Hashimoto thyroiditis
Updates to Article Attributes
Body
was changed:
Hashimoto thyroiditis (also known as lymphocytic thyroiditis 1 or chronic autoimmune thyroiditis 2) is a sub typesubtype of autoimmune thyroiditis. It is one of the commonestmost common of all thyroid disorders.
Epidemiology
Typically affects middle aged females (30-50 year age group with a F:M ratio of ~ 10 10-15:1).
Clinical presentation
Patients usually present with hypothyroidism +/- a goitre. However a very small proportion of cases (~5%) can present with hyperthyroidism (hashithyrotoxicosis
Pathology
There is autoimmunity to the thyroid gland which bears both humoral and cell mediated features. This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. May affect the thyroid gland in either a diffuse or focal manner. Cell populations include
- lymphocytic aggregates
- transformed follicular cells (Askanazy/oxyphilic/Hurthle cells)
Later stages show added fibrosis.
Serological markers
- antithyroglobulin antibodies
- found: found in55-90~70% of cases 2 - thyroid peroxidase antibodies (TPO)
- found: found in 90-95% of cases 2
Associations
- Turner syndrome
- primary thyroid lymphoma 6
- Hashimoto encephalopathy (rare)
- Down syndrome
- Other auto immune disorders
Radiographic features
Ultrasound
It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending of the severity and phase of disease 1,5. :
-
adiffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation 6. -
thepresence of hypoechoic micronodules (1-6mm) with asurroundningsurrounding echogenic septations is also considered to have a relatively high positive predictive value 3-4,4. - colour Doppler study usually shows normal or decreased flow but occasionally there might be hypervascularity similar to thyroid inferno
.
In some situations, large nodules may be present - see nodular Hashimoto thyroiditis 10.
Scintigraphy
Radioactive iodine
- early stages
- may: may show increased uptake - late stages
- single: single or multiple areas of reduced uptake (cold spots).
History and etymology
It was first described in 1912 by Hikaru Hashimoto, Japanense physician (1881-1934) 7 while working in Germany in 1912.
Differential diagnosis
For ultrasound appearencesappearances consider:
See also
-<p><strong>Hashimoto thyroiditis</strong> (also known as <strong>lymphocytic thyroiditis</strong> <sup>1</sup> or <strong>chronic autoimmune thyroiditis</strong> <sup>2</sup>) is a sub type of <a href="/articles/autoimmune-thyroiditis">autoimmune thyroiditis</a>. It is one of the commonest of all thyroid disorders. </p><h4>Epidemiology</h4><p>Typically affects middle aged females (30-50 year age group with a F:M ratio of ~ 10-15:1). </p><h4>Clinical presentation</h4><p>Patients usually present with <a href="/articles/hypothyroidism">hypothyroidism</a> +/- a <a href="/articles/goitre">goitre</a>. However a very small proportion of cases (~5%) can present with <a href="/articles/hyperthyroidism">hyperthyroidism</a> (<a href="/articles/hashithyrotoxicosis">hashithyrotoxicosis</a>). There is often a gradual painless enlargement of the thyroid gland during the initially phase with atrophy and fibrosis later on in the course.</p><h4>Pathology</h4><p>There is autoimmunity to the <a href="/articles/thyroid-gland">thyroid gland</a> which bears both humoral and cell mediated features. This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. May affect the thyroid gland in either a diffuse or focal manner. Cell populations include </p><ul>- +<p><strong>Hashimoto thyroiditis</strong> (also known as <strong>lymphocytic thyroiditis</strong> <sup>1</sup> or <strong>chronic autoimmune thyroiditis</strong> <sup>2</sup>) is a subtype of <a href="/articles/autoimmune-thyroiditis">autoimmune thyroiditis</a>. It is one of the most common of all thyroid disorders. </p><h4>Epidemiology</h4><p>Typically affects middle aged females (30-50 year age group with a F:M ratio of 10-15:1). </p><h4>Clinical presentation</h4><p>Patients usually present with <a href="/articles/hypothyroidism">hypothyroidism</a> +/- <a href="/articles/goitre">goitre</a>. However a very small proportion of cases (~5%) can present with <a href="/articles/hyperthyroidism">hyperthyroidism</a> (hashithyrotoxicosis). There is often a gradual painless enlargement of the thyroid gland during the initially phase with atrophy and fibrosis later on in the course.</p><h4>Pathology</h4><p>There is autoimmunity to the <a href="/articles/thyroid-gland">thyroid gland</a> which bears both humoral and cell mediated features. This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. May affect the thyroid gland in either a diffuse or focal manner. Cell populations include </p><ul>
-<li>antithyroglobulin antibodies - found in 55-90% of cases <sup>2</sup>- +<li>antithyroglobulin antibodies: found in ~70% of cases <sup>2</sup>
-<li>thyroid peroxidase antibodies (TPO) - found in 90-95% of cases <sup>2</sup>- +<li>thyroid peroxidase antibodies (TPO): found in 90-95% of cases <sup>2</sup>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending of the severity and phase of disease <sup>1,5</sup>. </p><ul>-<li>a diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation <sup>6</sup>. </li>-<li>the presence of hypoechoic micronodules (1-6mm) with a surroundning echogenic septations is also considered to have a relatively high positive predictive value <sup>3-4</sup>. </li>-<li>colour Doppler study usually shows normal or decreased flow but occasionally there might be hypervascularity similar to <a href="/articles/thyroid-inferno">thyroid inferno</a>. </li>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending of the severity and phase of disease <sup>1,5</sup>:</p><ul>
- +<li>diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation <sup>6</sup>
- +</li>
- +<li>presence of hypoechoic micronodules (1-6mm) with a surrounding echogenic septations is also considered to have a relatively high positive predictive value <sup>3,4</sup>
- +</li>
- +<li>colour Doppler study usually shows normal or decreased flow but occasionally there might be hypervascularity similar to <a href="/articles/thyroid-inferno">thyroid inferno</a>
- +</li>
-<li>early stages - may show increased uptake </li>-<li>late stages - single or multiple areas of reduced uptake (cold spots). </li>-</ul><h4>History and etymology</h4><p>It was first described in 1912 by <strong>Hikaru Hashimoto</strong>, Japanense physician (1881-1934) <sup>7 </sup>while working in Germany in 1912.</p><h4>Differential diagnosis</h4><p>For ultrasound appearences consider</p><ul>-<li>-<a href="/articles/lymphoma-">lymphoma </a>affecting thyroid gland</li>- +<li>early stages: may show increased uptake </li>
- +<li>late stages: single or multiple areas of reduced uptake (cold spots). </li>
- +</ul><h4>History and etymology</h4><p>It was first described in 1912 by <strong>Hikaru Hashimoto</strong>, Japanense physician (1881-1934) <sup>7 </sup>while working in Germany in 1912.</p><h4>Differential diagnosis</h4><p>For ultrasound appearances consider:</p><ul>
- +<li><a title="Thyroid lymphoma" href="/articles/thyroid-lymphoma">thyroid lymphoma</a></li>
Unable to process the form. Check for errors and try again.