Endocrinology Book

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Hashimoto's Thyroiditis

Aka: Hashimoto's Thyroiditis, Hashimoto's Disease, Chronic Lymphocytic Thyroiditis, Chronic Autoimmune Thyroiditis, Askenazy Cell, Hurthle Cell
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  1. See Also
    1. Hypothyroidism
    2. Thyroiditis
  2. Epidemiology
    1. More common in women than men by 3-7 fold
    2. Age of onset peaks at 40-60 years
    3. Prevalence of Antithyroid Antibody
      1. Total population: 3-4%
      2. Euthyroid asymptomatic adolescents: 1.4%
      3. Middle aged to elderly women: 30-40%
  3. Pathophysiology
    1. Chronic autoimmune Thyroid inflammation
    2. Thyroid infiltration by Lymphocytes
    3. Results in formation of Askanazy cells (Hurthle Cells)
  4. Risk Factors: Hashimoto's with Hypothyroidism
    1. Excess Iodide intake
    2. Tobacco abuse (thiocyanate exposure)
  5. Symptoms
    1. See Hypothyroidism
      1. May initially experience Hyperthyroidism
    2. Painless Goiter (painful in rare cases)
  6. Signs
    1. Hypothyroidism
    2. ThyroidGoiter (90% of cases)
      1. Symmetric, diffusely enlarged Thyroid
      2. Firm, irregular Thyroid surface
  7. Labs
    1. Antithyroid Antibody
      1. Antithyroid Microsomal Antibody (Peroxidase Antibody)
        1. Present in up to 95% of Hashimoto cases
      2. Antithyroglobulin Antibody may be present
      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
  8. Associated conditions
    1. Pernicious Anemia
    2. Sjogren's Syndrome
    3. Chronic hepatitis
    4. Systemic Lupus Erythematosus
    5. Rheumatoid Arthritis
    6. Adrenal Insufficiency
    7. Diabetes Mellitus
    8. Vitiligo
  9. Management
    1. TSH >10 mU/L
      1. Levothyroxine in all patients
    2. TSH 4.5 to 10 mU/L
      1. Pregnancy: Levothyroxine
      2. Other: Variable recommendations on whether to treat
  10. Course
    1. Initially metabolically normal
    2. Later Thyroid failure usually ensues
  11. Complications: Thyroid Cancers
    1. Primary ThyroidLymphoma (80 fold increased risk)
      1. Presents as rapidly growing Thyroid Nodule
      2. FNA Thyroid Nodule
    2. Papillary Carcinoma
  12. References
    1. Bindra (2006) Am Fam Physician 73:1769-76
    2. Dayan (1996) N Engl J Med 335:99-107

Hashimoto Disease (C0677607)

Definition (NCI) An inflammatory disorder that affects the thyroid gland. It is characterized by the infiltration of the thyroid parenchyma by lymphocytes. It includes Hashimoto thyroiditis and subacute lymphocytic thyroiditis.
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, C535842
ICD9 245.2
ICD10 E06.3
SnomedCT 237537002, 237534009, 21983002, 190297000, 154667002, 267466008
English Hashimoto's struma, Struma lymphomatosum, THYROIDITIS, HASHIMOTO, HASHIMOTO DISEASE, STRUMA LYMPHOMATOSA, THYROIDITIS, CHRONIC LYMPHADENOID, THYROIDITIS, LYMPHOID, Hashimoto's Thyroiditis, Chron lymphocytic thyroiditis, THYROIDITIS CHRONIC LYMPHOCYTIC <HASHIMOTOS>, HASHIMOTO THYROIDITIS, HASHIMOTO STRUMA, lymphomatous thyroiditis, HT, HASHIMOTOS DIS, HASHIMOTO DIS, hashimoto's thyroiditis, Struma lymphomatosis (disorder), Hashimoto's thyroiditis (disorder), Hashimoto's thyroiditis (diagnosis), THYROIDITIS HASHIMOTO, 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 Struma, hashimoto's disease, chronic thyroiditis, Disease;Hashimotos, chronic lymphocytic thyroiditis, hashimoto disease, autoimmune thyroiditides, hashimoto thyroiditis, lymphocytic thyroiditis, autoimmune thyroiditis, hashimoto's struma, 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, Lymphocytic 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 lymphocytique, Thyroïdite lymphocytique chronique, 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, Struma lymphomatosis, Hashimoto's disease, Hashimoto's thyroiditis, 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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hurthle Cells (C0949667)

Definition (MSH) Oxyphil cells in the thyroid gland are known as Hurthle cells and Askenazy cells.
Definition (NCI) A large, granular eosinophilic cell derived from thyroid follicular epithelium by accumulation of mitochondria
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
Portuguese Células de Hürthle
Spanish Celulas de Hurthle, Células de Hürthle
German Hürthle-Zellen
Dutch Hurthle-cellen
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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