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Hashimoto's Thyroiditis


Hashimoto's Thyroiditis overview and Definition

Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's functions. It often leads to hypoactive thyroid gland resulting in decreased supply of thyroid hormone to the tissues.


Epidemiology

it is usually found in the middle aged women.


Pathophysiology

It is an autoimmune reaction. Several B- and T-cell activation pathways through antigen-presenting cells (APCs) and cytokine production lead to specific differentiation of T helper (Th) and T regulatory (Treg) cells. 


Clinical signs & symptoms

  • Fatigue and sluggishness
  • Increased sensitivity to cold
  • Constipation
  • Pale, dry skin
  • A puffy face
  • Brittle nails
  • Hair loss
  • Enlargement of the tongue
  • Unexplained weight gain
  • Muscle aches, tenderness and stiffness
  • Joint pain and stiffness
  • Muscle weakness
  • Excessive or prolonged menstrual bleeding
  • Depression
  • Memory lapses


Differential Diagnosis

Physical findings are variable and it purely depends upon the extent of the hypothyroidism and also other factors such as age. Examination of the findings might include the following:

  • Puffy face and periorbital edema typical of hypothyroid facies
  • Cold, dry skin, which may be rough and scaly
  • Peripheral edema of hands and feet, typically nonpitting
  • Thickened and brittle nails (may appear ridged)
  • Bradycardia
  • Elevated blood pressure (typically diastolic hypertension)
  • Diminished deep tendon reflexes and the classic prolonged relaxation phase
  • Macroglossia
  • Slow speech
  • Ataxia

Testing:

The potential results for patients with suspected Hashimoto thyroiditis include the following:

 Serum thyroid stimulating hormone (TSH):

It is the sensitive test for thyroid. Levels are raised in hypothyroidism due to hashimoto’s thyroiditis and in primary hypothyroidism from any cause.

Free T4 levels:

 It is used to correctly interpret the TSH in some clinical cases. The presence of an elevated TSH confirms the diagnosis of primary hypothyroidism.

Thyroid autoantibodies:

Presence of typically anti thyroid peroxidase and anti thyroglobulin antibodies or its variant. The 10-15 $ of patients with the hashimoto’s thyroiditis shows negative.

 

The following tests are not necessary for the diagnosis of primary hypothyroidism but may be used to evaluate complications of hypothyroidism in some patients, as indicated:

  • Complete blood count: Anemia in 30-40% of patients with hypothyroidism
  • Total and fractionated lipid profile: Possibly elevated total cholesterol, LDL, and triglyceride levels in hypothyroidism
  • Basic metabolic panel: Decreased glomerular filtration rate, renal plasma flow, and renal free water clearance in hypothyroidism; may result in hyponatremia
  • Creatine kinase levels: Frequently elevated in severe hypothyroidism
  • Prolactin levels: May be elevated in primary hypothyroidism

Imaging tests

Features of Hashimoto thyroiditis are usually identifiable on an ultrasonogram; however, a thyroid ultrasonogram is usually not necessary for diagnosing the condition. This imaging modality is useful for assessing thyroid size, echotexture, and, most importantly, whether thyroid nodules are present.

Chest radiography and echocardiography are not usually performed and are not necessary in routine diagnosis or evaluation of hypothyroid patients.

Procedures

Hashimoto thyroiditis is a histologic diagnosis. Therefore, perform fine-needle aspiration of any dominant or suspicious thyroid nodules to exclude malignancy or the presence of a thyroid lymphoma in fast-growing goiters. 

 


Prognosis

The prognosis is excellent with the proper treatment.


Prevention

It is an autoimmune condition and there is no way to prevent it .