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Introduction
  • hashimotosA condition characterized by the autoimmune destruction of the thyroid
  • Pathophysiology 
    • the inflammatory reaction is a combination type II and type IV hypersensitivity reaction
      • type II hypersensitivity reaction
        • anti-TSH receptor antibodies are formed that inhibit thyroid hormone release
          • opposite of Grave's disease
        • anti-microsomal and anti-thyroglobulin antibodies are formed that lead to destruction of thyroid stroma
          • do not confuse with anti-mitochondrial in primary biliary sclerosis
      • type IV hypersensitivity reaction
        • CD8 cells directly destroy thyroid tissue
        • CD4-attracted macrophages destroy thyroid tissue
  • Genetics
    • association with HLA-DR3, DR5 genotype
  • Associated conditions
    • chromosomal aneuploidies
Presentation
  • Symptoms
    • hyperthyroidism
      • seen early in the disease course
      • consequence of thryoid tissue destruction which releases stored thyroid hormones
    • hypothyroidism 
      • seen later in the disease course
      • after pre-formed thyroid hormone stores are released there is a decreased release as a result of impaired production
  • Physical exam
    • moderately enlarged, non-tender gland
Evaluation
  • Histology
    • lymphocytic infiltrate
    • germinal follicles
    • Hürthle cells (eosinophilic-staining cells)
    • fibrosis
Treatment
  •  Pharmacologic
    • thyroid hormone supplementation
Complications
  • Primary B-cell lymphoma of thyroid
    • increased risk of primary B-cell lymphoma of thyroid
 

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