Hashimoto's thyroiditis overview
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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.
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
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. 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
Differentiating Hashimoto's Thyroiditis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
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 decreased amplitude of cardiac waves.
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.
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
References
- ↑ 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.
- ↑ "Thyroiditis — NEJM".