There is a mutation in HLA gene (HLA DR3 & HLA DR4) that is responsible for abnormal immune functions (Katarina et. al, 2021). The abnormal immune functions lead to the undesired production of:

3 antibodies that attack thyroid antigens (Mincer & Jialal, 2023):

1. anti-thyroid peroxidase (anti-TPO) -

2. antithyroglobulin (anti-Tg) - direct attack on thyroglobulin so the thyroid cannot produce thyroid hormone (T3/T4)

3. TSH receptor-blocking antibodies (TBII)

So, even though there is enough iodine to produce thyroid hormone. Ultimately, the destruction of the thyroid tissue and makes it so that iodine has nothing to bind to. Therefore, there is no production of thyroid hormone. Without the body's ability to produce T3/T4, major problems within the body occur.

Hashimoto’s disease: MedlinePlus Genetics. (n.d.). Retrieved January 28, 2025, from https://medlineplus.gov/genetics/condition/hashimotos-disease/

Katahira, M., Ogata, H., Takashima, H., Ito, T., Hodai, Y., Miwata, T., Goto, M., Yamaguchi, M., Mizoguchi, A., Kawakubo, M., & Nakamura, S. (2021). Critical amino acid variants in HLA-DRB1 allotypes in the development of Graves’ disease and Hashimoto’s thyroiditis in the Japanese population. Human Immunology, 82(4), 226–231. https://doi.org/10.1016/j.humimm.2020.12.007

Mincer, D. L., & Jialal, I. (2025). Hashimoto thyroiditis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459262/

Ninja Nerd. Hypothyroidism | Clinical Medicine (2024). Retrieved January 28, 2025, from https://www.youtube.com/watch?v=hLNXJWLsjAE

T-4 hormone replacement therapy:

• treat with a synthetic hormone called levothyroxine (Levoxyl, Synthroid, others) ORAL MEDICATIONS! Can be taken at home

• synthetic hormone works like the T-4 hormone naturally produced by the thyroid

• goal is to restore and maintain adequate T-4 hormone levels and improve symptoms of hypothyroidism.

• need this treatment for the rest of your life.

T-3 hormone replacement therapy

• T-4 replacement hormone is also converted into triiodothyronine (T-3), and for most people the T-4 replacement therapy results in an adequate supply of T-3 for the body.

• doctor also may prescribe a synthetic T-3 hormone (Cytomel) or a synthetic T-4 and T-3combination.

• side effects of T-3 hormone replacement include rapid heartbeat, insomnia and anxiety. (may be tested with a trial period of 3 to 6 months)

• can be taken at home, orally tablets

Everything below is from DVC STEM:

Corticosteroids like Prednisone

Corticosteroids like Prednisone (tablet; oral) can be used short-term to reduce inflammation and thyroid damage in active Hashimoto’s. However, long-term corticosteroid use has significant side effects, so it is not a sustainable treatment option. Can be taken at home.

‍

Immunotherapies like Rituximab, Etanercept, and Tocilizumab (To Target Autoimmune Response)

These biologic drugs suppress the overactive immune response in Hashimoto's by targeting specific immune system components:

• Rituximab depletes B cells

• Etanercept blocks TNF-alpha

• Tocilizumab blocks IL-6

• Patients need to go into facility to receive this parenteral drug (IV infusion).

‍

Thyroid Hormone Analogs like Tiratricol (To Compensate for Hormone Deficiency)

Tiratricol is similar to thyroid hormones T3 and T4 and can help compensate for the deficiency in Hashimoto's. It may also help normalize the autoimmune response, but more research is required.

• Patients need to go into facility to receive this parenteral drug (IV infusion).

‍

Thyroid Peroxidase Inhibitors (To Limit Autoimmune Attack)

These compounds inhibit a key enzyme needed for thyroid hormone synthesis, which may decrease autoimmune attack by reducing antigen presentation. However, effects on thyroid hormone levels need further study. Look up route of administration.

‍

Selenium Supplements (To Improve Thyroid Hormone Metabolism)

Selenium is needed for proper thyroid hormone metabolism and may reduce antibody levels. However, optimal dosing and effects need more investigation.

• ORAL, can be taken at home

‍

Vitamin D Supplementation (In Deficient Patients, To Improve Thyroid Function)

Vitamin D may improve thyroid function and reduce antibodies in Hashimoto’s patients with vitamin D deficiency. Further studies on dosing and long-term impacts are warranted.

• ORAL, can be taken at home

‍

Mesenchymal Stem Cell Therapy

Stem cell therapy involves using stem cells to regenerate damaged tissue and modulate the immune system. Some early research suggests mesenchymal stem cells (MSCs) from bone marrow or umbilical cord could benefit.

• Route of administration: intravenous (IV), intra-arterial (IA), intra-thecal (IT), intra-cardiac (IC), intra-articular (IAT), intra-muscular (IM), and intra-osseous (IO)