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Research Articles and Papers on:

Hashimoto's Disease


Cardiac function in borderline hypothyroidism: a study by pulsed wave tissue Doppler imaging

European Journal of Endocrinology, Vol 152, Issue 4, 527-533
Sandra Zoncu, Francesca Pigliaru1, Claudia Putzu1, Lorella Pisano, Sara Vargiu, Martino Deidda, Stefano Mariotti1 and Giuseppe Mercuro
(April 2005)

Some of you will already know about the workings of the heart due to having heart problems but I thought I would explain briefly what diastolic dysfunction and systolic dysfunction means:

“The heart contracts and relaxes with each heartbeat. The contraction part of this cycle is called systole (SIS'to-le). The relaxation portion is called diastole (di-AS'to-le).

“In some people with heart failure, the contraction function is normal but there's impaired relaxation of the heart. This affects the heart's lower, pumping chambers (the ventricles) specifically. If the relaxation part of the cycle is abnormal, it's called diastolic (di"as-TOL'ik) dysfunction. Because the ventricle doesn't relax normally, the pressure in it increases and exceeds what's normal as blood for the next heartbeat. (It's harder for all of the blood to go into the ventricle.)

“This can cause increased pressure and fluid in the blood vessels of the lungs. (This is called pulmonary congestion.) It can also cause increased pressure and fluid in the blood vessels coming back to the heart. (This is called systemic congestion.) People with certain types of cardiomyopathy (kar"de-o-mi-OP'ah-the) may also have diastolic dysfunction.”1

It is well known that impaired diastolic function has been documented both at rest and on effort in sub-clinical hypothyroidism but systolic dysfunction has only been assessed on effort. The researchers’ aim of this study was to further assess systolic function at rest in sub-clinical hypothyroidism and to ascertain whether cardiac dysfunction could precede TSH increase in euthyroid patients with a high risk of developing sub-clinical hypothyroidism.

The researchers studied 32 patients with Hashimoto’s disease using Doppler Imagining – a special type of 3D radar - (22 with TSH of over 3.0 mU/ml; 10 “normal” patients who had TSH levels of less than 3.0 mU/ml and a group of 13 healthy controls (people without Hashimoto’s Disease).

In both groups with Hashimoto’s Disease, it was found they had a significant impairment of systyolic ejection, a delay in diastolic relaxation and a decrease in the compliance to the ventricular filling. Several significant correlations were found between these patients and free T3 and T4 and TSH concentrations.

The researchers concluded that the significant correlations of several pulsed wave tissue Doppler imaging indices with serum FT3 and TSH concentrations strongly support the concept of a continuum spectrum of a slight thyroid failure in auto-immune thyroiditis extending to subjects with serum TSH still within the normal range. In other words, people with Hashimoto’s Disease have heart problems, even if they have normal TSH levels. Very worrying. If you have Hashimoto’s Disease with normal TSH levels and your doctor won’t give you a trial of thyroxine, perhaps you should show him this research paper


Effects of Prophylactic Thyroid Hormone Replacement in Euthyroid Hashimoto’s Thyroiditis

Endocrine Journal (Japan) 2005, 52(3) 337-343
Duygu Yazgan Aksoy et. al.

Hashimoto’s Disease is very common but one of the major problems is many people have antibodies which prove they have this disease but the doctor won’t treat the patient with thyroxine, even though the patient has many symptoms of hypothyroidism. The reason given by the doctors is that the blood test levels are “normal”. A recent study may help to persuade GP’s to give thyroxine on a trial basis.
Researchers at a Turkish university ran a study with 33 patients with Hashimoto’s Thyroiditis. All the patients were euthyroid with only two having low normal T4 results but they were all symptom free. 17 patients received no treatment whilst the rest received thyroxine. 29 patients completed the 15 month study.

The results of the study showed there was no statistical difference between age, sex, thyroid hormone between the two study groups. All the patients were positive for TPO-Ab but 24.1% were negative for the Tg-Ab.

The conclusion was that thyroxine “treatment at doses keeping TSH at low-normal levels appears to be effective not only in decreasing the auto-antibody levels but also in the goitre size.”  They also concluded, “…there appears to be an inhibitory effect of LT4 treatment on the ongoing disease process in Hashimoto’s thyroiditis patients. Early treatment of euthyroid Hashimoto’s thyroiditis patients with L-thyroxine may slow down not only the disease process itself but through its immune modulating events, it may also affect the course of other auto-immune disease which accompany.”

If doctors could treat people as soon as they know they have antibodies, the full blown hypothyroidism could be averted. If you start to have symptoms of thyroid disease, get checked for antibodies and if they are positive, take this report with you to your GP. Wouldn’t it be great if the doctors listened to this study?


Effects of Prophylactic Thyroid Hormone Replacement in Euthyroid Hashimoto's Thyroiditis. Aksoy DY, Kerimoglu U, Okur H, Canpinar H, Karaagaoglu E, Yetgin S, Kansu E, Gedik O.  Endocr J. 2005 Jun;52(3):337-43.
Section of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University. – Endocr. J. 2005 Jun; 52(3): 337-43

Hashimoto's thyroiditis is the most frequent autoimmune thyroid disease. L-thyroxine therapy can reduce the incidence and alleviate the symptoms of this disease.

The aim of this study was to evaluate the effects of prophylactic (protective) L-thyroxine treatment on clinical and laboratory findings of patients who were euthyroid at the time of diagnosis.

Thirty-three patients who had diagnosis of euthyroid Hashimoto's thyroiditis were randomized to two groups, one group received prophylactic L-thyroxine treatment and the other was followed-up without treatment. Initial thyroid function tests, autoantibodies, ultrasonography, fine needle aspiration biopsy and peripheral blood lymphocyte subsets were similar in the two study groups.

After 15 months of L-thyroxine treatment, there was a significant increase in free T(4) and a significant decrease in TSH and anti-thyroglobulin antibody anti-thyroid peroxidase antibody levels. Scans showed a decrease in thyroid volume in L-thyroxine receiving patients whereas an increase was detected in patients who were followed without treatment.

In conclusion, prophylactic thyroid hormone therapy can be used in patients with Hashimoto's thyroiditis even if they are euthyroid.

PMID: 16006728 [PubMed - in process]

The full text of this study can be downloaded free from here: