• Clinical science

Hashimoto thyroiditis

Summary

Hashimoto disease is the most common form of autoimmune thyroiditis and the leading cause of hypothyroidism in the United States. Although currently thought to be due to chronic autoimmune-mediated lymphocytic inflammation of the thyroid tissue, the exact pathophysiology remains unclear. Patients are initially asymptomatic or hyperthyroid, progressing to hypothyroidism as the organ parenchyma is destroyed. Diagnosis is based on a combination of specific antibodies, thyroid function tests, and sonography of the thyroid. Treatment involves lifelong hormone replacement therapy with levothyroxine (L-thyroxine).

Epidemiology

  • Prevalence: : 5% in the US; Hashimoto disease is the most common form of thyroiditis and the most frequent cause of hypothyroidism in the US.
  • Sex: > (7:1)
  • Age of onset: occurs in all age groups; , particularly in women aged 30–50 years

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Pathophysiology

References:[1][4][5]

Clinical features

References:[3][6][2][1]

Diagnostics

Anti-TPO antibodies are also elevated in 70% of patients with Graves disease!

References:[1][3][7][6][8]

Pathology

References:[9][1]

Differential diagnoses

References:[2][3][10][6]

The differential diagnoses listed here are not exhaustive.

Treatment

  • Levothyroxine (T4) replacement therapy
    • Life-long oral administration of L-thyroxine (T4)
    • Commence at a lower and more slow-acting dose with increasing severity of hypothyroidism because of the risk of cardiac side effects.
  • Life-long monitoring
    • Due to decline in T4 production with increasing age
    • Life-long monitoring of thyroid parameters (primarily TSH) is necessary to adjust treatment accordingly and avoid hyperthyroidism

References:[3]

Complications

References:[2][3][11]

We list the most important complications. The selection is not exhaustive.

  • 1. Davies TF. Pathogenesis of Hashimoto's thyroiditis (chronic autoimmune thyroiditis). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/pathogenesis-of-hashimotos-thyroiditis-chronic-autoimmune-thyroiditis. Last updated March 23, 2016. Accessed January 9, 2017.
  • 2. Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: An Integrated Approach. American Family Physician. 2014; 90(6): pp. 389–396. url: http://www.aafp.org/afp/2014/0915/p389.html.
  • 3. Lee SL. Hashimoto Thyroiditis. In: Griffing GT. Hashimoto Thyroiditis. New York, NY: WebMD. http://emedicine.medscape.com/article/120937. Updated July 11, 2016. Accessed January 9, 2017.
  • 4. Menconi F, Monti MC, Greenberg DA, et al. Molecular amino acid signatures in the MHC class II peptide-binding pocket predispose to autoimmune thyroiditis in humans and in mice. Proc Natl Acad Sci USA. 2008; 105(37): pp. 14034–14039. doi: 10.1073/pnas.0806584105.
  • 5. Wiebolt J, Achterbergh R, Den boer A, et al. Clustering of additional autoimmunity behaves differently in Hashimoto's patients compared with Graves' patients. Eur J Endocrinol. 2011; 164(5): pp. 789–794. doi: 10.1530/EJE-10-1172.
  • 6. Agabegi SS, Agabegi ED. Step-Up To Medicine. Baltimore, MD, USA: Lippincott Williams & Wilkins; 2013.
  • 7. Khandelwal D, Tandon N. Overt and subclinical hypothyroidism: who to treat and how. Drugs. 2012; 72(1): pp. 17–33. doi: 10.2165/11598070-000000000-00000.
  • 8. Baloch ZW, Livolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. Best Pract Res Clin Endocrinol Metab. 2008; 22(6): pp. 929–939. doi: 10.1016/j.beem.2008.09.011.
  • 9. Le T, Bhushan V, Sochat M, Petersen M, Micevic G, Kallianos K. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical; 2014.
  • 10. Heufelder AE, Hay ID. Evidence for autoimmune mechanisms in the evolution of invasive fibrous thyroiditis (Riedel's struma). Clin Investig. 1994; 72(10): pp. 788–793. pmid: 7865983.
  • 11. DeGroot LJ, Akamizu T. Hashimoto's Thyroiditis. http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/. Updated December 20, 2013. Accessed January 26, 2017.
  • Herold G. Internal Medicine. Cologne, Germany: Herold G; 2014.
last updated 12/10/2019
{{uncollapseSections(['4p03pS', 'lp0vpS', '5p0iJS', 'Mp0MJS', 'op00qS', 'Kp0UqS', '6p0jqS', 'pp0LqS', 'Jp0sqS'])}}