Hashimoto’s thyroiditis is a chronic autoimmune condition where the body’s immune system mistakenly targets the thyroid gland, leading to a decline in the production of thyroid hormones. Confusion about which specialist manages this disease is common, as both rheumatologists and endocrinologists deal with autoimmune disorders. However, rheumatologists generally do not treat Hashimoto’s thyroiditis; the condition is managed by an endocrinologist.
Hashimoto’s Thyroiditis: An Autoimmune Overview
Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, involves a T-lymphocyte-mediated attack on the thyroid gland. These immune cells trigger the destruction of thyroid follicular cells, which are responsible for hormone production. This process leads to chronic inflammation and the gradual destruction of the thyroid tissue.
The immune response involves the production of autoantibodies that target the thyroid gland. The two primary antibodies associated with this condition are Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb). TPO antibodies are a strong indicator of autoimmune thyroid disease, with nearly 95% of patients having elevated levels.
The progressive damage to the thyroid tissue eventually results in insufficient hormone output, leading to hypothyroidism. This deficiency causes a range of systemic symptoms, including fatigue, unexplained weight gain, and increased sensitivity to cold. Other common complaints are constipation, dry skin, and hair loss.
Specialist Focus: Rheumatology vs. Endocrinology
The distinction between which specialist treats Hashimoto’s rests on the primary target of the disease. Endocrinologists are specialists dedicated to the endocrine system, which includes glands like the thyroid, pituitary, and adrenal glands, and the hormones they produce. Since Hashimoto’s directly involves the destruction of the thyroid gland and the resulting deficiency of thyroid hormone, it falls within the scope of endocrinology.
The standard treatment for hypothyroidism caused by Hashimoto’s is hormone replacement therapy with a synthetic thyroid hormone like levothyroxine. An endocrinologist is trained to accurately diagnose the condition, monitor thyroid-stimulating hormone (TSH) and thyroid hormone levels, and adjust the medication dosage. They focus on restoring the body’s hormonal balance disrupted by the autoimmune attack.
In contrast, a rheumatologist treats systemic autoimmune diseases that primarily affect the musculoskeletal system and connective tissues. Their domain includes conditions like rheumatoid arthritis, systemic lupus erythematosus (Lupus), and Sjögren’s syndrome. While both specialties manage autoimmune diseases, the organ system under attack determines the appropriate specialist: the thyroid for Hashimoto’s versus joints and connective tissue for many rheumatic diseases.
Managing Complex Autoimmunity
The question of rheumatologist involvement becomes relevant when Hashimoto’s occurs alongside another systemic autoimmune disease, a phenomenon known as polyautoimmunity. It is not uncommon for a person with one autoimmune condition to develop others. Estimates suggest that between 15% and 30% of people with Hashimoto’s will develop a second autoimmune condition over time.
Conditions that frequently co-occur with Hashimoto’s include rheumatoid arthritis, Lupus, Type 1 diabetes, and pernicious anemia. When a patient has both Hashimoto’s and a systemic condition like Lupus, care becomes collaborative between the two specialties. The endocrinologist maintains responsibility for monitoring and managing the thyroid hormone levels with levothyroxine.
Simultaneously, the rheumatologist manages the systemic disease, such as a connective tissue disorder, focusing on suppressing body-wide inflammation and preventing joint or organ damage. This coordinated approach ensures that both the hormonal imbalance and the systemic immune attack are addressed by the appropriate expert.