Diagnose Hashimoto-Thyreoiditis (German Edition)

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More recent epidemiological studies support a connection between dietary iodine and Hashimoto's thyroiditis.

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Similar results were obtained by Bjergved et al. Nevertheless, despite epidemiological studies and animal experiments clearly indicating that more dietary iodine increases the incidence of autoimmune thyroiditis 40 , 41 , the mechanism for the proimmunogenic effect of iodine remains to be explained The association between Hashimoto's thyroiditis and papillary thyroid cancer was responsible for the significant increase in the number of surgical Hashimoto's thyroiditis cases observed during the last two decades — in our study.

This association, documented since 43 , remains mysterious. Scholars have debated as to whether it represents the mere co-occurrence of two relatively common conditions, which are ascertained now more frequently due to the increased usage of thyroid ultrasound, or if instead it indicates a true cause—effect relationship. In the case of the latter scenario, it is unclear whether cancer or autoimmunity comes first.

The clinical consequences of this association have also been debated, although most recent studies suggest that papillary thyroid cancer follows a more benign course when accompanied by Hashimoto's thyroiditis 44 , Our analysis provides some insights into this association. It shows that the increased incidence of papillary thyroid cancer observed in recent years 46 — 49 , and reflected in our data, was paralleled by increases in both the form of papillary thyroid cancer associated with Hashimoto's thyroiditis and in the one associated with the milder form of lymphocytic infiltration referred to as chronic nonspecific thyroiditis.

These findings suggest that papillary thyroid cancer is the initial lesion, which then induces a lymphocytic infiltration that in some patients progresses to assume the features of full-blown Hashimoto's thyroiditis, whereas in others remains at the stage of chronic nonspecific thyroiditis.

Rather than being part of the same causal pathway, the lymphocytic infiltration of the thyroid thus seems to be the consequence of the neoplastic transformation of the thyroid cell. It is interesting to reflect on the reasons for which patients with Hashimoto's thyroiditis today undergo thyroidectomy, since the disease is largely a medical disease. The most common reason in our series was a thyroid nodule with a cytology suspicious for malignancy, in keeping with previous reports These patients had a long-standing history of Hashimoto's thyroiditis, were usually on thyroxine replacement, and developed thyroid nodules with time.

As shown in the results section, interstitial fibrosis is one of the key pathological features, and thus, nodularity is to be expected in Hashimoto glands. Lymphocytes are often seen to make intimate contact with groups of thyroid cells, a feature that has recently been considered useful to distinguish Hashimoto's thyroiditis from thyroid neoplasms Although the recommendation of the Bethesda reporting system for thyroid cytopathology for atypia of undetermined significance is conservative management 53 , many patients are referred to a surgeon, and then undergo thyroidectomy.

Thus, even one century after the original description, there are still patients who might be spared from a thyroidectomy if a more accurate preoperative diagnosis of Hashimoto's thyroiditis is established. This is especially relevant if we consider that thyroidectomy in patients with Hashimoto's thyroiditis causes more surgical complications, both transient and permanent, than thyroidectomy performed for other pathologies The cytoplasmic granularity is caused by the increased number of mitochondria that appear abnormal in size, shape, and content on analysis by electron microscopy The role of the immunoproteasome has been recently confirmed in a mouse model of thyroiditis induced by iodine where selective blockade of LMP7 decreased thyroiditis severity In conclusion, Hashimoto's thyroiditis remains an intriguing and multifaceted disease one century after its original description.

Improvements in the preoperative diagnosis, advances in the understanding of disease pathogenesis, and development of novel therapies based on mechanisms rather than symptoms will improve the quality of life for this patient population. We dedicate this work to the memory of Professor Aldo Pinchera, a truly larger-than-life figure who dedicated his life to promoting the study and awareness of thyroid diseases.

Paul Ladenson and David Cooper for critically reading the manuscript, and Drs. William Westra and Justin Bishop for improving the classification presented in Table 1. The authors declare that no competing financial interests exist. National Center for Biotechnology Information , U. Find articles by Patrizio Caturegli.

Find articles by Alessandra De Remigis. Find articles by Kelly Chuang. Find articles by Marieme Dembele. Find articles by Akiko Iwama. Find articles by Shintaro Iwama. Author information Copyright and License information Disclaimer. This article is presented as part of the American Thyroid Association's Clark Sawin historical series.

Copyright , American Thyroid Association. This article has been cited by other articles in PMC. Abstract Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. Introduction H ashimoto's thyroiditis is an autoimmune disease of the thyroid gland that has a characteristic pathological appearance. Materials and Methods Data sources We compiled a database of all thyroidectomies performed at the Johns Hopkins Hospital no consult slides included using both paper and electronic records. Open in a separate window.

Discussion Hashimoto's thyroiditis is now the most common autoimmune disease in humans 9 , 26 , and the most frequent cause of hypothyroidism 27 , Acknowledgments We dedicate this work to the memory of Professor Aldo Pinchera, a truly larger-than-life figure who dedicated his life to promoting the study and awareness of thyroid diseases. Disclosure Statement The authors declare that no competing financial interests exist.

I. What every physician needs to know.

The pathology of autoimmune thyroid disease: Intrathyroidal and circulating lymphocyte subsets in different stages of autoimmune postpartum thyroiditis. J Clin Endocrinol Metab. IgG4-related disease of the thyroid gland. Hakaru Hashimoto — and his disease. Atrophy and fibrosis associated with lymphoid tissue in the thyroid. Struma lymphomatosa Hashimoto Arch Surg. The pathology, diagnosis, and treatment of Hashimoto's disease struma lymphomatosa Brit J Surg.

Tunbridge F, et al. The incidence of thyroid disorders in the community: Epidemiology and estimated population burden of selected autoimmune diseases in the United States.

The clinical aspects of chronic thyroiditis. Lymphadenoid goitre and its clinical significance. The effect of the oral administration of potassium iodide and thyroid substance on the mitotic proliferation and structure of acini in the thyroid gland in guinea pigs. Colloidophagy in the human thyroid gland. Testicular lesions induced in the guinea pig by iso- and auto-sensitization.

Ann Inst Pasteur Paris ; Studies on organ specificity. Changes in the thyroid glands of rabbits following active immunization with rabbit thyroid extracts. Thyroid peroxidase as an autoantigen. Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease.

Autoimmune murine thyroiditis relation to histocompatibility H-2 type. A patient with previously undiagnosed or untreated hypothyrodism could develop myxedema coma. The patient could have changes in mental status or arrthymias. A patient who has no other complication such as arrythmia would expect to have a length of stay of days while diagnostic tests and treatment are initiated. Once the patient is initiated on thyroid replacement hormone therapy and has follow-up, as long as they do not have complications such as arrhythmias, pericardial effusions or encephalopathy, they can be discharged.

The patient should also be advised that any increase in the size of their thyroid gland would require an earlier evaluation.

The patient should be followed by their primary care physician PCP in weeks with repeat testing to assess response to therapy. The patient should be followed by their PCP in weeks with repeat testing to assess response to therapy. They can also be established with an endocrinologist if they should have unusual presentations such as an enlarging single nodule. Any asymmetric or large increase in the size of their thyroid gland warrants early evaluation with imaging, possible radionuclide iodine uptake scan and FNA.

If a patient has psychosis or profound weakness as a result of their hypothyrodism they would need to be placed in a skilled nursing facility SNF to get a physical therapist PT. This needs to be based on the initial evaluation of patient and would require PT being involved early as long patient is hemodynamically stable. A straight forward patient with hypothyrodism related to Hashimotos's thyroiditis should not require SNF placement.

These patients should be advised on the need to stay on their thyroid replacement therapy. The resolution of symptoms take time and symptom recurrence might not occur until the levothyroxine is missed for days to weeks. Patient should be advised not to stop the medication just because they feel better. The need for follow-up should be re-inforced. Fall precautions if the patient is debilitated or weak on presentation. There are some who believe that there is an association between Hashimoto's and other autoimmune thyroid diseases and antiphospholipid syndrome. However, there is insufficient evidence and no consensus at this time to draw any conclusions.

Therefore provide deep vein thrombosis prophylaxis for your patient based on their medical risk. Ensure that the patient has a scheduled follow-up with their PCP at the time of discharge. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. What every physician needs to know. Are you sure your patient has Hoshimoto's thyroiditis?

Competing diagnoses that can mimic Hoshimoto's thyroiditis. What diagnostic tests should be performed? What laboratory studies if any should be ordered to help establish the diagnosis? How should the results be interpreted? What imaging studies if any should be ordered to help establish the diagnosis?

Physical Examination Tips to Guide Management. Management with Co-Morbidities A. Systolic and Diastolic Heart Failure D. Diabetes or other Endocrine issues F. Immunosuppression HIV, chronic steroids, etc. Gastrointestinal or Nutrition Issues J. Hematologic or Coagulation Issues K. Transitions of Care A. Sign-out considerations While Hospitalized.

Hashimoto's thyroiditis

Anticipated Length of Stay. When is the Patient Ready for Discharge. Arranging for Clinic Follow-up 1. When should clinic follow up be arranged and with whom. What tests should be conducted prior to discharge to enable best clinic first visit. What tests should be ordered as an outpatient prior to, or on the day of, the clinic visit. Prognosis and Patient Counseling. Patient Safety and Quality Measures A.

Core Indicator Standards and Documentation. Common complaints at the time of presentation include: Then when I filmed a movie last summer, I actually went under pounds. It was crazy, but things have leveled out, and I'm back to normal. The year-old model's thyroid levels went haywire after she gave birth to her son Brooks in My neck was a thick as a football player. There was no way this was all due to pregnancy pounds.

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