Hashimoto's Thyroiditis

Aka: Hashimoto's Thyroiditis, Hashimoto's Disease, Hashimoto Thyroiditis, Chronic Lymphocytic Thyroiditis, Chronic Autoimmune Thyroiditis, Askenazy Cell, Hurthle Cell

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II. Epidemiology

  1. More common in women than men by 3-7 fold
  2. Age of onset peaks at 40-60 years
  3. Increased risk with Family History of autoimmune Thyroid disease
  4. Incidence: 0.3 to 1.5 cases per 1000 persons per year (U.S.)
    1. Most common Autoimmune Disease worldwide
  5. Prevalence of Antithyroid Antibody
    1. Total population: 3-4%
    2. Euthyroid asymptomatic adolescents: 1.4%
    3. Middle aged to elderly women: 30-40%

III. Pathophysiology

  1. Chronic autoimmune Thyroid inflammation
  2. Thyroid infiltration by Lymphocytes as well as Thyroid fibrosis
  3. Results in formation of Askanazy cells (Hurthle Cells)

IV. Risk Factors: Hashimoto's with Hypothyroidism

  1. Excess Iodide intake
  2. Tobacco Abuse (thiocyanate exposure)

V. Symptoms

  1. See Hypothyroidism
    1. May initially experience Hyperthyroidism (rarely, hashitoxicosis)
    2. Generalized Fatigue
    3. Weight gain
    4. Cold intolerance
    5. Diffuse myalgias
  2. Painless Thyroiditis (painful in rare cases)
    1. However neck fullness (Goiter) Sensation is common
    2. Dysphagia may occur (from Goiter related compression)

VI. Signs

  1. Hypothyroidism
    1. Rarely Thyrotoxicosis occurs due to the Thyroid Autoantibody stimulating effects
  2. Thyroid Goiter (90% of cases)
    1. Symmetric, diffusely enlarged, non-tender Thyroid
    2. Firm, irregular Thyroid surface
    3. Goiter is absent in atrophic form in which fibrosis dominates (with overt Hypothyroidism)

VII. Labs

  1. Antithyroid Antibody
    1. Antithyroid Microsomal Antibody (Thyroid Peroxidase Antibody or TPO Antibody)
      1. Present in up to 90-95% of Hashimoto cases (and most specific if significantly elevated)
      2. More mild elevations of TPO Antibody are seen with other thyroid Autoimmunity
        1. Examples: Postpartum Thyroiditis, Silent Thyroiditis, Subacute Thyroiditis
    2. Antithyroglobulin Antibody are increased in 60-80% of patients
    3. TSH-receptor blocking Antibody may be present
  2. Thyroid function stepwise change
    1. First: TSH rises
    2. Next: T4 declines
    3. Next: T3 decline
    4. Last: Symptomatic Hypothyroidism

VIII. Associated conditions

  1. Pernicious Anemia
  2. Sjogren's Syndrome
  3. Chronic hepatitis
  4. Systemic Lupus Erythematosus
  5. Rheumatoid Arthritis
  6. Adrenal Insufficiency (Addison Disease)
  7. Type I Diabetes Mellitus
  8. Vitiligo
  9. Hepatitis C (untreated)

IX. Management

  1. TSH >10 mU/L
    1. Levothyroxine starting at 1.6 mcg/kg/day in young, healthy patients
    2. Indications for Levothyroxine starting at low dose (12.5 to 25 mcg/day)
      1. Elderly
      2. Underlying Coronary Artery Disease
      3. Tachydysrhythmias
    3. Recheck Serum TSH every 10-12 weeks
  2. TSH 4.5 to 10 mU/L
    1. Pregnancy: Levothyroxine
      1. See Hypothyroidism in Pregnancy for dosing and monitoring frequency
    2. Other: Variable recommendations on whether to treat
      1. Consider treatment for positive TPO Antibody and Hypothyroidism symptoms
      2. If treated
        1. Start Levothyroxine 25 to 50 mcg daily
        2. Recheck Serum TSH in 10-12 weeks
      3. If not treated
        1. Recheck Serum TSH for overt Hypothyroidism in 6-12 months

X. Course

  1. Initially metabolically normal
  2. Later Thyroid failure usually ensues
  3. Thyroid Goiter and symptoms typically resolve by 6 months after becoming euthyroid on replacement

XI. Complications: Thyroid Cancers

  1. Primary Thyroid Lymphoma (80 fold increased risk)
    1. Presents as rapidly growing Thyroid Nodule
    2. FNA Thyroid Nodule
  2. Papillary Carcinoma

XII. References

  1. Bindra (2006) Am Fam Physician 73:1769-76 [PubMed]
  2. Dayan (1996) N Engl J Med 335:99-107 [PubMed]
  3. Quintero (2021) Am Fam Physician 104(6): 609-17 [PubMed]
  4. Sweeney (2014) Am Fam Physician 90(6): 389-96 [PubMed]

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Related Studies

Ontology: Hashimoto Disease (C0677607)

Definition (NCI_NCI-GLOSS) An autoimmune condition of the thyroid gland (a gland located beneath the larynx). It is caused by the formation of antibodies that attack the thyroid gland and it usually causes hypothyroidism (too little thyroid hormone). Symptoms include fatigue, weight gain, constipation, dry skin, depression, and the inability to exercise. It is more common in females and can run in families.
Definition (NCI) An autoimmune disorder caused by the production of autoantibodies against thyroid tissue. There is progressive destruction of the thyroid follicles leading to hypothyroidism.
Definition (CSP) progressive enlargement of the thyroid gland, often associated with hypothyroidism.
Definition (MSH) Chronic autoimmune thyroiditis, characterized by the presence of high serum thyroid AUTOANTIBODIES; GOITER; and HYPOTHYROIDISM.
Concepts Disease or Syndrome (T047)
MSH D050031
ICD9 245.2
ICD10 E06.3
SnomedCT 267466008, 237537002, 190297000, 237534009, 154667002, 21983002
LNC LA17785-9
English Chron lymphocytic thyroiditis, THYROIDITIS CHRONIC LYMPHOCYTIC <HASHIMOTOS>, HASHIMOTO THYROIDITIS, HASHIMOTO STRUMA, lymphomatous thyroiditis, HT, HASHIMOTOS DIS, HASHIMOTO DIS, Hashimoto's thyroiditis (diagnosis), Hashimoto's Thyroiditis, THYROIDITIS CHRONIC LYMPHOCYTIC HASHIMOTOS, Chr lymphocyt thyroidit, Hashimoto's Syndrome, Hashimoto's Syndromes, Hashimotos Syndrome, Syndromes, Hashimoto's, Hashimoto Syndrome, Syndrome, Hashimoto's, Hashimoto Disease [Disease/Finding], hashimoto's disease, chronic thyroiditis, Disease;Hashimotos, chronic lymphocytic thyroiditis, hashimoto's thyroiditis, hashimoto disease, autoimmune thyroiditides, hashimoto thyroiditis, lymphocytic thyroiditis, hashimoto's struma, Hashimoto Struma, Hashimoto's Struma, Struma lymphomatosis (disorder), Hashimoto's thyroiditis (disorder), Hashimoto disease, autoimmune thyroiditis, Hashimoto's thyroiditis, Lymphocytic thyroiditis, Chronic lymphocytic thyroiditis, Autoimmune lymphocytic chronic thyroiditis, Hashimoto thyroiditis, Struma lymphomatosa, Hashimoto's disease, Struma lymphomatosis, Hashimoto thyroiditis (disorder), Hashimoto; thyroiditis, Hashimoto, chronic; thyroiditis, lymphadenoid, lymphocytic; thyroiditis, lymphoid; thyroiditis, lymphomatosa; goiter, lymphomatous; thyroiditis, struma; lymphomatosa, thyroiditis; Hashimoto, thyroiditis; chronic, lymphadenoid, thyroiditis; lymphocytic, thyroiditis; lymphoid, thyroiditis; lymphomatous, Autoimmune Thyroiditis, Disease, Hashimoto, Hashimoto's Disease, Hashimotos Disease, Disease, Hashimoto's, Chronic Lymphocytic Thyroiditis, Chronic Lymphocytic Thyroiditides, Hashimoto Thyroiditides, Hashimoto Thyroiditis, Lymphocytic Thyroiditides, Chronic, Lymphocytic Thyroiditis, Chronic, Thyroiditides, Chronic Lymphocytic, Thyroiditides, Hashimoto, Thyroiditis, Chronic Lymphocytic, Thyroiditis, Hashimoto, Hashimoto Disease, Hashimotos disease
Dutch ziekte van Hashimoto, chronische lymfocytische thyreoïditis, Hashimoto-thyreoïditis, lymfocytische thyreoïditis, Hashimoto; thyroïditis, chronisch; thyroïditis, lymfadenoïd, lymfocytair; thyroïditis, lymfomateus; thyroïditis, lymfoïd; thyroïditis, lymphomatosa; struma, struma; lymphomatosa, thyroïditis; Hashimoto, thyroïditis; chronisch, lymfadenoïd, thyroïditis; lymfocytair, thyroïditis; lymfomateus, thyroïditis; lymfoïd
French Thyroïdite chronique de Hashimoto, Thyroïdite lymphocytaire chronique, Thyroïdite lymphocytaire, Maladie d'Hashimoto, Maladie de Hashimoto, Thyroidite lymphocytaire de Hashimoto, Thyroïdite chronique lymphocytaire, Thyroïdite d'Hashimoto, Thyroïdite de Hashimoto
German chronische lymphozytische Thyroiditis, lymphozytische Thyroiditis, Hashimoto-Thyroiditis, Hashimoto-Krankheit, Chronische lymphyzytäre Thyreoiditis, Hashimoto-Thyreoiditis, Thyreoiditis, chronische lymphozytäre
Italian Tiroidite linfocitica, Tiroidite linfocitaria cronica, Malattia di Hashimoto, Tiroidite di Hashimoto
Portuguese Tiroidite linfocítica crónica, Tiroidite de Hashimoto, Tiroidite linfocítica, Doença de Hashimoto
Spanish Tiroiditis linfocítica, Toroiditis linfocítica crónica, enfermedad de Hashimoto, estruma linfomatoso, tiroiditis crónica linfocitaria autoinmune, tiroiditis de Hashimoto (trastorno), tiroiditis de Hashimoto, tiroiditis linfocítica, Enfermedad de Hashimoto, Tiroiditis de Hashimoto
Japanese リンパ球性甲状腺炎, 慢性リンパ球性甲状腺炎, ﾘﾝﾊﾟｷｭｳｾｲｺｳｼﾞｮｳｾﾝｴﾝ, ﾊｼﾓﾄﾋﾞｮｳ, ﾏﾝｾｲﾘﾝﾊﾟｷｭｳｾｲｺｳｼﾞｮｳｾﾝｴﾝ, 橋本甲状腺炎, Hashimoto甲状腺炎, 橋本病
Swedish Hashimotos sjukdom
Czech chronická lymfocytární tyreoiditida, Hashimotova nemoc, Lymfocytická tyreoiditida, Chronická lymfocytická tyreoiditida, Hashimotova choroba, Hashimotova tyreoiditida
Finnish Hashimoton tauti
Russian KHASHIMOTO BOLEZN', HASHIMOTO BOLEZN', HASHIMOTO БОЛЕЗНЬ, ХАШИМОТО БОЛЕЗНЬ
Polish Wole Hashimoto, Choroba Hashimoto
Hungarian Lymphocytás thyreoiditis, Hashimoto-betegség, Chronicus lymphocytás thyreoiditis, Hashimoto-thyreoiditis
Norwegian Kronisk lymfocytt tyreoiditt, Hashimotos syndrom, Hashimotos sykdom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hurthle Cells (C0949667)

Definition (NCI) A large, granular eosinophilic cell derived from thyroid follicular epithelium by accumulation of mitochondria
Definition (MSH) Oxyphil cells in the thyroid gland are known as Hurthle cells and Askenazy cells.
Concepts Cell (T025)
MSH D024862
English Hurthle Cell, Oxyphil cell of thyroid, Thyroid gland oxyphil cell, hurthle cells, hurthle cell, cells hurthles, Askenazy Cells, Cells, Askenazy, Cells, Hurthle, Thyroid Gland Oxyphil Cell, Thyroid Gland Oxyphilic Cell, Hurthle Cells
French Cellule de Hürthle, Cellules de Hürthle
Czech Hürthleovy buňky, Askenazyho buňky
Portuguese Células de Hürthle
German Hürthle-Zellen
Spanish Células de Hürthle
Italian Cellule di Hurthle
Norwegian Ashkenazy-celler, Hürthle-celler
Dutch Hurthle-cellen
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Thyroid Disease

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