Maybe you feel worn out. Perhaps you’re also having trouble losing weight. Generally, you just don’t feel 100%.

Could it be Hashimoto’s disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it’s your thyroid – a gland located at the base of your neck – and can cause low thyroid hormones levels (hypothyroidism).

Hypothyroidism affects one in 33 Australians and Hashimoto’s is one of the most common thyroid conditions in first-world countries.

While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility. Here is what you need to know.

What happens when you have Hashimoto’s?

Your thyroid gland is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart and lungs. In children, thyroid hormones are also needed for normal growth and development.

Hashimoto’s thyroid disease, named after the Japanese doctor who discovered it in 1912, is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism).

Hashimoto’s can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won’t have any symptoms.

However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goitre) and occasionally hair loss, including at the ends of your eyebrows.

What causes Hashimoto’s thyroid disease?

Several risk factors can contribute to the development of Hashimoto’s including:

• genetic risk – your risk is higher if you have family members with Hashimoto’s

• gender – women are up to ten times more likely than men to develop the disease

• age – you are more likely to develop the disease from 30 to 50 years of age

• autoimmune condition – having another autoimmune condition like systemic lupus, Type 1 diabetes and celiac disease increases your risk

• excessive iodine intake and radiation exposure may also increase risk in people who are already genetically at greater risk.

What are the long-term risks?

Long-term, untreated Hashimoto’s thyroiditis can cause heart issues, higher cholesterol levels, nerve damage (peripheral neuropathy), reduced cognition and infertility.

In pregnancy, Hashimoto’s has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, pregnancy loss.

The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into cancer cells to cause thyroid lymphoma.

How is Hashimoto’s diagnosed?

Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies.

Thyroid peroxidase antibodies are commonly present but about 5% of patients test antibody-negative. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious.

Three hormone levels are tested to determine if you have Hashimoto’s.

Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones – T3 and T4.

If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.

Can it be treated?

The management of Hashimoto’s depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but normal thyroid levels. This is still Hashimoto’s thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone.

Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended.

When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed “subclinical hypothyroidism”. When it is paired with low hormone levels it is called “overt hypothyroidism”. The first is a mild form of the disease and treatment depends on the degree of stimulating hormone elevation.

Overt hypothyroidism warrants treatment. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimised, hormone levels usually remain relatively stable.

In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered.

Hashimoto’s thyroiditis is a common condition caused by your body’s immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.

Aakansha Zala, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Apple has announced a package of health features, alongside the launch of the new Apple Watch Series 11, including an alert that the wearer may have high blood pressure, also known as hypertension.

Around 1.3 billion people worldwide have high blood pressure. But almost half are unaware of their diagnosis.

This lack of awareness is often due to limited access to regular medical care, the absence of noticeable symptoms or warning signs, and because a single blood pressure reading could miss the condition.

Better detection of high blood pressure could help prevent heart attacks, strokes, kidney disease and dementia.

But can the Apple Watch really tell if you have high blood pressure?

How does it work?

Limited details are available so far.

But we know the Apple Watch’s high blood pressure indicator is based on analysis of changes in blood volume as your heart beats. These are detected using the light sensor on the back of the watch.

This is not new technology; a number of other companies, such as Samsung and Aktiia, use similar approaches.

When the sensor and underlying algorithm identifies a significant change in blood flow, the user will get an alert that they may have high blood pressure. This is done without a conventional blood pressure cuff that tightens around the arm.

However, if a user receives a “possible hypertension” notification, this is not a diagnosis, as their blood pressure has not yet been measured and confirmed by a health-care professional.

From what we know so far, it seems users won’t be given blood pressure numbers straight from the Apple Watch.

What does the evidence say?

Cuffless blood pressure monitoring devices can be more comfortable and convenient than using arm cuffs. Without a cuff, they can also more easily monitor blood pressure continuously during daily activities.

However, the evidence to show whether these technologies accurately estimate blood pressure remains scarce and with many limitations.

Unlike traditional cuff-based blood pressure devices, there is no standard protocol for manufacturers to test cuffless devices for accuracy, and to ensure they live up to their claims. Without such a protocol, it’s difficult to evaluate and compare their performance.

This is particularly important for cuffless devices, because accuracy depends on how well the signal picks up changes in blood flow – which can vary across different skin tones – and how well it performs in everyday settings, such as when a person is awake or asleep, sitting or standing, active or resting.

Nevertheless, some companies have received clearance from government regulatory agencies to market and sell these technologies as medical devices. Apple has received such clearance for its hypertension technology.

However, cuffless devices for measuring blood pressure are not currently recommended by any clinical guidelines based on the uncertainty about their accuracy. So it’s important to have your blood pressure checked regularly by a health-care professional and potentially also at home using a validated cuff-based device.

There is no evidence yet of how well these technologies would work when used clinically and with real patients. Studies are underway.

What are the challenges?

While these devices hold promise for improving individual and population health, they also pose some challenges.

Alerts for “possible hypertension” are just that: a sign for a potential health concern that needs to be evaluated and confirmed in a health-care setting.

Knowing the breadth of Apple’s market share and the prevalence of undiagnosed hypertension, these alerts have the potential to overburden existing health-care systems and cause patient anxiety.

As these devices become more mainstream, health-care systems may need to adapt to accommodate the growing number of patients seeking care.

What if you want to use it?

If you start using the new Apple Watch and receive the hypertension notification, you should check your blood pressure with a cuff-based monitor over three to seven days and take these readings to your doctor.

The fine print on Apple’s website notes this “possible hypertension” feature should not be used by people under 22 years old, those who are pregnant or those previously diagnosed with hypertension.

Cuffless devices have the potential to improve detection of high blood pressure – an urgent need – and these devices may be the future of optimal heart health. But this potential must be matched by rigorous efforts to confirm their accuracy and relevance for patients and clinicians.

Ritu Trivedi, Postdoctoral Research Fellow, School of Health Sciences, University of Sydney; Dean Picone, Senior Research Fellow, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, and Tammy Brady, Professor, School of Medicine, Johns Hopkins University

This article is republished from The Conversation under a Creative Commons license. Read the original article.