What is Hashimoto’s?
Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that causes the immune system to attack and damage the thyroid gland. The thyroid is responsible for producing hormones that regulate metabolism, heart rate, body temperature, and other vital bodily functions. When the thyroid is damaged by Hashimoto’s, it is no longer able to produce adequate amounts of these hormones, leading to a condition known as hypothyroidism.
Some quick facts about Hashimoto’s:
– It is the most common cause of hypothyroidism in the United States.
– Hashimoto’s most often affects middle-aged women, but can occur at any age and in anyone.
– In addition to hypothyroidism, Hashimoto’s can cause an enlarged thyroid gland (goiter).
– There is no cure, but thyroid hormone replacement medication can treat symptoms.
– Hashimoto’s often runs in families.
How does hypothyroidism affect the heart?
Hypothyroidism, regardless of the cause, can have several detrimental effects on cardiovascular health if left untreated. Here are some of the major ways hypothyroidism impacts the heart:
– **Altered heart rate and rhythm** – Thyroid hormones help control heart rate and regulate electrical conductivity in the heart muscle. Without enough thyroid hormones, heart rate can become slower and arrhythmias may develop.
– **Increased blood pressure** – Hypothyroidism causes blood pressure to rise due to increased systemic vascular resistance. High blood pressure is a major risk factor for heart attack, stroke, and heart failure.
– **Elevated cholesterol** – Thyroid hormones play an important role in cholesterol metabolism. Hypothyroidism leads to higher levels of total cholesterol and LDL (bad) cholesterol. High cholesterol furthers the risk for heart disease.
– **Enlarged heart muscle** – A chronic shortage of thyroid hormone causes the heart muscle to enlarge or thicken in order to improve pumping strength. However, this eventually weakens the heart and reduces its efficiency.
– **Heart failure** – Untreated hypothyroidism can progress to dilated cardiomyopathy and overt heart failure in some cases. This is characterized by an enlarged, weakened heart muscle that is unable to pump enough blood to meet the body’s needs.
– **Atherosclerosis** – By altering cholesterol levels and blood pressure, hypothyroidism promotes the development of atherosclerosis (hardening and narrowing of the arteries). This can lead to serious cardiovascular events like heart attack or stroke.
Can Hashimoto’s increase the risk of heart problems?
Yes, there is substantial evidence linking Hashimoto’s disease with an increased likelihood of cardiovascular issues. Here’s an overview of the research:
– Multiple population studies have shown higher rates of heart disease and cardiovascular mortality among people with Hashimoto’s and hypothyroidism compared to the general public.
– Patients with Hashimoto’s are more prone to cardiac dysfunctions like impaired diastolic function, elongated systolic time intervals, and decreased myocardial contractility reserve. These issues indicate heart disease.
– Even when thyroid hormone levels are normalized through medication, Hashimoto’s patients face a higher prevalence of cardiovascular risk factors like hypertension, hyperlipidemia, and excess weight gain.
– Hashimoto’s diagnosis alone is associated with a 20-80% increase in risk for cardiovascular disease after adjusting for other factors. The risk appears higher in younger individuals diagnosed with Hashimoto’s.
– Subclinical hypothyroidism, an early stage of Hashimoto’s before overt thyroid failure, is linked to an elevated rate of atherosclerosis, cardiac strain, heart failure, and mortality.
– Multiple studies show antibodies implicated in Hashimoto’s (TPOAb, TgAb) correlate with arterial stiffness, impaired vascular function, and endothelial dysfunction – changes that precede cardiovascular disease.
So in summary, research clearly demonstrates that Hashimoto’s predisposes patients to various cardiovascular abnormalities and an increased likelihood of clinically significant heart disease over time. Regular screening and proactive treatment are important for minimizing the cardiovascular impact of Hashimoto’s.
Heart-related symptoms of hypothyroidism
In many cases, the cardiovascular effects of Hashimoto’s manifest through recognizable signs and symptoms related to the heart and circulatory system. Be aware of these common hypothyroidism symptoms:
Fatigue and Weakness
Thyroid hormones regulate metabolism and energy production. As metabolism slows in hypothyroidism, persistent fatigue, tiredness, and muscular weakness are some of the most common complaints. Simple physical exertion may become exhausting.
Dizziness
Low thyroid function reduces the pumping capacity of the heart and lowers blood pressure. This can cause lightheadedness, especially when standing up suddenly.
Shortness of Breath
Fluid accumulation in the body (edema) along with poor blood flow due to heart dysfunction lead to shortness of breath and difficulty breathing – particularly during activity.
Chest Pain or Discomfort
Constrained blood flow to the heart muscle because of cholesterol plaque buildup or coronary spasms can cause chest pain mimicking angina.
Palpitations
The heart’s electrical system depends on thyroid hormones and becomes irritable in hypothyroidism. This leads to noticeable heart palpitations and abnormal beats.
Swollen Extremities
Fluid retention caused by heart failure or decreased kidney filtration due to low thyroid levels results in swelling of the lower legs and feet.
Keeping a lookout for cardiac-related symptoms can help identify hypothyroidism early and prevent further cardiovascular decline in Hashimoto’s patients. Do not hesitate to report persistent symptoms to your doctor.
Diagnostic screening for heart disease
Individuals with Hashimoto’s disease should undergo periodic cardiovascular testing beyond standard thyroid function tests. Here are some diagnostic evaluations that can detect early heart abnormalities:
Electrocardiogram (EKG)
An EKG monitors electrical signals in the heart to uncover irregular rhythms, inadequate blood flow, chamber enlargement, and evidence of past heart attacks. EKGs may be abnormal in up to 60% of hypothyroid patients.
Exercise Stress Testing
Monitoring the heart rate and EKG during exercise provides important data on the cardiovascular response to increased demand. Inadequate heart rate increases with exertion are suggestive of heart disease.
Echocardiogram
Using ultrasound waves, echocardiograms produce images of the heart’s size, shape, structure, and functionality. Doctors can visualize heart chamber enlargement, valve abnormalities, and pumping capacity.
Cardiac CT Scan
Cardiac CT scans use X-rays and contrast dye to create 3D images of the heart and blood vessels. This allows direct visualization of blockages, plaque buildup, and coronary artery disease.
Chest X-Ray
While not a direct test of heart function, chest X-rays can reveal an enlarged heart shadow indicative of cardiomyopathy and heart failure associated with long-standing hypothyroidism.
Cardiac Blood Tests
Blood tests assess biomarkers that reflect stress and damage to the heart muscle. Examples include troponin, BNP, high-sensitivity C-reactive protein. Elevated levels signal possible cardiovascular pathology.
Risk reduction for heart disease
Hashimoto’s patients can take certain steps to minimize the increased cardiovascular risks of hypothyroidism:
– Take thyroid hormone replacement medication daily and maintain TSH in the optimal range. This prevents cardiovascular effects of profound hypothyroidism.
– Monitor thyroid levels with TSH blood tests at least twice yearly to ensure adequate thyroid hormone replacement.
– Have an annual cardiovascular risk assessment, including blood pressure, cholesterol profile, blood sugar, body weight, and smoking status.
– Follow a heart-healthy diet low in saturated fats, trans fats, sodium, and added sugars. Emphasize vegetables, lean proteins, high-fiber carbs, and healthy fats.
– Exercise regularly, aiming for at least 30 minutes daily of moderate activity like brisk walking. Exercise improves cholesterol, blood pressure, and cardiovascular fitness.
– Achieve and maintain a healthy body weight through diet and physical activity. Obesity worsens cardiovascular risk.
– Limit alcohol intake to moderate levels at most. Heavy alcohol use contributes to cardiomyopathy.
– Stop smoking and avoid secondhand smoke. Smoking amplifies the cardiovascular effects of hypothyroidism.
– Manage other cardiovascular risk factors, like diabetes or hypertension, through proper treatment.
– Seek screening and early treatment for depression, anxiety, and stress. Psychological health impacts heart disease risk.
With diligent thyroid monitoring, lifestyle measures, and cardiovascular screening, it’s possible to minimize the heart consequences of Hashimoto’s thyroiditis.
Treatment options for heart problems
If cardiovascular testing uncovers significant heart abnormalities in someone with Hashimoto’s disease, additional medical treatment may be warranted alongside thyroid hormone therapy. Treatment options depend on the specific heart issue but can include:
Medications
– Beta-blockers and calcium channel blockers to reduce blood pressure
– Cholesterol medications like statins to improve lipid profile
– Anticoagulants to prevent blood clots that could cause heart attack/stroke
– Diuretics to decrease fluid retention and edema
– Digoxin to strengthen the heartbeat
Medical Procedures
– Angioplasty and stenting to open blocked coronary arteries
– Coronary artery bypass grafting for improved blood flow to the heart
– Implantable cardioverter defibrillator to regulate life-threatening heart rhythms
– Heart valve repair/replacement for defective valves
– Heart transplant in end-stage heart failure
Lifestyle Adjustments
– Smoking cessation and avoidance of secondhand smoke
– Limiting sodium and saturated fat intake
– Increasing fruits, vegetables, whole grains, and lean protein
– Losing weight if overweight or obese
– Getting regular physical activity but avoiding overexertion
– Pacing activity and rest to manage fatigue and shortness of breath
– Reducing stress through relaxation techniques and mind-body therapies
The outlook for Hashimoto’s patients with heart abnormalities depends on the severity of the cardiovascular disease and response to treatment interventions. Close follow-up care with both an endocrinologist and cardiologist is recommended.
Conclusion
In summary, there is a well-established link between Hashimoto’s disease and increased risk for cardiovascular problems. Hypothyroidism alters heart rate, blood pressure, and cholesterol in ways that damage the heart muscle, accelerate atherosclerosis, and predispose to issues like heart failure.
People with Hashimoto’s thyroiditis need to be monitored not just for thyroid function but also for signs of heart disease through EKGs, cardiac imaging, and biomarker tests. Detecting changes early on allows for treatment to prevent cardiovascular morbidity and mortality.
Diligent thyroid hormone replacement, heart-healthy lifestyle habits, and active surveillance for cardiac abnormalities are the keys to maintaining cardiovascular wellbeing for Hashimoto’s patients. With proper management, it’s possible to minimize the heart effects of this common autoimmune disorder.