Presentation
[…] in 40-70% of individuals Provides no additional information over TRAb or TPO antibodies Hashimoto Thyroiditis Present in >90% of individuals Presence of antibody is pathognomonic for HT Not recommended for monitoring Not present Present in 60-80% of [arupconsult.com]
Antimicrosomal antibodies are present in 50 to 80 percent of patients, while antithyroid peroxidase antibodies are present in nearly all patients. 3, 6, 7 Subacute lymphocytic thyroiditis starts with an initial hyperthyroid phase, followed by subsequent [aafp.org]
EXAM: In most cases a small, nontender, firm goiter is present. [enotes.tripod.com]
Alexander Matthies, MD Nayer Nikpoor, MD April 8, 1997 Presentation A 38 year old female physician had right sided pain in the thyroid region for about 8 weeks and symptoms of hyperthyroidism for about 3 weeks prior to presentation. [med.harvard.edu]
The classic presentation of Graves disease include: 1. Hyperthyroidism 2. Goitre 3. Opthalmopathy 4. Dermopathy (unusual) 5. [sites.google.com]
Entire Body System
- Anemia
With regard to laboratory diagnosis, in some cases, when conducting a general blood test, there is a slight neutrophilic leukocytosis, normochromic anemia, an increase in ESR. [en.detadoctor.com]
Airways and lungs Alcohol use disorder Alcoholic liver disease Alopecia Alport syndrome Alzheimer disease AMBOSS content updates Amebiasis Amino acids Amiodarone Amyloidosis Amyotrophic lateral sclerosis Anal abscess and fistula Anal cancer Anal fissures Anemia [amboss.com]
Associated conditions • Diabetes mellitus type 1 • Autoimmune adrenal insufficiency (Addison disease) • Autoimmune polyglandular syndrome type II (adrenal insufficiency, thyroid disease, and/or type 1 diabetes mellitus) • Atrophic body gastritis/pernicious anemia [clinicaladvisor.com]
Clin Endocrinol (Oxf) 2009;71:451 ) No female predominance in children with Down syndrome ( Horm Res 2008;70:278 ) Associated with HLA-DR5 (goitrous form), HLA-DR3 (atrophic form) May coexist with SLE, rheumatoid arthritis, Sjögren syndrome, pernicious anemia [pathologyoutlines.com]
Patient Monitoring Hashimoto's is associated with other autoimmune diseases (Addison's disease, pernicious anemia, etc.), so monitor the patient for these. [syrianclinic.com]
- Myxedema
Seite 220 - Isolation and identification of the long acting thyroid stimulator and its relation to hyperthyroidism and circumscribed pretibial myxedema, J. Clin. Endocrinol. Metab., 24. 1005, 1964. 440. [books.google.de]
On gross examination, there is often presentation of a hard goiter that is not painful to the touch; [21] other symptoms seen with hypothyroidism, such as periorbital myxedema, depend on the current state of progression of the response, especially given [en.wikipedia.org]
Fibrous atrophy variant The gland is very small (1 to 6 g) and is characterized by abundant fibrous tissue, parenchymal atrophy and lymphoplasmacytic infiltration. 32,33 This variant is clinically associated with myxedema and a high incidence of Tg Abs [hormones.gr]
However the clinical spectrum may vary from myxedema to hyperthyroidism, rarely thyroid pain, steroid responsive encephalitis, post-partum pituitary failure, post-partum exacerbation, and multi-glandular autoimmune disease. [japanthyroid.jp]
- Lymphadenopathy
To differentiate between thyroid nodules and other cervical masses like lymphadenopathy, thyroglossal cyst and cystic hygroma. To evaluate diffuse changes in thyroid parenchyma. [ijem.in]
[…] stressor-related disorders Traumatic brain injury Traumatic eye injuries Tremor Trigeminal neuralgia Tuberculosis Tubulointerstitial diseases Tumor markers Typhoid fever, Paratyphoid fever Ulcerative colitis Ulnar nerve entrapment Unilateral cervical lymphadenopathy [amboss.com]
Further reading Case report: IgG4-related mass-forming thyroiditis accompanied by regional lymphadenopathy Yasuhiro Sakai & Yoshiaki Imamura Diagnostic Pathology (2018) Immunohistochemical Biomarkers in Diagnosis of Hematolymphoid Neoplasms of Endocrine [nature.com]
De Jong SA, Demeter JG, Jarosz H, Lawrence AM, Paloyan E (1993) Primary papillary thyroid carcinoma presenting as cervical lymphadenopathy: the operative approach to the ″lateral aberrant thyroid″. Am Surg 59:172–176 PubMed Google Scholar 88. [link.springer.com]
- Trisomy 21
Similarly, adults with trisomy 21 (Down syndrome) are also at an increased risk for developing Hashimoto thyroiditis and hypothyroidism. [humpath.com]
Gastrointestinal
- Overeating
are even more accurate Prognostic marker for relapse after treatment Presence predicts increased risk of thyroid dysfunction in newborns born to mothers with current or treated GD Present in 40-70% of individuals Provides no additional information over [arupconsult.com]
Elsevier Health Sciences, ٢٥/٠٢/٢٠١٥ - 2700 من الصفحات Considered the definitive source in its field for over 35 years, Endocrinology: Adult and Pediatric, has been thoroughly updated to reflect today's recent advances in adult and pediatric endocrinology [books.google.com]
Autoimmune thyroiditis is characterized oligosymptomatic over (during the first years of the disease). Over time, the thyroid gland becomes non-uniformly enlarged and dense. [medicineinfo.net]
The description of the histological changes of Hashimoto’s thyroiditis, only just a century ago, gained credibility over several decades. [em-consulte.com]
Skin over a thyroid gland is not soldered to the last, easily undertakes pleated. Lymph nodes are not increased. Body temperature is not increased. Datas of laboratory. There are no changes of peripheral blood. Increase in SOE is sometimes observed. [infomeds.net]
- Dysphagia
This compression produces the following symptoms: Hoarseness Difficulty swallowing (dysphagia) Choking Shortness of breath (dyspnoea) Eventually, as the normal thyroid tissue is replaced by fibrous scar tissue, there is insufficient functioning tissue [thyroid.com.au]
[…] to possible etiologic agent (i.e., methysergide) CLINICAL ISSUES Epidemiology Incidence Uncommon disease Age Primarily occurs in adults Gender Female > Male Presentation Painless neck mass &/or goiter Pressure in anterior neck often associated with dysphagia [basicmedicalkey.com]
Thyroid moderately enlarged and firm but not tender or painful Suppurative: Severe pain, tenderness, redness, fluctuation in thyroid area Riedel's: Thyroid asymmetrically enlarged, stony, adheres to neck structures Signs of compression and invasion—dysphagia [syrianclinic.com]
In RT, morbidity is most frequently related to local compressive symptoms, such as dysphagia, dyspnea, hoarseness, and cough. Hypothyroidism is present in 30% of cases. [emedicine.medscape.com]
SX & EXAM: usually acutely ill with fever, dysphagia, dysphonia, anterior neck pain and erythema, and a tender thyroid mass. Symptoms may be preceded by an acute upper respiratory infection. [enotes.tripod.com]
Skin
- Erythema
[…] multiforme Erythema nodosum Erythrasma Erythrocyte morphology and hemoglobin Esophageal atresia Esophageal barium swallow Esophageal cancer Esophageal diverticula Esophagus Estrogen and associated diseases Eye and orbit Facial nerve palsy Febrile seizures [amboss.com]
SX & EXAM: usually acutely ill with fever, dysphagia, dysphonia, anterior neck pain and erythema, and a tender thyroid mass. Symptoms may be preceded by an acute upper respiratory infection. [enotes.tripod.com]
Other clinical features include fever, pharyngitis and dermal erythema. 5, 9 The pain is typically worse during swallowing and radiates locally. 5, 9, 12 Tachycardia is common, along with leukocytosis and an elevated ESR level. 3, 5, 9, 12 TSH, T 4 and [aafp.org]
- Brittle Hair
Symptoms, signs and additional investigation findings in hypothyroidism Organ system Symptoms and signs Appearance Puffy and pale facies Dry, brittle hair Sparse eyebrows Dry, cool skin Thickened and brittle nails Myxoedema – fluid infiltration of tissues [racgp.org.au]
Workup
(See Etiology and Workup.) Gross pathology of Riedel thyroiditis. The cut edge is avascular, with a characteristic white color. Image courtesy of SL Lee. Involvement in RT may be unilateral or bilobar. [emedicine.medscape.com]
^ "Hashimoto Thyroiditis Workup: Approach Considerations, Serum TSH Test and Other Studies, Ultrasonography". emedicine.medscape.com. Retrieved 4 December 2017. ^ "Prasad's syndrome" (PDF). [en.wikipedia.org]
Other Pathologies
- Lymphocytic Infiltrate
Diagram showing thyroid enlargement in Hashimoto's thyroiditis Histology showing lymphocytic infiltration into the glandular tissue Subacute lymphocytic thyroiditis: This disorder comprises of three subtypes. [sites.google.com]
[…] cells (third image also has giant cells) Resembles lymphoma Grade I: mild lymphocytic inflammatory infiltrate Grade II: moderate lymphocytic inflammation Grade III: marked inflammation with polymorphous lymphocytes ThinPrep versus Pap stain Electron microscopy [pathologyoutlines.com]
Description • Autoimmune lymphocytic infiltration of the thyroid gland closely associated with the presence of antithyroid autoantibodies and often resulting in chronic hypothyroidism • Sometimes associated with a euthyroid state or transient hyperthyroidism [clinicaladvisor.com]
Current concepts Hashimoto’s thyroiditis is an organ-specific AITD characterized by diffuse goiter with lymphocytic infiltration and the presence of thyroid-specific autoantibodies. [hormones.gr]
Microscopic examination reveals extensive infiltration of the parenchyma by a mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and well-developed germinal centers. [humpath.com]
HLA Type
- HLA-DR5
Incidence/prevalence • Overall U.S. prevalence approximately 4.6% • Estimated prevalence by gender 5.8% for females and 3.4% for males (CDC data) Risk factors • Postpartum state (i.e., postpartum thyroiditis) • Specific alleles (HLA-DR3, HLA-DR4, HLA-DR5 [clinicaladvisor.com]
[…] hyperthyroidism Children have variable hypothyroidism and reversion to euthyroidism so must monitor thyroid function ( Clin Endocrinol (Oxf) 2009;71:451 ) No female predominance in children with Down syndrome ( Horm Res 2008;70:278 ) Associated with HLA-DR5 [pathologyoutlines.com]
There are reports that polymorphisms in the HLA locus, specifically the HLA-DR3 and HLA-DR5 alleles, are linked to Hashimoto thyroiditis, but the association is weak. [humpath.com]
Genetic Susceptibility The genetics of autoimmune thyroid disease are complex. 13 Association of Hashimoto's thyroiditis and painless postpartum thyroiditis with HLA-DR3, HLA-DR4, and HLA-DR5 has been reported in white persons, 14, 15, 16 but other associations [enotes.tripod.com]
CTLA-4 downregulates., i.e. transmits an inhibitory signal to T cells, so reduced functioning is associated with increased T-lymphocyte activity. [16] [17] A family history of thyroid disorders is common, with the HLA-DR5 gene most strongly implicated [en.wikipedia.org]
Treatment
Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]
Rapidly consult with trusted authorities thanks to new expert-opinion treatment strategies and recommendations. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.de]
Treatment is symptomatic with beta-blockers in hyperthyroid phase and levothyroxine if hypothyroidism appears. [dialnet.unirioja.es]
Radiation-induced thyroiditis is caused by radiation treatment that is given for the treatment of cancer or radioactive iodine treatment. Sometime even taking certain drugs causes thyroiditis. [medigoo.com]
Treatment should begin as early as possible in order to avoid complications. [medusanews.com]
Prognosis
In the same study, the mean age at diagnosis of RT was 47.8 years (range, 23-77 y). [3] Prognosis Riedel thyroiditis (RT) is generally a self-limited disease with a favorable prognosis. [emedicine.medscape.com]
Prognosis • Presence of serum antithyroid antibodies associated with increased risk for future development of hypothyroidism • Patients with subclinical Hashimoto thyroiditis may progress to overt hypothyroidism at a rate of Treatment • Treatment for [clinicaladvisor.com]
Prognosis depends on the extent of extracervical fibrosclerosis. [link.springer.com]
Prognosis Some degree of compromise or disability is expected for 6 to 12 months: hyperthyroid phase, 1 to 3 months; hypothyroid phase, 3 to 6 months, then gradual return to euthyroid. [syrianclinic.com]
It is frequently afflicted by cancer ... but the common cancer has such a good prognosis there is debate about how aggressively it should be treated. The cytopathology of the thyroid gland is dealt with in the thyroid cytology article. [librepathology.org]
Etiology
Etiology and pathogeny. The disease etiology not ustanovlena-Hronichesky inflammatory process in a thyroid gland is followed by primary growth of connecting is woven its germination in a capsule and surrounding fabrics. [infomeds.net]
TERMINOLOGY Abbreviations Riedel thyroiditis (RT) Synonyms Invasive fibrous thyroiditis Ligneous thyroiditis Definitions Idiopathic fibrosing process Not per se an inflammatory thyroid disease (thyroiditis) of thyroid gland ETIOLOGY/PATHOGENESIS Autoimmune [basicmedicalkey.com]
Abstract The authors present the case of a 42-year-old female patient, initially admitted to hospital for the etiological diagnosis--which remained negative--and the treatment of a superior vena cava syndrome. [ncbi.nlm.nih.gov]
However, IgG4-RSD may unify these 2 seemingly disparate etiologies. [emedicine.medscape.com]
Introduction: Inflammatory disorders of thyroid gland are a mixture of various disorders characterized by variable clinical presentations, etiologies and treatment modalities. [sites.google.com]
Epidemiology
[…] tract, parotid gland, lacrimal gland, hepatobiliary tract (sclerosing cholangitis) RT may coexist with one or more of these other sites of involvement Only retroperitoneal fibrosis linked to possible etiologic agent (i.e., methysergide) CLINICAL ISSUES Epidemiology [basicmedicalkey.com]
Epidemiologic studies have demonstrated a significant genetic component to Hashimoto thyroiditis, although, as in most other autoimmune disorders, the pattern of inheritance is non-Mendelian and likely to be influenced by subtle variations in the functions [humpath.com]
EPIDEMIOLOGY Women are three to five times more likely to be affected than men. [aafp.org]
The disorders are characterized by lymphoplasmacytic infiltrates containing IgG4-positive plasma cells. [5] These infiltrates ultimately lead to fibrosis and elevated serum levels of IgG4. [6, 7] Epidemiology United States Riedel thyroiditis (RT) is a [emedicine.medscape.com]
[…] intracranial pressure and brain herniation Elimination disorders Embryogenesis Emotional and behavioral disorders in children and adolescents Endarterectomy Endometrial cancer Endometriosis Endophthalmitis Environmental injuries Enzymes and biocatalysis Epidemiology [amboss.com]
Pathophysiology
The hallmarks of the disease are fibrosis and infiltration by IgG4 secreting plasma cells. [1] Pathophysiology [ edit ] Riedel's thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense fibrosis that invades adjacent structures [en.wikipedia.org]
[…] titers in Hashimoto's; possible in other types Erythrocyte sedimentation rate: elevated in subacute; markedly elevated in silent Biopsy: only if antibodies not detected and no apparent cause for symptoms; see giant cells in silent thyroiditis Pathology/Pathophysiology [syrianclinic.com]
Although IgG4-related Hashimoto’s thyroiditis and Riedel’s thyroiditis are two distinct entities, they share the pathophysiology of IgG4-related disease. [nature.com]
Resources Thyroid Disease Manager is an online, regularly updated resource that includes chapters on all aspects of thyroid disorders from pathophysiology through to management: www.thyroidmanager.org The American Thyroid Association provides clinical [racgp.org.au]
Prevention
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.de]
0% Emergent - ED Care Needed - Preventable/Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis [medicbind.com]
Screening and prevention in pregnancy • Selenomethionine treatment during and after pregnancy may prevent postpartum thyroid dysfunction. • Women with a history of autoimmune thyroiditis should be monitored during and after pregnancy for disease progression [clinicaladvisor.com]
Some patients are able to retain sufficient thyroid reserve to prevent hypothyroidism. Silent thyroiditis is also a typically a temporary condition with only a slight enlargement of the thyroid gland. [medigoo.com]