Hashimoto thyroiditis

Last updated: February 3, 2022

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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).

Epidemiological data refers to the US, unless otherwise specified.

  • Early-stage
    • Primarily asymptomatic
    • Goiter: nontender or painless, rubbery thyroid with moderate and symmetrical enlargement [2]
    • Hashitoxicosis may occur: transient hyperthyroidism due to follicular rupture of hormone-containing thyroid tissue that manifests with, e.g., irritability, heat intolerance, diarrhea.
  • Late-stage

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

The differential diagnoses listed here are not exhaustive.

  • 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

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

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  4. 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): p.789-794. doi: 10.1530/EJE-10-1172 . | Open in Read by QxMD
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  7. James V. Hennessey. Riedel's Thyroiditis: A Clinical Review. The Journal of Clinical Endocrinology & Metabolism. 2011; 96 (10): p.3031-3041. doi: 10.1210/jc.2011-0617 . | Open in Read by QxMD
  8. Heufelder AE, Hay ID. Evidence for autoimmune mechanisms in the evolution of invasive fibrous thyroiditis (Riedel's struma). Clin Investig.. 1994; 72 (10): p.788-793.
  9. Hashimoto's Thyroiditis. http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/. Updated: December 20, 2013. Accessed: January 26, 2017.
  10. Herold G. Internal Medicine. Herold G ; 2014

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