Hashimoto thyroiditis is an inflammatory thyroid disease that has been first described in pregnant women who develop this in the postpartum period in about 8% after all deliveries. That is to say, it is relatively common.
Truly, the natural course of the disease is a thyroid enlargement where the blood tests show hyperthyroidism. In fact, this lasts for a period of several weeks and is then followed by a period of normal thyroid function.
For one thing, some patients stay stable, but others get the late complication, which consists of hypothyroidism. Indeed, we know from biopsy studies that Hashimoto thyroiditis is an autoimmune disease where lymphocytes invade the thyroid gland.
Certainly, there are several forms of thyroiditis, but Hashimoto’s thyroiditis is the most common form of it.
It is important to realize, the postpartum thyroiditis is usually more silent and disappears faster. In particular, Hashimoto’s thyroiditis has a ratio of 8:1 with regard to occurrence in women versus men. To emphasize, it is more frequent in the older generation and particularly in elderly women. To clarify, it is often only diagnosed when hypothyroidism occurs. By all means, thyroid autoimmune disease is associated with other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren’s syndrome and pernicious anemia. In addition, diabetes mellitus, adrenal insufficiency and hypoparathyroidism are also associated with Hashimoto’s thyroiditis. By all means, later in life these patients have an increased frequency of thyroid cancers, particularly the papillary thyroid cancer and thyroid lymphoma.
This condition is associated with other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren’s syndrome and pernicious anemia. Diabetes mellitus, adrenal insufficiency and hypoparathyroidism are also associated with Hashimoto’s thyroiditis.
In general, patients complain about a painless enlargement of the thyroid gland or in males that they have difficulties to button up the collar of their shirt. Notably, a small percentage will experience pain with the swelling of the thyroid gland. Specifically, on examination the doctor finds a goiter, which is a smooth or a nodular enlargement of the thyroid gland just below the voice box. It often has a rubbery consistency to it.
To clarify, in the beginning of the disease Hashimoto’s thyroiditis patients have normal T4 and TSH tests, but very high thyroid peroxidase antibodies with occasional positive anti-thyroglobulin antibodies. Another key point, later, during the hypothyroid phase, the tests are accordingly (low T4, high TSH and decreased thyroid uptake test). Certainly, the high TSH levels are significant in causing papillary thyroid cancer and thyroid lymphoma, as TSH is known to be an oncogenic. To explain, this stresses the importance of treating conditions with elevated TSH with thyroid hormone to suppress TSH levels.
In general, treatment requires lifelong thyroid replacement therapy with thyroid hormone. In particular, this keeps the TSH level suppressed. The first thing to remember, a high TSH causes thyroid cancer. Consequently, thyroid replacement decreases the goiter size and normalizes hypothyroidism. At the same time the pituitary gland stops overproducing TSH as the negative feedback loop shuts down TRH production in the hypothalamus and TSH production in the anterior pituitary gland (see introduction to this chapter). This will help thyroid cancer prevention later in life.
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