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Updated: Nov 13 2019

Hashimoto Thyroiditis

  • Introduction
    • A 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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