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Hashimoto's ThyroiditisAka: Hashimoto's Disease, Chronic Lymphocytic Thyroiditis, Chronic Autoimmune Thyroiditis, Askanazy Cells, Hurthle Cells

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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. Thyroid Goiter (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 Thyroid Lymphoma (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
    2. Dayan (1996) N Engl J Med 335:99

Hashimoto Disease (C0677607)

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.
ConceptsDisease or Syndrome (T047)
ICD9245.2
EnglishAutoimmune lymphocytic chronic thyroiditis, CHR LYMPHOCYT THYROIDIT, Chronic Lymphocytic Thyroiditides, Chronic Lymphocytic Thyroiditis, HASHIMOTO DIS, Hashimoto Disease, HASHIMOTO STRUMA, Hashimoto Thyroiditides, HASHIMOTO THYROIDITIS, Hashimoto's Disease, Hashimoto's thyroiditis, HASHIMOTOS DIS, Hashimotos Disease, HT, Lymphocytic thyroiditis, lymphomatous thyroiditis, Struma lymphomatosa, Struma lymphomatosis, THYROIDITIS CHRONIC LYMPHOCYTIC <HASHIMOTOS>, THYROIDITIS CHRONIC LYMPHOCYTIC HASHIMOTOS
Spanishenfermedad de Hashimoto, estruma linfomatoso, tiroiditis crónica linfocitaria autoinmune, tiroiditis cronica linfocitaria autoinmune, tiroiditis de Hashimoto, tiroiditis linfocítica, tiroiditis linfocitica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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