Presentation
Hyperthyroidism duration positively correlated with thyroid peroxidase autoantibody (TPOAb) levels at presentation (r = 0.729, p = 0.002). [ncbi.nlm.nih.gov]
Entire Body System
- Goiter
Unlike the classical diffusely enlarged, lobular, bruit-associated goiter that is described with classical Graves disease the goiter is small, diffuse and often firm in these cases. [thetrp.net]
(plunging) (substernal) E04.9 ICD-10-CM Diagnosis Code E04.9 Nontoxic goiter, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Goiter NOS Nodular goiter (nontoxic) NOS lymphadenoid E06.3 Hashimoto's disease or thyroiditis E06.3 Hashitoxicosis [icd10data.com]
Diffuse nontoxic goiter is caused by an increased production of TSH from an enlarging thyroid gland, thus resulting in multi-nodular goiters. [hyperthyroidismsymptomsx.com]
Over time the thyroid may enlarge, forming a painless goiter. Some people eventually develop hypothyroidism with accompanying weight gain, feeling tired, constipation, depression, and general pains. [wikivividly.com]
- Euthyroid
She had remained stably euthyroid for 12 years. She was first observed in April 2016, while euthyroid. She came back after 11 months because of fatigue and palpitations, in the absence of neck pain. [pubmed.ncbi.nlm.nih.gov]
The second patient passed from a phase of hyperthyroidism to euthyroidism, while the third patient first experienced hypothyroidism, then subclinical hyperthyroidism and later became euthyroid. Thyroid hormone course is presented with the table. [abstracts.eurospe.org]
Euthyroidism was established after two weeks and the thionamides were withdrawn one week later. [touchendocrinology.com]
- Heat Intolerance
He initially presented with complaints of increased appetite, heat intolerance, fatigue, and sweating. On a physical exam, he had mild exophthalmos with lid lag and a fine tremor in the hands. [mendeley.com]
- Thyroid Nodule
An MRI with and without contrast revealed “heterogeneous in intensity and multiple small nodules.” There was also a 1.2x1.4x1.5 cm nodule at the thyroid isthmus. [healio.com]
Topics covered include the following: thyroid synthesis and physiology; hyperthyroidism; hypothyroidism; thyroid nodules; goiter; differentiated thyroid cancer; subacute, silent, and postpartum thyroiditis; thyroid and pregnancy; thyroid and the elderly [books.google.com]
Thyroid Cancer –Development of malignant thyroid tissue or nodules. [hyperthyroidismsymptomsx.com]
nodule on an ultrasound can give an idea as to whether a nodule is malignant or benign. [naturalendocrinesolutions.com]
- Fever
The hallmark symptoms of a thyroid storm is a fever which can go as high as 40.5 - 41.1 C (105 - 106 F). [medhelp.org]
Case 33: Headache Case 34: Vision loss Case 35: Heartburn Case 36: Fatigue Case 37: Skin changes Case 38: Ankle pain Case 39: Shoulder pain Case 4: Vaginal bleeding Case 40: Dizziness Case 5: Nausea Case 6: Pelvic pain Case 7: Toddler with a cough and fever [amboss.com]
Exacerbations with sudden enlargement and tenderness of the thyroid gland and general features of inflammation (elevated C-reactive protein [CRP] levels and erythrocyte sedimentation rate [ESR], rarely with fever) are very rare; they may be accompanied [empendium.com]
[…] body, manifested by fever and sore throat); * Propylthiouracil (PTU) "can cause serious liver damage. [drllynch.com]
Cardiovascular
- Tachycardia
The second patient The second patient was a 42-year-old female presenting with tachycardia and mood swings who was diagnosed with hyperthyroidism in February 2008. [schildkliertje.blogspot.com]
The second patient was a 42-year-old female presenting with tachycardia and mood swings who was diagnosed with hyperthyroidism in February 2008. [touchendocrinology.com]
Clinically, GD can present with a firm, nontender goiter, ophthalmopathy, a peripheral tremor, tongue fasciculations, tachycardia, and/or hypertension [1]. [hindawi.com]
There were no eye changes typical of Graves' and no peripheral manifestations aside from tachycardia and brisk deep tendon reflexes. [healio.com]
Psychiatrical
- Suggestibility
In this subgroup, TPOAb levels at diagnosis were higher than in the subgroup with less severe presentation and earlier hyperthyroidism resolution, suggesting a relationship between TPOAb levels and severity of the disease. Copyright © 2012 S. [ncbi.nlm.nih.gov]
It has been suggested that they are 2 entirely separate disease processes due to unique genetic differences demonstrated by genome studies [3]. [hindawi.com]
The patient eventually developed hypothyroidism suggesting that Hashimoto's thyroiditis was the most likely diagnosis. He was started on levothyroxine replacement therapy and remained euthyroid on levothyroxine since that day. [mendeley.com]
- Withdrawn
Euthyroidism was established after two weeks and the thionamides were withdrawn one week later. [touchendocrinology.com]
[…] disease Radiology images Images hosted on PathOut server: Contributed by Ayana Suzuki, Cytotechnologist, Japan: Isoechoic nodule Treatment Often no treatment needed, thyroid hormone for hypothyroidism (may remain euthyroid after 1 year when drug is withdrawn [pathologyoutlines.com]
Neurologic
- Hyperactivity
[…] thyroiditis disturbing the thyroid follicles, resulting in excess release of thyroid hormone. [ 2 ] Symptoms Major clinical signs include weight loss (often accompanied by an increased appetite ), anxiety, intolerance to heat, fatigue, hair loss, weakness, hyperactivity [research.omicsgroup.org]
Hashimoto's thyroiditis disturbing the thyroid follicles, resulting in excess release of thyroid hormone.[2] Major clinical signs include weight loss (often accompanied by an increased appetite), anxiety, intolerance to heat, fatigue, hair loss, weakness, hyperactivity [wikiwand.com]
[…] thyroiditis disturbing the thyroid follicles, resulting in excess release of thyroid hormone. [2] Symptoms Major clinical signs include weight loss (often accompanied by an increased appetite ), anxiety, intolerance to heat, fatigue, hair loss, weakness, hyperactivity [ipfs.io]
Hashimoto's thyroiditis disturbing the thyroid follicles, resulting in excess release of thyroid hormone. [2] Major clinical signs include weight loss (often accompanied by an increased appetite ), anxiety, intolerance to heat, fatigue, hair loss, weakness, hyperactivity [wikivividly.com]
- Seizure
Dementia, disturbances of consciousness and epileptic seizures are the most common features. [jeffreydachmd.com]
Seizure 20(9):717–719 Article PubMed Google Scholar Zhao W, Li J, Wang J et al (2011) A case of Hashimoto encephalopathy: clinical manifestation, imaging, pathology, treatment, and prognosis. [link.springer.com]
Female reproductive organs Femoral hernia Femoral shaft fracture Fever and inflammation Fibromuscular dysplasia Fibromyalgia Fifth disease Finger infections Finger injuries Focal seizures and syndromes Folate deficiency Food allergies Food poisoning [amboss.com]
Thyroid storm in a toddler presenting as a febrile seizure. Pediatrics. 2020;145:e20191920. https://doi.org/10.1542/peds.2019-1920 Esen İ, Bayramoğlu E, Yildiz M, Aydin M, Özturhan EK, Aycan Z, et al. [revistabiomedica.org]
- Excitement
Individuals suffering from this disorder may become excited and behave in an abnormal manner. Hyperactivity Patients tend to be abnormally active during the transient phase of hyperthyroidism. [primehealthchannel.com]
Workup
The patient underwent a thorough medical and neurological workup. Circulating thyroperoxidase antibodies were highly elevated but thyroid function was adequately maintained with L-thyroxine substitution. [jeffreydachmd.com]
Other Pathologies
- Lymphocytic Infiltrate
[…] 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]
Lymphocytic infiltration of the thyroid gland 3. Presence of thyroid autoantibodies. Age incidence: 45 – 65yrs. Male: Female: 1:10 to 1:20 It can occur in children and is a major cause of nonendemic goiter in children. 1. Genetic predisposition. 2. [ilovepathology.com]
This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. This may affect the thyroid gland in either a diffuse or focal manner. [radiopaedia.org]
Pathology Diffuse lymphocytic infiltration (cytotoxic T lymphocytes) with germinal center, oncocytic-metaplastic cells (Hurthle cells) and fibrotic tissue Differential diagnoses See “Differential diagnoses of hypothyroidism” and “Overview of common causes [www-amboss-com.db.rsu.lv]
HLA Type
- HLA-DR4
HLA-DR4, among others, is found both in patients with HD and in those with stress-induced Graves’ disease, which indicates an indirect connection of HD and hashitoxicosis with stress [ 48 ].…” Section: Discussionmentioning [scite.ai]
We also found HLA Cw7 (C*07) and HLA DR4 (DRB1*04) in our patient. [scielo.br]
HLA-DR4, among others, is found both in patients with HD and in those with stress-induced Graves’ disease, which indicates an indirect connection of HD and hashitoxicosis with stress [48]. [jmedicalcasereports.biomedcentral.com]
Treatment
In the few patients with a more severe presentation, methimazole treatment was required, and definitive hyperthyroidism resolution was delayed. [ncbi.nlm.nih.gov]
Hashitoxicosis Treatment Hyperthyroidism, if left untreated for a prolonged duration, may lead to Osteoporosis in the middle-aged population. Naturally, it requires professional medical treatment. [primehealthchannel.com]
Prospective identification of the individual benefit/risk ratio would facilitate personalized treatment strategies when IFN-α treatment is planned. [wjgnet.com]
This is an alternative treatment to thyroid removal (thyroidectomy and ablation), however, if the treatment fails, once given an ample trial, thyroid removal might be recommended as a follow up treatment." [medhelp.org]
Her thyroid was growing in size, not decreasing, and this continued as she became biochemically euthyroid when treatment with thyroxine was initiated. [healio.com]
Prognosis
Seizure 20(9):717–719 Article PubMed Google Scholar Zhao W, Li J, Wang J et al (2011) A case of Hashimoto encephalopathy: clinical manifestation, imaging, pathology, treatment, and prognosis. [link.springer.com]
Prognosis Top The disease may lead to permanent hypothyroidism, which requires lifelong hormone replacement therapy (with adequate treatment, the disease causes no sequelae). [empendium.com]
If a papillary microcarcinoma is discovered incidentally in a surgically removed hyperthyroid gland, the prognosis is excellent. [frontiersin.org]
Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis. Thorax 2006; 61: 68–74. ↵ Sulica R, Teirstein AS, Kakarla S, et al. [err.ersjournals.com]
Etiology
However, initial studies and the subsequent evolution of the patient, the diagnosis oriented toward a different etiology. Keywords : Hashitoxicosis; hyperthyroidism; hypothyroidism. [scielo.org.co]
Grave's disease and toxic nodular goitre are always considered as the prime etiologies in a patient with thyrotoxicosis. [ijcasereportsandimages.com]
Etiology Although there have been many theories for the etiology of Hashimoto's, no definitive causative agent has yet been identified. [med.ucla.edu]
Pathophysiology Unknown etiology: Genetic and environmental factors likely play a role. [www-amboss-com.db.rsu.lv]
Last Updated: May 11, 2022 Last Reviewed: May 11, 2022 Chapter Information Definition, Etiology, Pathogenesis Top Chronic autoimmune (lymphocytic) thyroiditis (Hashimoto thyroiditis) is a painless thyroiditis associated with antibodies against thyroid [empendium.com]
Epidemiology
1) Age of onset: occurs in all age groups, most prevalent in women aged 30–50 years Epidemiological data refers to the US, unless otherwise specified. [www-amboss-com.db.rsu.lv]
“[An epidemiological study on the relationship between selenium and thyroid function in areas with different iodine intake]” (article in Chinese). Zhonghua Yi Xue Za Zhi Vol. 83, No. 23 (2003): 2036–2039. [naturopathiccurrents.com]
EPIDEMIOLOGY Women are three to five times more likely to be affected than men. [aafp.org]
Epidemiology of childhood hyperthyroidism in France: A nationwide population-based study. J Clin Endocrinol Metab. 2018;103:2980-7. https://doi.org/10.1210/jc.2018-00273 Léger J, Oliver I, Rodrigue D, Lambert AS, Coutant R. [revistabiomedica.org]
Pathophysiology
Pathophysiology Unknown etiology: Genetic and environmental factors likely play a role. [www-amboss-com.db.rsu.lv]
Cardiovascular risk with subclinical hyperthyroidism and hypothyroidism: pathophysiology and management. J Cardiometab Syndr. 2007 Summer; 2(3): 198-206. Review. Shrier D.K. Burman K.D. Subclinical hyperthyroidism: controversies in management. [internationaljournalofcardiology.com]
The antibodies produced may cross-react with more than one gland [34], leading to complex pathophysiological interconnections. Chrousos highlighted that stress enhances the susceptibility to autoimmune disorders. [jmedicalcasereports.biomedcentral.com]
GD and HT share similar pathophysiologic mechanisms but different clinical manifestations. The autoantibodies in GD and HT are different in these disorders; TRAb in GD and thyroid peroxidase antibody (TPOAb) in HT (2). [journals.aace.com]
Pathophysiology of Hashimoto’s Hashimoto’s thyroiditis is an autoimmune disease in which the thyroid gland is infiltrated by lymphocytes which attack and destroy the functioning thyroid cells called thyrocytes. [jeffreydachmd.com]
Prevention
Beginning proper treatment for Hashimoto’s disease, even in its earliest stages, can prevent further damage to the thyroid gland and possibly prevent full-blown hypothyroidism. [holtorfmed.com]
[…] p If you can do anything to prevent it, don't have RAI done. I really, really regret it now. [forum.lowcarber.org]
[…] thyrotoxic phase of autoimmune thyroiditis can not be confirmed with certainty, i.e. if a possibility of Graves' disease is suspected, then a short course of anti-thyroid drugs may be prescribed, while cautiously watching out with periodic testing, for preventing [thetrp.net]