Hashimoto Thyroiditis

• • Autoimmune thyroiditis

  • Possible initial transient hyperthyroidism

  • Possible chronic hypothyroidism

Epidemiology

• • Most common form of thyroiditis

  • 0.3 to 1.5 cases per 1000 population per year; 10-15 times more common in women

  • Approximately 15% of women are affected in the United States; majority are 30-50 years of age

Symptoms and Signs

• • Enlarged, occasionally tender, thyroid

  • Atrophic stage, shrunken, firm thyroid

  • Dysphagia

Laboratory Findings

• • Elevated thyroid-stimulating hormone (TSH)

  • Decreased tri-iodothyronine (T3) and thyroxine (T4 ) levels

  • Elevated titers of antimicrosomal and antithyroglobulin antibodies

• • Patient may have other associated autoimmune conditions

  • Associated with HLA-DR3, HLA-DR5, and HLA-B8

  • Thyroid neoplasia should be ruled out in the setting of asymmetry or cervical lymphadenopathy

Rule Out

• • Thyroid lymphoma

  • Thyroid carcinoma

• • History and physical exam

  • Serum thyroid function tests and thyroglobulin and microsomal antibody titers

  • Needle biopsy if concerned about malignancy

• • Initial treatment includes administration of exogenous thyroid hormone

Surgery

Indications

• • Local symptoms of pressure

  • Suspected malignancy

  • Enlarging gland despite a trial of thyroid hormone suppression

Medications

• • Thyroid hormone

  • Occasionally, a β-blocker is required to control symptoms of hyperthyroidism

Treatment Monitoring

• • TSH, T3, and T4 levels

Complications

• • Association with thyroid lymphoma

References