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  • • 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

Kon YC, DeGroot LJ: Painful Hashimoto’s thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. J Clin Endocrinol Metab 2003;88:2667.  [PubMed: 12788871]
Mezosi E et al: Aberrant apoptosis in thyroid epithelial cells from goiter nodules. J Clin Endocrinol Metab 2002;87:4264.  [PubMed: 12213883]

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