Gina Rodriguez Surprised by Hashimoto’s Diagnosis- UPDATED

In the new CW series Jane the Virgin, Jane Villanueva, (played by actress Gina Rodriguez), is a hard-working, religious young Latina woman whose family tradition leads her to vow to save her virginity until her marriage.  That plan is shattered when she learns at a doctor’s appointment that she was been mistakenly artificially inseminated during a routine pap smear.

But this scenario hit close to home for Rodriguez, who got some shocking news of her own at a doctor’s appointment shortly after filming the pilot episode of the program. Gina, 29, was diagnosed as having “thyroid disease” 10 years earlier. However, she did not realize that the cause of her condition was something called Hashimoto’s Thyroiditis (or Hashimoto’s Disease), telling Entertainment Tonight:

“While I was shooting the pilot, I was training for a half marathon and I went to see my holistic doctor right after the marathon was done.

“She said, ‘From your test results, let’s talk about your Hashimoto’s (disease).’ And I was like, ‘What are you talking about? I have thyroid disease’ and she said, ‘No, no you have Hashimoto’s and to be honest, I don’t know how you’re standing right now and why you’re not asleep. I thought somebody would be bringing you here.’

But Gina is undaunted. You may be tired,” but you get up and push forward!’ Asked if she experienced any symptoms of depression?: “‘Yeah, but mind over matter?”

What is Hashimoto’s Thyroiditis?

Hashimoto’s disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease. An autoimmune disease is a disorder in which the body’s immune system attacks the body’s own cells and organs. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

Hashimotos-Thyroiditis-Symptoms-of-Hypothyroidism_01In Hashimoto’s disease, the immune system attacks the thyroid gland, causing inflammation and interfering with its ability to produce thyroid hormones. Large numbers of white blood cells called lymphocytes accumulate in the thyroid. Lymphocytes make the antibodies that start the autoimmune process.

Hashimoto’s disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesn’t make enough thyroid hormone for the body’s needs. Thyroid hormones regulate metabolism—the way the body uses energy—and affect nearly every organ in the body. Without enough thyroid hormone, many of the body’s functions slow down. Hashimoto’s disease is the most common cause of hypothyroidism in the United States

What is the thyroid?

Drawing of the head and neck with the thyroid, pituitary gland, TSH, and T3–T4 labeled. Arrows show the direction of TSH from the pituitary gland to the thyroid gland and of T3–T4 from the thyroid to the pituitary gland.

The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe.

The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce and store hormones and release them into the bloodstream. The hormones then travel through the body and direct the activity of the body’s cells.

The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain, regulates thyroid hormone production. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary decreases TSH production.

What are the symptoms of Hashimoto’s disease?

Hypothyroidism-Symptoms-in-women-253x300Many people with Hashimoto’s disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful. After many years, or even decades, damage to the thyroid causes it to shrink and the goiter to disappear.

Not everyone with Hashimoto’s disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinical—mild and without symptoms, especially early in its course. With progression to hypothyroidism, people may have one or more of the following symptoms:

  • fatigue
  • weight gain
  • cold intolerance
  • joint and muscle pain
  • constipation, or fewer than three bowel movements a week
  • dry, thinning hair
  • heavy or irregular menstrual periods and problems becoming pregnant
  • depression
  • memory problems
  • a slowed heart rate

How is Hashimoto’s disease diagnosed?

Diagnosis begins with a physical exam and medical history. A goiter, nodules, or growths may be found during a physical exam, and symptoms may suggest hypothyroidism. Health care providers will then perform blood tests to confirm the diagnosis. Diagnostic blood tests may include:

  • TSH test. The ultrasensitive TSH test is usually the first test performed. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, a TSH reading above normal means a person has hypothyroidism.
  • T4 test. The T4 test measures the actual amount of thyroid hormone circulating in the blood. In hypothyroidism, the level of T4 in the blood is lower than normal.
  • antithyroid antibody test. This test looks for the presence of thyroid autoantibodies, or molecules produced by a person’s body that mistakenly attack the body’s own tissues. Two principal types of antithyroid antibodies are
    • anti-TG antibodies, which attack a protein in the thyroid called thyroglobulin
    • anti-thyroperoxidase (TPO) antibodies, which attack an enzyme called thyroperoxidase in thyroid cells that helps convert T4 to T3. Having TPO autoantibodies in the blood means the body’s immune system attacked the thyroid tissue in the past. Most people with Hashimoto’s disease have these antibodies, although people whose hypothyroidism is caused by other conditions do not.

How is Hashimoto’s disease treated?

Treatment generally depends on whether the thyroid is damaged enough to cause hypothyroidism. In the absence of hypothyroidism, some health care providers treat Hashimoto’s disease to reduce the size of the goiter. Others choose not to treat the disease and simply monitor their patients for disease progression.

Hashimoto’s disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. Health care providers prefer to use synthetic T4, such as Synthroid, rather than synthetic T3, because T4 stays in the body longer, ensuring a steady supply of thyroid hormone throughout the day. The thyroid preparations made with animal thyroid are not considered as consistent as synthetic thyroid (Levothyroxine) and rarely prescribed today.

Health care providers routinely test the blood of patients taking synthetic thyroid hormone and adjust the dose as necessary, typically based on the result of the TSH test. Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed.

Source: National Endocrine and Metabolic Diseases Information Service (NEMDIS)

More information is available in the Resounding Health Casebook on the topic.

UPDATE: Rice Student’s Video Response to this Story:

Rice student Greta Shwachman responds to this story for Dr. Kirsten Ostherr’s Medicine and Media course:

“This latest post grabbed my attention right off the bat because I myself suffer from Hashimoto’s Thyroiditis. I first heard the term Hashimoto’s after being diagnosed with hypothyroidism back in 2007. I have been taking medication since my diagnosis, and for the most part, I feel completely normal. Truthfully, I was kind of surprised to see the headline: “Gina Rodriguez Surprised by Hashimoto’s Diagnosis.” I mean, is it that surprising? After all, Hashimoto’s is the most common cause of hypothyroidism. While I think the phrase “shocking news” is a bit extreme to describe Rodriguez’s diagnosis, this article raises some interesting questions, particularly when it comes to taking charge of our health and fully understanding our medical conditions. I think it’s great that hypothyroidism is being brought to the limelight. This story gives Rodriguez the potential to become a role model for other Hashimoto’s patients. It’s important that she and other patients fully understand Hashimoto’s and what they can do to successfully treat the disease. There are a variety of support groups and resources available to Hashimoto’s patients online. Stop the Thyroid Madness is a good one that has been very influential in my personal struggle with hypothyroidism. I wish Gina luck in getting the condition under control and encourage her to join the growing number of e-patients who are educating themselves and taking control of their healthcare.”

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

5 Comments

  1. Chaney Turney

    October 30, 2014 at 7:20 pm

    I find this article particularly interesting because I too have Hashimoto’s thyroiditis. As Gina’s doctor mentioned, the fatigue that encompasses your entire body can often be overwhelming, and it’s an absolute wonder that she completed a half marathon with undiagnosed Hashimoto’s. However, I’m specifically curious as to what her doctor meant by “thyroid disease” when she was diagnosed ten years earlier. In my experience at the endocrinologist, diseases of the thyroid stem from a variety of causes, such as autoimmune problems like Grave’s or Hashimoto’s, inflammation as with thyroiditis, or enlargement of the thyroid gland with cancer, nodules, or goiter. A diagnosis of thyroid disease seems quite broad to me, and the shock Gina experienced upon receiving her recent diagnosis could have been alleviated had her previous diagnosis been explained to her in full. Furthermore, I wonder if Gina’s current doctor that determined Hashimoto’s was the cause of her symptoms was aware of her previously diagnosed “thyroid disease.” The manner in which Gina worded it in this article makes it seem as though this physician did not have any background knowledge of her former thyroid issue, a problem which could be alleviated through the adoption and maintenance of electronic medical records by all physicians. Had her recent doctor possessed a compilation of Ms. Rodriguez’ entire medical history in an easily accessible, electronic format, she might have noticed a pattern in Gina’s symptoms, especially since Hashimoto’s symptoms can fluctuate drastically over a long period of time. Proceeding forward with treatment will require close monitoring of Gina’s T3 and T4 hormone levels and varying the amount of synthetic T4 she takes in pill form accordingly. These tasks would prove to be more sustainable long-term if Gina’s medical records were compiled in an EMR and could be transferred efficiently from doctor to doctor, since she is involved in the acting business and her ability to visit a doctor in a single location might not always be guaranteed. I have a similar problem since I am unable to visit my endocrinologist in my hometown while I am away at college, and I can personally vouch for the confusion, surprise, and frustration that can arise when my doctors are not on the same page in regards to my hormonal treatment. The medical system is in dire need of revamping the manner in which medical records are transferred, stored, and relayed to the patients.

  2. Angelina Iyinbor

    October 30, 2014 at 7:23 pm

    As health information becomes more readily available to the common population via medical blogs, social media, online patient support groups, and, most importantly, electronic medical records (EMRs), the medical community has raised the question of how much information should be revealed to patients. They argue that if patients were to have full, unrestricted access to their electronic medical records without the context that would otherwise be provided in a physical, face-to-face appointment, they may misinterpret the medical data. This could indeed be a serious problem that could cause anxiety in patients where it is not warranted, but, as shown in the article above, it may not be such a bad idea for patients to understand their health. Jane Villanueva found out she has Hashimoto’s Thyroiditis ten years after being diagnosed. If she had had access to her medical record, she could have treated her symptoms in a much more effective way. As stated in the article, Hashimoto’s does not always cause symptoms and, depending on the severity, may not even be treated, and for this reason, Villanueva’s doctor may have chosen to not disclose this information. However, even if some of the symptoms, like hair thinning, may not be clinically significant, they may still cause other problems, such as, in the example of thinning hair, anxiety over the patient’s appearance. In other words, it is important for the patient to have a complete picture of their health status as most diseases not only affect a certain organ or organ system, but also affect the way the person interacts with others, their emotional status, and their behavior. The fear that the medical community has over the knowledge disparity between patients and health care professionals and how that will negatively affect patients who have access to their EMRs, should really be abandoned. As mentioned in the beginning of this comment, there is a plethora of medical information on the internet that is actually bridging the knowledge gap between patients and doctors, making it much more practical for patients to have access to their medical information, and thereby make more informed decisions about their health.

  3. Francisca Acosta

    November 4, 2014 at 12:47 am

    How many of us can say that we ever heard of Hashimoto’s disease before? Hashimoto’s disease affects an average of 1 to 1.5 in every 1000 people. (1) When you compare this to the prominence of Ebola in Liberia and Sierra Leone, where the virus has affected an average of 0.4-0.5 in every 1000 people, you realize that although relatively prominent, especially when compared to the health problems that are currently widely advertised, this condition is not well known. (2) It is often that what is more commonly seen in the news or online is not the disease or condition that is affects the most people, but rather one the “newest” condition or one that networks, magazines, or newspapers feel would capture their audience’s attention. That being said, it is websites like Celebrity Diagnosis that provide the public with information that would otherwise not be talked about or even recognized.

    In the case of Gina Rodriguez, her Hashimoto’s disease diagnosis was a shock to her. However what if she had heard about the disease before her diagnosis? If her disease was a common household name such as Ebola, where almost everyone in this country is aware of its signs and symptoms along with its consequences. Would she have been aware of the possibility that she had Hashimoto’s Disease?

    EMRs, or electronic medical records, I feel have been a great tool in trying to get each patient involved in their own health. They can help patients recognize patterns in their symptoms, keep a doctor aware of what is going on with each patient, and ultimately provide an intervention if they feel it is necessary. Perhaps if Gina Rodriguez had been keeping track of her symptoms with her doctor, through an EMR throughout the years, her and her doctor could have been in the same page in terms of diagnosis, and she could have acquired the treatment she needs much sooner.

    In recent years, EMR adoption has increased dramatically nationwide due to the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, this policy has moved forward in such a way that starting in 2015 hospitals and doctors will be penalized through Medicare if they are not using EMRs. Why this push? EMRs are truly valuable allowing tracking of data over time, identifying patients who are due for preventive visits and screening, monitoring how patients measure up to different parameters, and overall they aim to improve overall quality of care in practice. (3)

    With all this is mind, you should definitely check in with your doctor and ask to learn more on how they are using EMRs, in the case of Gina Rodriguez, I do feel they would have definitely helped.

    Sources:
    1. “24: The Endocrine System”. Robbins and Cotran Pathologic Mechanisms of Disease (8th ed.). Philadelphia, PA: Elsevier. pp. 1111–205.
    2. Michaud, Josh, and Jennifer Kates. “Measuring the Impact of Ebola: Will It Reach 1.4 Million?” Perspectives. Kaiser Foundation, n.d. Web. 30 Oct. 2014.
    3. “HealthIT.gov.” Definition and Benefits of Electronic Medical Records (EMR). N.p., n.d. Web. 30 Oct. 2014.

  4. Elizabeth Godfrey

    November 4, 2014 at 5:07 pm

    Apparently, actor Gina Rodriguez has had Hashimoto’s Thyroiditis for ten years. This would be less surprising for Rodriguez if she had not just this past year been made aware of the fact. Though diagnosed with general thyroid disease at the age of 19, Rodriguez was never told that she had a chronic autoimmune disease that requires careful monitoring and sometimes treatment. In Rodriguez’s case, no unrecoverable harm seems to have been done; she continues work on her TV program, Jane the Virgin, and describes herself as “pushing forward” through her symptoms. But what if her disorder had suddenly intensified in that decade? What if she had been stricken with severe depression and hadn’t known what treatment to seek? What if she had been prescribed some medication that worsened her Hashimoto’s?
    The failure of Rodriguez’s doctor to inform her of her condition reflects two larger, persistent problems in the modern medical profession. The first is the enormous incidence of medical error even today, in a supposedly enlightened era. Rodriguez could have suffered much more serious consequences from her doctor’s failure to communicate—and many people do. Some estimate fatalities due to this and other types of preventable medical error at 98,000 annually, many of which can be attributed to physicians’ inability to use their patients’ full medical history. Medical records, even electronic ones (EMRs), are difficult to transport from other systems, and once in front of the doctor, are too bulky and bury relevant information, so the doctor orders tests or makes diagnoses without the benefit of that information.
    The second, closely related issue is that patients like Rodriguez are kept in the dark about their own health. A diabetic may never be informed of her A1c. A patient with a liver condition may not know the results of his last liver function test. Yet if an individual were aware of his or her test results and were able to access them, he or she could pass that information to the doctor much more quickly than any medical record, even an electronic one. If someone like Gina Rodriguez has access to an interface that displays results of diagnostic tests, then perhaps he or she won’t spend a decade unaware of his or her health condition. The patient will be able to directly communicate to the health care provider what health data and information is most relevant, and may be able to detect abnormalities in his own diagnostic data to call to the doctor’s trained eye.
    The dangers of a health information system that allows individuals to be diagnosed with a major health condition and remain unaware of the fact are too dire to be ignored. While the patient should not be expected to keep track of all of his or her information, he or she should be at least supplied with interpretable test results. A busy, under-informed health professional should not be a patient’s only defense against the medical errors that claim almost 100,000 lives a year.

  5. Hannah Willey

    November 10, 2014 at 5:35 pm

    I found this article regarding Gina Rodriguez’s diagnosis of Hashimoto’s disease a great example of the communication issues that arise between doctors and patients. I can personally relate to not receiving complete information about a medical diagnosis. When my doctor’s office made my health records available online, I noticed that the previous year my doctor had diagnosed me with a heart murmur of which I had never received information. Like Gina I was surprised to learn I had this condition and was confused as to why I had not previously been informed of it. In my case there was nothing different I would have been able to do for my health even if I had known about the condition. However, in other situations there may be lifestyle modifications people could make if they were fully aware of their diagnosis.
    As we discussed in class, and as Eric Topol’s book “The Creative Destruction of Medicine” discussed, there has recently been a push by patients to receive complete and convenient access to their medical records. There are both advantages and disadvantages to this access. On one hand, patients who have access to their health records tend to be more engaged with their healthcare, and, therefore, have better outcomes. On the other hand, allowing patients more access to their healthcare records may expose them to terminology or conditions that they do not understand. Because patients have not received the same background and training as healthcare professionals, they do not always have the knowledge needed to understand their conditions. This places an additional burden on the doctor who must now spend more time explaining things to the patient. In our healthcare system today, there is no time for this. Despite these disadvantages, I believe that patients should have access to their medical records, and with electronic medical record (EMR) systems that becoming routinely used in healthcare settings, providing this access is very easy. With access to electronic medical records, Gina could have known about her thyroid disease being caused by Hashimoto’s Disease, and being more educated on her diagnosis may have had better outcomes. Hopefully EMR use will continue to eliminate these gaps in patient’s knowledge of their conditions, such as the insight I gained into my own health conditions when receiving access to my EMR.

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