Hashimoto’s Thyroiditis

Background and Epidemiology

  • Also known as chronic lymphocytic thyroiditis or chronic auto-immune thyroiditis
  • Characterised by the destruction of the thyroid cells by autoimmune processes
  • Most common cause of hypothyroidism
  • Incidence increases with age; more common in women (4-5:1); prevalence of around 0.35% of women and 0.08% of men.

Aetiology/Pathophysiology

  • Aetiology not fully understood but smoking can worsen the disease process
  • Autoimmune process
    • Presence of anti-TPO antibodies found in high titres in 90-95%
      • Antithyroglobulin antibodies may be present in 20-25%
      • TRAb may also be present
    • Causes a chronic, lymphocytic infiltration and the development of Hurthle cells (enlarged epithelial cells with eosinophilic granular cytoplasm)

Presentation

  • Many present with a small-moderately sized diffuse goitre
    • Characteristically firm and rubbery, painless
    • Can come on quite rapidly, and may slowly increase in size
  • Early on in the disease, there may be symptoms of hyperthyroidism (as destroyed thyroid cells release their contents)
  • Around 20% of patients will present with features of hypothyroidism
    • Most patients will go onto develop these symptoms later on and, actually, the goitre is usually responsive to treatment
    • E.g. fatigue, constipation, dry skin and weight gain; cold intolerance; slowed movement, loss of energy; peripheral neuropathy; menstrual irregularities; mood changes

Investigations

  • Thyroid function tests
  • Occasionally, thyroid antibodies (see above) may be useful
  • Imaging is rarely useful/required

Management

  • Levothyroxine- usually treatment for either goitre and/or hypothyroid symptoms
    • Treat to suppress TSH levels to low levels (even if this is slightly high free T3/T4 levels)
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