Hashimoto thyroiditis: Difference between revisions
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'''Hashimoto thyroiditis''', also called chronic autoimmune hypothyroidism is an autoimmune condition characterised by <abbr>CD8</abbr>-mediated destruction of the thyroid parenchyme. It’s the most common cause of chronic [[hypothyroidism]] in western countries, affecting 3 – 5 per 10 000. It mostly affects middle-aged females. | <section begin="clinical biochemistry" />'''Hashimoto thyroiditis''', also called chronic autoimmune hypothyroidism is an autoimmune condition characterised by <abbr>CD8</abbr>-mediated destruction of the thyroid parenchyme. It’s the most common cause of chronic [[hypothyroidism]] in western countries, affecting 3 – 5 per 10 000. It mostly affects middle-aged females. | ||
It’s associated with other autoimmune diseases and with HLA-DR5. | It’s associated with other autoimmune diseases and with HLA-DR5. | ||
<section end="clinical biochemistry" /> | |||
== Clinical features == | == Clinical features == | ||
In the early phase [[Hyperthyroidism and thyrotoxicosis|thyrotoxicosis]] develops as the destroyed cells release preformed hormones, sometimes called “hashitoxicosis”. In this phase, there’s a non-tender and painless [[goitre]]. | In the early phase [[Hyperthyroidism and thyrotoxicosis|thyrotoxicosis]] develops as the destroyed cells release preformed hormones, sometimes called “hashitoxicosis”. In this phase, there’s a non-tender and painless [[goitre]]. | ||
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The patient may present in any of these stages. The goitre may be diffuse or nodular. | The patient may present in any of these stages. The goitre may be diffuse or nodular. | ||
<section begin="clinical biochemistry" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
The following features are typical for Hashimoto: | The following features are typical for Hashimoto: | ||
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The anti-thyroid antibodies are the main factors in the diagnosis of Hashimoto thyroiditis. Ultrasound is rarely indicated in the evaluation of Hashimoto thyroiditis. | The anti-thyroid antibodies are the main factors in the diagnosis of Hashimoto thyroiditis. Ultrasound is rarely indicated in the evaluation of Hashimoto thyroiditis. | ||
<section end="clinical biochemistry" /> | |||
== Treatment == | == Treatment == | ||
The treatment of Hashimoto thyroiditis is lifelong L-thyroxine replacement therapy, as for other causes of [[hypothyroidism]]. Immunosuppressants are not helpful in the treatment of Hashimoto thyroiditis. | The treatment of Hashimoto thyroiditis is lifelong L-thyroxine replacement therapy, as for other causes of [[hypothyroidism]]. Immunosuppressants are not helpful in the treatment of Hashimoto thyroiditis. | ||
<noinclude>[[Category:Endocrinology]]</noinclude> | <noinclude>[[Category:Endocrinology]]</noinclude> | ||
Latest revision as of 15:13, 30 May 2024
Hashimoto thyroiditis, also called chronic autoimmune hypothyroidism is an autoimmune condition characterised by CD8-mediated destruction of the thyroid parenchyme. It’s the most common cause of chronic hypothyroidism in western countries, affecting 3 – 5 per 10 000. It mostly affects middle-aged females.
It’s associated with other autoimmune diseases and with HLA-DR5.
Clinical features
In the early phase thyrotoxicosis develops as the destroyed cells release preformed hormones, sometimes called “hashitoxicosis”. In this phase, there’s a non-tender and painless goitre.
Later, hypothyroidism occurs in the chronic phase, as the number of cells decreases. In this phase, the thyroid may be normal or small. Hashimoto causes painless goitre.
The patient may present in any of these stages. The goitre may be diffuse or nodular.
Diagnosis and evaluation
The following features are typical for Hashimoto:
- Typical clinical features
- Ultrasound findings (inhomogenous, hypoechogenic thyroid)
- Normal leukocyte count
- Moderately elevated ESR
- Initial thyrotoxicosis followed by hypothyroidism
- Elevated anti-thyroid antibodies (anti-TPO, anti-Tg)
The anti-thyroid antibodies are the main factors in the diagnosis of Hashimoto thyroiditis. Ultrasound is rarely indicated in the evaluation of Hashimoto thyroiditis.
Treatment
The treatment of Hashimoto thyroiditis is lifelong L-thyroxine replacement therapy, as for other causes of hypothyroidism. Immunosuppressants are not helpful in the treatment of Hashimoto thyroiditis.