HASHIMOTO’S THYROIDITIS
Synonyms:
➣ Struma Lymphomatosa.
➣ Chronic lymphocytic thyroiditis.
➣ Hashimoto’s disease.
It is a common autoimmune disorder seen predominantly in women. Considered to be autoimmune since it coexists with other autoimmune conditions and is associated with presence of antithyroid antibodies in the serum.
Aetiology:
- Genetic factor: It is associated with-
- Environmental factors.
- Family history: Family history of having another autoimmune disease like celiac disease, type 1 diabetes, vitiligo, and alopecia.
Pathophysiology:
Clinical presentation:
- Common in women who have goitre and hypothyroidism.
- There is accompanying weight gain, feeling tired, constipation, depression, and general pains.
- Usually not associated with any other symptoms.
- The enlargement in the thyroid is diffuse and less commonly nodular or asymmetrical.
- Carcinoma should be suspected when thyroiditis is associated with one or more nodules.
Diagnosis:
- Detecting elevated levels of anti-thyroglobulin antibodies (anti-Tg) and anti-thyroid peroxidase antibodies (TPOAb) in the serum.
- Thyroid function studies are usually normal.
- Radioiodine uptake scans show decreased uptake with patchy distribution.
Treatment:
- Usually hypothyroidism caused by Hashimoto’s thyroiditis is treated with thyroid hormone replacement agents such as levothyroxine, triiodothyronine or desiccated thyroid extract. A tablet taken once a day generally keeps the thyroid hormone levels normal.
- Surgery is indicated when:
a) When mass does not get suppressed by thyroxine therapy.
b) When the gland continues to increase despite thyroxine.
c) When FNAC is suggestive of malignancy.
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