Hashimoto’s thyroiditis: What does it look like in males?

Hashimoto’s thyroiditis is  approximately ~7 times more frequent in females than in males¹. Nevertheless, the earlier a man starts regular checkups, the higher the probability that Hashimoto’s disease will have little to no effect on his quality of life.

How does Hashimoto’s manifest in males?

Before your first visit to a physician, it makes sense to think about any symptoms that worry you and write them down; this can be anything from muscle ache to hair loss. Add all possible symptoms, even if they seem unconnected to thyroid gland disorder. 

The fact is, autoimmune thyroiditis (AIT) does not have specific symptoms; many manifestations of this disease can be easily confused with simply not feeling well. The more details you add when describing your condition, the higher the chance of a timely and accurate diagnosis.

AIT develops asymptomatically until the level of thyroid hormones becomes too low. Below is a list of the most common signs which deserve your attention. If you have any of these symptoms, it is recommended to talk to a healthcare provider as soon as possible:

• Feeling cold even when you wear warm clothes
• Increased tiredness
• Dry skin
• Gastrointestinal issues, such as constipation or diarrhea
• Depression
• Feeling nervous or anxious for a long time
• Tremos
• Sleeping issues
• Trouble concentrating
• Muscle ache
• Rapid weight loss or gain
• Goiter, which is the thyroid gland swelling; the lower half of the neck thickens noticeably.

Thyroid hormones have effects on the sexual functions of both men and women. According to one study, about 48%-60% of surveyed males and females with diagnosed Hashimoto’s thyroiditis have libido issues². In men, Hashimoto’s can have several typical symptoms:

• Erectile dysfunction
• Delayed or premature ejaculation
• Decreased sperm count and motility, as well as a worsening of semen quality³, potentially resulting in infertility
• Hair loss
• Breast growth³

Some of these symptoms aren’t primarily linked to Hashimoto’s, which is why it’s important to have regular checkups to discover the disease at the earliest possible stage.

How is Hashimoto’s thyroiditis diagnosed in men?

During your first visit to a physician, you will be asked about your condition and any symptoms you have. Your healthcare provider will refer you to blood tests to check your thyroid and pituitary hormone levels, as well as to check for the presence of anti-thyroid antibodies (or anti-peroxidase antibodies). They may also refer you to an echography of the thyroid to assess its size.  

These are the main criteria of autoimmune thyroiditis diagnosis: 

• Increased level of thyroid stimulating hormones
• Normal or decreased T4 level
• Changes discovered by means of echography. These thyroid changes do not always mean the patient has AIT, and thus this examination should not be done without all other diagnostic tests. 
• Increased level of anti-thyroid tissue antibodies.

Increased level of anti-thyroid tissue antibodies helps diagnose not only autoimmune disease of the thyroid gland but also several other autoimmune diseases, such as celiac disease, type 1 diabetes mellitus, rheumatoid arthritis, and Sjogren disease, as well as malignant tumors of the thyroid. 

An increase in anti-thyroglobulin antibodies is seen in males much less often than in females. 

The thing about this test is that antibodies can be found even in completely healthy people, so to establish an exact diagnosis, it is necessary to assess the patient’s general condition and other signs and symptoms.

The disease can be diagnosed only after a comprehensive assessment that accounts for the patient’s complaints, the results of blood tests for hormones and anti-thyroid antibodies, and a visualization of the thyroid gland by means of echography.

How is Hashimoto’s treated in men? 

All your healthcare provider’s prescriptions will work on alleviating the symptoms of Hashimoto’s, providing you with a feeling of energy and power and allowing you to live comfortably with your condition.

Pharmacotherapy

Usually, synthetic hormones are used to replace lacking thyroid hormones: T4 or combined T3 and T4. It is important to remember that only a physician can prescribe this medication and define the dosage. Both mentioned hormones will regulate the release of pituitary hormone (TSH). Hormone replacement therapy has been used for the treatment of Hashimoto’s disease for several decades. Such a large timescale has permitted us to study the long-term effects of this treatment. 

One of known side effects of thyroid hormone replacement therapy is an increase in the risk of osteoporosis. For people who have been taking doses of 100 µg or higher over a period of at least 10 years, X-ray densitometry is recommended. This technique is used to measure bone density and predict the probability of fractures. Patients with AIT should regularly visit their healthcare provider to control the possible long-term effects of treatment. The frequency of examinations is determined by the doctor, depending on the patient’s age, baseline TSH level, and prescribed dose of the medication. 

Lifestyle changes

Data obtained in recent decades increasingly shows that some lifestyle modifications can have positive effects on an autoimmune disease’s state. These positive changes can mean that the patient is able to take their medication in lower doses. 

There are some examples listed below.

Alimentary changes. Recent studies suggest that some diets, including AIP, a low-FODMAP diet, intermittent fasting, and the Fast Mimicking Diet (FMD) can decrease the inflammation^5,6 and have positive effects on the development of several autoimmune diseases or decrease their risks.

Physical activity.It is well known that physical activity leads to a significant increase in the numbers of Treg lymphocytes. These are very powerful in terms of inhibiting the pathological immune response seen in different autoimmune disorders. In addition, investigations show that physical activity results in decreased release of immunoglobulines. When the level of these substances is high, it can be an indication of immune system disorders.⁷ These are not the only positive effects that exercise can have on the immune system.

Stress management. Patients with autoimmune diseases are 45% more likely to suffer from depression, according to a Danish study⁸. There is also a lot of evidence that stress can be a trigger for autoimmune reactions^9,10. To decrease the reaction on stressors, it makes sense to try mindfulness practices. It is also very important to minimize the sources of stress in your life. 

Key takeaways

1. Males have a lower risk of developing autoimmune thyroiditis, but this is not a reason to not visit a healthcare provider. Some symptoms might not indicate Hashimoto’s thyroiditis straight away, and in many cases, the disease can be asymptomatic for a long time. 
2. The symptoms of Hashimoto’s disease are similar in both genders, except for several symptoms specific to men, such as erectile dysfunction or decreased sperm count or sperm motility. 
3. Following your doctor’s recommendations will help you return to a normal and comfortable life. 
4. Some parts of your lifestyle deserve special attention, such as diet, physical activity, and stress levels. All of these can influence the development of Hashimoto’s, and have the potential to significantly decrease its symptoms.