HASHIMOTO THYROIDITIS
(CHRONIC LYMPHOCYTIC THYROIDITIS, AUTOIMMUNE THYROIDITIS)
Hashimoto thyroiditis is one of the chronic autoimmune thyroiditis and was discovered in 1912. It was described by Hashimoto in 1999 and was first named "struma lymphomatosa".
It is very common in all societies. It begins with enlargement of the thyroid gland, resulting in hypothyroidism. It is usually asymptomatic.
The prevalence of Hashimoto's thyroiditis has been shown to be related to iodine intake. A high prevalence has been found in countries with high iodine intake, such as the USA and Japan. It has been determined that iodine prophylaxis in areas with iodine deficiency increases lymphocyte infiltration in the thyroid gland by 3 times and the prevalence of serum thyroid antibody positivity exceeds 40%. Also, iodine-induced hypothyroidism is common in those using amiodarone. In patients using lithium, hypothyroidism often develops, albeit temporarily, in 1/3 cases. Thyroid antibodies and hypothyroidism may also develop in patients using interferon alpha therapy.
Hashimoto's thyroiditis is the most common of all thyroid diseases and is found in 2% of the population. Although it occurs at all ages, it is common between the ages of 30-50. It is 15-20 times more common in women than in men. The most common presentation is an elderly woman with asymptomatic goiter. 20% of the cases present with hypothyroidism findings.
Hashimoto's thyroiditis; It is common with hypogonadism, Addison's disease, diabetes mellitus, hypoparathyroidism and pernicious anemia. This combination is called "Polyglandular insufficiency syndrome". 2-4% of cases manifest with hyperthyroidism and this is called "Hashitoxicosis". After the thyrotoxic phase, transient hypothyroidism, then the euthyroidism phase, and finally permanent hypothyroidism occur.
In ultrasonographic examination, enlargement of the thyroid gland, low echogenicity and heterogeneous appearance are characteristic.
As laboratory findings; There is anti-thyroid peroxidase antibody positivity-anti TPO and anti-thyroglobulin antibody positivity. While 50-75% of thyroid antibody-positive cases were euthyroid, subclinical hypothyroidism was detected in 25-50%.
Thyroid lymphoma is a rare but serious complication of Hashimoto's thyroiditis. Thyroid Lymphoma is more common in older women and is limited to the thyroid gland.
TREATMENT
1. Treatment of hashitoxicosis: Treatment is with beta blocker drugs. Hashitoxicosis is difficult to distinguish clinically from Graves' hyperthyroidism. On palpation of the gland, there is a hard goiter in Hashitoxicosis, while there is a soft goiter in Graves' disease. High antibody titers may also suggest Hashitoxicosis.
2. Treatment of hypothyroidism: All cases with overt hypothyroidism should be treated with levothyroxine. Levothyroxine dose should be adjusted to bring the serum TSH level to the lower limit of normal, that is, 0.3-1.0 IU/L. Most women require a 25-50% increase in dose during pregnancy. If TSH is >4IU/L and anti-TPO (+), treatment must be started.
3. Goiter treatment: In cases of Hashimoto thyroiditis with goiter, levothyroxine should be given to shrink the goiter, even if the patient is euthyroid. It has been shown that goiter shrinks in 50-90% of cases with 6 months of levothyroxine treatment. A good response is usually obtained, especially in young patients.
4. Surgical treatment: Surgical treatment can only be considered in the presence of significant pressure symptoms and if there is a strong suspicion of cancer. Non-iodized salt is recommended for patients with Hashimoto's thyroiditis:
Situations in which Hashimoto's Disease is suspected
Hypothyroidism that cannot be attributed to other causes
Anti-TPO or anti-TG positivity without thyroid dysfunction/goiter
Cases with suspicion of thyroid lymphoma
Hypoechoic on ultrasonographic examination heterogeneous view
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