Hashimoto Thyroiditis

Thyroiditis
• Thyroiditis, or inflammation of the thyroid
gland, encompasses a diverse group of
disorders characterized by some form of
thyroid inflammation. These diseases include
conditions that result in acute illness with
severe thyroid pain (e.g., infectious thyroiditis)
and disorders in which there is relatively little
inflammation and the illness is manifested
primarily by thyroid dysfunction.
• This section focuses on the more common and
clinically significant types of thyroiditis:
• (1) Hashimoto thyroiditis (or chronic
lymphocytic thyroiditis)
• (2) subacute granulomatous thyroiditis
• (3) subacute lymphocytic thyroiditis
 Definition
• Hashimoto thyroiditis is the most common
cause of hypothyroidism in areas of the world
where iodine levels are sufficient. It is
characterized by gradual thyroid failure
because of autoimmune destruction of the
thyroid gland.Hashimoto thyroiditis is also one
of the autoimmune disease
• This disorder is most prevalent between 45
and 65 years of age and is more common in
women than in men, with a female
predominance of 10 : 1 to 20 : 1. Although it is
primarily a disease of older women, it can
occur in children and is a major cause of
nonendemic goiter in children.
 History
• Also known as Hashimoto's disease
• Hashimoto's thyroiditis is named after the
Japanese physician Hashimoto
Hakaru (1881−1934) of the medical school
at Kyushu University,who first described the
symptoms in 1912 in a German publication.
 Ethiological factor
• Hashimoto's disease tends to run in families,
and does have a genetic susceptibility (HLA-
DR3 and HLA DR5 are the most commonly
associated alleles)
• The genes implicated vary in different ethnic
groups and the incidence is increased in
patients with chromosomal disorders,
including Turner, Down’s, and Klinefelter’s
syndrome usually associated with
autoantibodies against thyroglobulin and
thyroperoxidase
 The normal thyroid gland on
the right side of the image is dark red-brown, whereas the thyroid
gland on the left side of the image is pale tan. The microscopic features
of Hashimoto thyroiditis (lymphocyte infiltrate and fibrosis in
later stage cases) contribute to the gross appearance
 The characteristic
histologic features of Hashimoto thyroiditis are a lymphocytic
infiltrate and oncocytic change of the follicular epithelium
(arrow)
External surface of an enlarged, nodular-appearing
thyroid gland
 Cut surface of a lobe of thyroid
gland in Hashimoto thyroiditis shows a lobulated
arrangement
 TREATMENT
Hypothyroidism caused by Hashimoto’s Thyroiditis is treated with :-
1. Thyroid Hormone Replacement
 Example : Levothyoxine or desiccated thyroid extract.
 A tablet taken one a day generally keeps the thyroid hormone levels normal.
 It is rcommended that TSH levels be kept under 3.0
2. Beta-blocker and/ or antithyroid medication
 Example : Carbimazole
 If the patient had a temporary phase of Hashitoxicosis (Hashimoto’s + toxic + condition).
3. Corticosteroids
 If the gland becomes uncomfortably painful
4. Surgery
 Particularly if there is any possibility that the goiter is due to cancer and not to
Hashimoto’s disease.
 This difficulty may arise when the thyroid feels very hard or is enlarged unevenly, but
usually a needle biopsy will resolve this diagnostic difficult.
 PROGNOSIS
If untreatment for extended period, Hashimoto’s thyroiditis
may lead to :-

1. Muscle failure
2. Heart failure
3. Hashimoto’s encephalopathy
4. Lymphoma of the thyroid gland (rare)
5. Can disrupt growth in chlidren and adolescents
 EPIDEMIOLOGY
Hashimoto’s disease is believed to be the
most common cause of :-
 Primary hypothyroidism
 For example, in North America an average of
1 to 1.5 in a 1000 people have this disease.
 It occurs far more often in women than in
men (between 10:1 and 20:1)
 Most prevalent between 45 and 65 years old.
 Hashimoto Thyroiditis

• Sign and symptoms

 Sign and Symptoms
• Similar to those of hypothyroidism in general
• They are not specific (which means they can mimic the
symptoms of many other conditions) and are often
attributed to aging
• Patients with mild hypothyroidism may have no signs
or symptoms
• The symptoms generally become more obvious as the
condition worsens and the majority of these complaints
are related to a metabolic slowing of the body
 Common Symptom
Fatigue and sluggishness
Increased sensitivity to cold
Constipation
Pale, dry skin
A puffy face
Hoarse voice
An elevated blood cholesterol level
Unexplained weight gain - occurring infrequently and rarely more than 10 to
20 pounds, most of which is fluid
Muscle aches, tenderness and stiffness, especially in your shoulders and hips
Pain and stiffness in your joints and swelling in your knees or the small
joints in your hands and feet
Muscle weakness, especially in your lower extremities
Excessive or prolonged menstrual bleeding (menorrhagia)
Depression
 Without treatment,
signs and symptoms
gradually become
more severe and your
thyroid gland may
become enlarged
(goiter). In addition,
you may become more
forgetful, your thought
processes may slow,
or you may feel
depressed