = Miguel | last3 = Carrilho | first3 = Francisco | date = 2017 | title=Selenium and Thyroid Disease: From Pathophysiology to Treatment| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307254/|journal=International Journal of Endocrinology|volume=|doi=10.1155/2017/1297658|issn=1687-8337|pmc=5307254|pmid=28255299}}</ref><ref>{{Cite journal | last = van Zuuren | first = Esther J. | last2 = Albusta | first2 = Amira Y. | last3 = Fedorowicz | first3 = Zbys | last4 = Carter | first4 = Ben | last5 = Pijl | first5 = Hanno | date = Mar 2014 | title = Selenium Supplementation for Hashimoto's Thyroiditis: Summary of a Cochrane Systematic Review | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005265/|journal=European Thyroid Journal|volume=3|issue=1 | pages = 25–31|doi=10.1159/000356040|issn=2235-0640|pmc=4005265|pmid=24847462|quote=|access-date=|via=}}</ref> A 2017 study demonstrated that the combination of Selenium and Myo-inositol had an even greater effect.<ref>{{Cite journal | last = Nordio | first = M. | last2 = Basciani | first2 = S. | date = Jun 2017 | title = Myo-inositol plus selenium supplementation restores euthyroid state in Hashimoto's patients with subclinical hypothyroidism| url = https://pubmed.ncbi.nlm.nih.gov/28724185/|journal=European Review for Medical and Pharmacological Sciences|volume=21|issue=2 Suppl | pages = 51–59|issn=2284-0729|pmid=28724185|doi=|pmc=|quote=|access-date=|via=}}</ref> Supplements most commonly used to treat Epstein-Barr Virus (EBV) triggered Hashimoto's include: * [[Olive leaf and olives|Olive leaf extract]] * Lauricidin/Monolaurin * [[Licorice|Licorice root]] (glycyrrhizic acid) * [[St. John’s Wort|St. John’s wort]] * [[Echinacea]] * [[Vitamin C]] * [[Vitamin D]] === Immunomodulator === [[Low dose naltrexone|Low-dose naltrexone (LDN)]] - LDN is an immunomodulating medication that many claim has improved their Hashimoto's symptoms. However, there is a lack of scientific studies to back up this claim. ==See also== * [[Autoimmune disease]] * [[Female predominant diseases]] * [[Triiodothyronine]] * [[Thyroid disease]] * [[Thyroid gland]] * [[Thyroxine]] ==Learn more== *[http://www.thyroiduk.org.uk/tuk/about_the_thyroid/hashimotos.html Hashimoto's] - Thyroid UK ==References== {{reflist}} [[Category:Diagnoses]] [[Category:Potential comorbidities]] [[Category:Thyroid diseases]] [[Category:Autoimmune diseases and disorders]] [[Category:Endocrine diseases and disorders]]
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