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The hallmark of [[Hashimoto's thyroiditis]] is [[hypothyroidism]]. A positive history of [[autoimmune diseases]] and certain drug use are suggestive of Hashimoto's thyroiditis. The most common symptoms of Hashimoto's thyroiditis include [[fatigue]], [[constipation]], and cold intolerance.
The hallmark of [[Hashimoto's thyroiditis]] is [[hypothyroidism]]. A positive history of [[autoimmune diseases]] and certain drug use are suggestive of Hashimoto's thyroiditis. The most common symptoms of Hashimoto's thyroiditis include [[fatigue]], [[constipation]], and cold intolerance.
===Physical Examination===
===Physical Examination===
Patients with [[Hashimoto's thyroiditis]] usually appear fatigued and have [[myxedema]]. Physical examination of patients with [[Hashimoto's thyroiditis]] is usually remarkable for [[bradycardia]], [[bradypnea]] and [[Reflexes|delayed reflexes]].<ref name="pmid24434360">{{cite journal |vauthors=Caturegli P, De Remigis A, Rose NR |title=Hashimoto thyroiditis: clinical and diagnostic criteria |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=391–7 |year=2014 |pmid=24434360 |doi=10.1016/j.autrev.2014.01.007 |url=}}</ref>
Patients with [[Hashimoto's thyroiditis]] usually appear fatigued and have [[myxedema]]. Physical examination of patients with [[Hashimoto's thyroiditis]] is usually remarkable for [[bradycardia]], [[bradypnea]] and [[Reflexes|delayed reflexes]].
 
===Laboratory Findings===
===Laboratory Findings===
Laboratory findings consistent with the diagnosis of [[Hashimoto's thyroiditis]] usually include increased [[Thyroid-stimulating hormone|thyroid stimulating hormone]], decreased [[free T3]] and [[free T4]], and [[thyroid peroxidase|anti-thyroid peroxidase antibodies]].
Laboratory findings consistent with the diagnosis of [[Hashimoto's thyroiditis]] usually include increased [[Thyroid-stimulating hormone|thyroid stimulating hormone]], decreased [[free T3]] and [[free T4]], and [[thyroid peroxidase|anti-thyroid peroxidase antibodies]].

Revision as of 20:04, 18 September 2017

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Overview

Historical Perspective

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Differentiating Hashimoto's Thyroiditis from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease where the body's own antibodies attack the cells of the thyroid. Hashimoto's thyroiditis was first described by Hashimoto Hakaru in 1912. He named it struma lymphomatosa which was renamed as Hashimoto's thyroiditis in 1931. Hashimoto's thyroiditis can be classified as primary or secondary types. Rarely, Hashimoto's thyroiditis can be categorized under the polyglandular syndromes. Hashimoto's thyroiditis (HT) is characterized by lymphocytic infiltration of the thyroid gland and production of antibodies that recognize thyroid-specific antigens. The pathogenesis is not yet completely understood. Thyroid cells undergo atrophy or transform into a type of follicular cell rich in mitochondria called Hurthle cell. It is currently thought that the disease is caused by abnormalities in cellular and humoral immunity which results in a localized cell-mediated immune response directed toward the thyroid parenchymal cells. This results in the decreased production of thyroid hormones. Hashimoto's thyroiditis is particularly common in middle aged women, Asians, and Whites. Hashimoto's thyroiditis usually begins slowly and may progress to hypothyroidism. Complications include heart failure, lymphoma, myxedema, and cervical compression. A positive history of autoimmune diseases and certain drug use are suggestive of Hashimoto's thyroiditis. The most common symptoms of Hashimoto's thyroiditis include fatigue, constipation, and cold intolerance. Laboratory findings consistent with the diagnosis of Hashimoto's thyroiditis usually include increased thyroid stimulating hormone, decreased free T3 and free T4, and anti-thyroid peroxidase antibodies. Ultrasound findings associated with Hashimoto's thyroiditis are reduced echogenicity, glandular irregularities, and nodules. 24-hour iodine-123 uptake is decreased in Hashimoto's thyroiditis. The mainstay of therapy for Hashimoto's thyroiditis is synthetic levothyroxine. Corticosteroids and selenium can also be used in certain cases. Thyroidectomy is usually performed when the enlarged thyroid produces cervical compression symptoms and there is a high suspicion for malignancy.

Historical Perspective

Hashimoto's thyroiditis was first described by Hashimoto Hakaru in 1912. He named it struma lymphomatosa which was renamed as Hashimoto's thyroiditis in 1931.

Classification

On the basis of the etiology, Hashimoto's thyroiditis can be classified as primary or secondary types. Rarely, Hashimoto's thyroiditis can be categorized under the polyglandular syndromes.

Pathophysiology

Hashimoto's thyroiditis (HT) is characterized by lymphocytic infiltration of the thyroid gland and production of antibodies that recognize thyroid-specific antigens.The pathogenesis is not yet completely understood. Thyroid cells undergo atrophy or transform into a type of follicular cell rich in mitochondria called Hurthle cell. It is currently thought that the disease is caused by abnormalities in cellular and humoral immunity which results in a localized cell-mediated immune response directed toward the thyroid parenchymal cells. This results in the decreased production of thyroid hormones.

Causes

Hashimoto's thyroiditis may be caused by T cells and B cells auto activation, genetic factors, and autoimmune antibodies against thyrotropin receptors.

Differentiating Hashimoto's Thyroiditis from other Diseases

Hashimoto's thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.

Epidemiology and Demographics

Hashimoto's thyroiditis is particularly common in middle aged women, Asians, and Whites. Annually, there are around 22 per 100,000 individuals worldwide.

Risk Factors

Common risk factors in the development of Hashimoto's thyroiditis are family history, female gender, and other autoimmune diseases.

Screening

There is insufficient evidence to recommend routine screening for Hashimoto's thyroiditis.

Natural History, Complications and Prognosis

Hashimoto's thyroiditis usually begins slowly and may progress to hypothyroidism. Complications include heart failure, lymphoma, myxedema, and cervical compression.

Diagnosis

Diagnostic Criteria

The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion. It includes the TPO antibodies, hypothyroidism, the presence of germinal centers and lymphocytic infiltration of the thyroid gland.

History and Symptoms

The hallmark of Hashimoto's thyroiditis is hypothyroidism. A positive history of autoimmune diseases and certain drug use are suggestive of Hashimoto's thyroiditis. The most common symptoms of Hashimoto's thyroiditis include fatigue, constipation, and cold intolerance.

Physical Examination

Patients with Hashimoto's thyroiditis usually appear fatigued and have myxedema. Physical examination of patients with Hashimoto's thyroiditis is usually remarkable for bradycardia, bradypnea and delayed reflexes.

Laboratory Findings

Laboratory findings consistent with the diagnosis of Hashimoto's thyroiditis usually include increased thyroid stimulating hormone, decreased free T3 and free T4, and anti-thyroid peroxidase antibodies.

Electrocardiogram

The findings associated with ECG in Hashimoto's thyroiditis are bradycardia and low voltage QRS complex.

Chest X Ray

The findings associated with Chest X ray in Hashimoto's thyroiditis are pleural effusion and cardiomegaly.

CT

Non-contrast CT may be used in Hashimoto's thyroiditis to assess the tracheal or esophageal compression.

MRI

There are no MRI findings associated with Hashimoto's thyroiditis.

Echocardiography or Ultrasound

Ultrasound findings associated with Hashimoto's thyroiditis are reduced echogenicity, glandular irregularities, and nodules.

Other Imaging Findings

24-hour iodine-123 uptake is decreased in Hashimoto's thyroiditis.

Other Diagnostic Studies

The histological analysis in Hashimoto's thyroiditis may show inflammatory cell infiltration and hurthle cells. Fine needle aspiration cytology helps to differentiate between the benign and malignant nodules. [1][2]

Treatment

Medical Therapy

The mainstay of therapy for Hashimoto's thyroiditis is synthetic levothyroxine. Corticosteroids and selenium can also be used in certain cases.

Surgery

Thyroidectomy is usually performed when the enlarged thyroid produces cervical compression symptoms and there is a high suspicion for malignancy.

Primary Prevention

There are no primary preventive measures available for Hashimoto's thyroiditis.

Secondary Prevention

There are no secondary preventive measures available for Hashimoto's thyroiditis.

References

  1. Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.
  2. "Thyroiditis — NEJM".

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