Hashimoto's thyroiditis; chronic lymphocytic thyroiditis; struma lymphomatosa; lymphadenoid goiter; primary myxedema
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Introduction
Hashimoto's thyroiditis is the first organ-specific autoimmune disease to be described.
Etiology
- autoimmune
- association with other autoimmune diseases:
Epidemiology
- most common cause of goitrous hypothyroidism in geographic regions with sufficient iodine
- female to male ratio 5-7:1
- incidence increases with age, but may occur in children[5]
Pathology
- classic goitrous form: (most common form)
- intense infiltrate of lymphocytes admixed with plasma cells that virtually replace the thyroid parenchyma
- Askanazy cells
- atrophic variant: (less common form)
- fibrosis with a scant lymphoid infiltrate
Genetics
- association with HLA-DR5 & HLA B8 with goitrous form
- association with HLA-DR3 with atrophic variant
- association with CTLA-4[5]
Clinical manifestations
- most patients are asymptomatic
- incidental finding of painless, slowly enlarging thyroid
- gland shrinks & becomes undetectable late in the disease
- occasional-rare symptoms of mechanical compression
- enlarged regional lymph nodes is uncommon
- hypothyroidism
- 20% at presentation
- may be precipitated by a large iodine dose in the form of radiographic contrast[3]
- hyperthyroidism (Hashitoxicosis) in 5%
- euthyroid in 75%
- may be associated with polyglandular failure
- fatigue[11]
Laboratory
- antibodies to thyroid peroxidase (anti-microsomal Ab)
- anti thyroglobulin (85%)
- may be associated with other disorders
- serum T3, serum T4, serum TSH related to stage of disease
- antibodies to TSH receptor
- specific for autoimmune thyroid disease
- inhibitory rather than stimulatory antibodies as in Grave's disease
- rare cause of hypothyroidism[6] (no Loinc?)
- other autoantibodies
- LMOD1
- antibodies to the Na+/I- symporter (< 20%)
Radiology
- scintigraphy reveals uniformly functioning thyroid tissue
Complications
Differential diagnosis
Management
- some patients do not require therapy
- Hashimoto's disease may result in hypothyroidism, thus TSH should be monitored regularly
- thyroxine may shrink symptomatic goiters through decreasing TSH production
- surgery for symptoms of compression
- euthyroid patients with Hashimoto's thyroiditis are sensitive to iodine exposure, which may result in a reversible form of hypothyroidism
- total thyroidectomy may improve health-related quality of life & fatigue[11]
More general terms
More specific terms
Additional terms
Component of
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 473
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 646-50
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2018, 2022
- ↑ Williams Textbook of Endocrinology, 8th ed, JD Wilson & DW Foster (eds), WB Saunders Co, Philadelphia PA, 1992, pg 475
- ↑ 5.0 5.1 5.2 UpToDate 2004 http://www.uptodate.com
- ↑ 6.0 6.1 NEJM Knowledge+ Question of the Week. Sept 19, 2017 https://knowledgeplus.nejm.org/question-of-week/4350/
- ↑ De Luca F, Santucci S, Corica D, Pitrolo E, Romeo M, Aversa T. Hashimoto's thyroiditis in childhood: presentation modes and evolution over time. Ital J Pediatr 2013 Feb 1; 39:8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23363471 Free PMC Article
- ↑ Zirilli G, Velletri MR, Porcaro F et al In children with Hashimoto's thyroiditis the evolution over time of thyroid status may differ according to the different presentation patterns. Acta Biomed. 2015 Sep 14;86(2):137-41. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26422427
- ↑ Ajjan RA, Weetman AP. The Pathogenesis of Hashimoto's Thyroiditis: Further Developments in our Understanding. Horm Metab Res. 2015 Sep;47(10):702-10. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26361257
- ↑ Pyzik A, Grywalska E, Matyjaszek-Matuszek B, Rolinski J Immune disorders in Hashimoto's thyroiditis: what do we know so far? J Immunol Res. 2015;2015:979167. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26000316 Free PMC Article
- ↑ 11.0 11.1 11.2 Guldvog I,Reitsma LC, Johnsen L et al Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial. Ann Intern Med. 2019. March 12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30856652 https://annals.org/aim/article-abstract/2728199/thyroidectomy-versus-medical-management-euthyroid-patients-hashimoto-disease-persisting-symptoms
Patient information
Hashimoto's thyroiditis patient information