Name
HASHIMOTO THYROIDITIS
DESCRIPTION
DETAIL
CAUSES : 1. PRIMARY A. AUTOIMMUNE HYPOTHYROIDISM : - ATROPHIC THYROIDITIS B. IATROGENIC - IODINE-131 TREATMENT - SUBTOTAL OR TOTAL THYROIDECTOMY - EXTERNAL RADIATION OF NECK FOR LYMPHOMA OR CANCER C. DRUGS : - IODINE EXCESS - AMIODARONE - LITHIUM - ANTITHYROID DRUGS - PARA AMINOSALICYLIC ACID - INTERFERON- ALPHA & OTHER CYTOKINES - AMINOGLUTETHIMIDE D. CONGENITAL HYPOTHYROIDISM - ABSENT OR ECTOPIC THYROID GLAND - DYSHORMOGENESIS - TSH-R MUTATION E. IODINE DEFICIENCY F. INFILTRATIVE DISORDERS - AMYLOIDOSIS - SARCOIDOSIS - HEMOCHROMATOSIS -SCLERODERMA - CYSTENOSIS - RIEDELS THYROIDITIS 2. TRANSIENT - SILENT THYROIDITIS , INCLUDING POSTPARTUM - SUBACUTE THYROIDITIS - WITHDRAWAL OF THYROXINE TREATMENT IN PATIENTS WITH INTACT THYROID - AFTER I-131 TREATMENT OR SUBTOTAL THYROIDECTOMY FOR GRAVES DISEASE 3. SECONDARY A. HYPOPITUITARISM : - TUMORS - PITUITARY SURGERY OR IRRADIATION - INFILTRATIVE DISORDERS - SHEEHAN SYNDROME - TRAUMA - GENETIC FORMS OF COMBINED PITUITARY HORMONE DEFICIENCIES B. ISOLATED TSH DEFICIENCY OR INACTIVITY C. BEXAROTENE TREATMENT D. HYPOTHALAMIC DISEASE - TUMORS - TRAUMA - INFILTRATIVE DISORDERS - IDIOPATHIC* TSH-RECEPTOR-BLOCKING ANTIBODIES - PRESENT ( 10-20 % ) * THYROID PEROXIDASE ANTIBODIES & ANTI-THYROGLOBULIN ANTIBODIES - PRESENT * OTHER ANTIBODIES PRESENT ARE - THYROID STIMULATING ANTIBODIES & CYTOTOXIC ANTIBODIES * TSH - HIGH * FT4 - LOW * FT3 - NORMAL
TYPENOTES
ALSO LOOK FOR OTHER ENDOCRINE PATHOLOGIES Medical Care The treatment of choice for Hashimoto thyroiditis (or hypothyroidism of any cause) is thyroid hormone replacement. The drug of choice is orally administered levothyroxine sodium, usually for life. Tailor and titrate the dose to meet the individual patient's requirements. The goal of therapy is to restore a clinically and biochemically euthyroid state. The standard dose is 1.6-1.8 mcg/kg lean body weight per day, but the dose is patient dependent. Both the free T4 and TSH levels are within reference ranges in the biochemically euthyroid state, with the TSH level in the lower half of the reference range. Patients younger than 50 years who have no history or evidence of cardiac disease can usually be started on full replacement doses. Start patients older than 50 years and younger patients with cardiac disease on a low dose of 25 mcg (0.025 mg) per day, with clinical and biochemical reevaluation in 6-8 weeks. Carefully titrate the dose upward to achieve a clinical and biochemical euthyroid state. Rarely, it may not be possible to achieve a euthyroid state in a patient with baseline cardiac dysrhythmic disease without worsening his or her cardiac status. In such cases, the astute clinician is content to achieve the clinically euthyroid state and to accept a slightly elevated TSH level. Elderly patients usually require a smaller replacement dose of levothyroxine, sometimes less than 1 mcg/kg lean body weight per day. One popular treatment, moreso among patients than physicians, is the combined use of liothyronine (T3) and levothyroxine in an effort to mimic more closely thyroid hormone physiology. However, of 9 controlled clinical trials, in only one did combined therapy appear to have beneficial effects on the mood, quality of life, and psychometric performance of the patients over levothyroxine alone. Until clear advantages of levothyroxine plus liothyronine are demonstrated, the administration of levothyroxine alone should remain the treatment of choice for replacement therapy of hypothyroidism. Surgical Care Indications for surgery A large goiter with obstructive symptoms such as dysphagia, voice hoarseness, and stridor from extrinsic obstruction to airflow: Evaluate patients with these symptoms with a barium swallow study and pulmonary function tests, including flow volume loops and a neck CT scan. Presence of a malignant nodule, as found by cytologic examination by fine-needle aspiration. Presence of a lymphoma diagnosed on fine-needle aspiration: Thyroid lymphoma responds very well to radiotherapy and is the treatment modality of choice in this situation. Cosmetic reasons for unsightly large goiters
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
T3, T4, TSH, ANTI-THYROGLOBULIN ANTIBODIES, COMPLETE BLOOD COUNT, ANTI-THYROID PEROXIDASE ANTIBODIES TEST(TPO), ULTRA SOUND EXAM