Many of you have heard of Hashimoto’s disease, but you don’t know much about it. The full name of Hashimoto’s disease is Hashimoto thyroiditis, the scientific name for chronic lymphocytic thyroiditis, which is an autoimmune disease.
I. Main features
Hashimoto’s thyroiditis has a slow onset and most patients do not feel anything at the onset of the disease and gradually find an enlarged thyroid gland. In a few patients with advanced disease, there is a large amount of fibrosis formation in the thyroid gland, then it is hard as a stone, often adhering to the surrounding tissues, which can grow progressive compression symptoms, respiratory distress and difficulty in swallowing. Features are as follows.
1. Patients will develop enlarged and painful thyroid gland after consuming large amount of fishy food. Some people may also develop hyperthyroid symptoms.
2. The thyroid gland is enlarged, most have pressure pain, no vascular murmur and nodules.
3. Enlarged thyroid gland in adolescence.
4. Limited mucinous edema in the anterior shin of the lower leg.
5. Patients with Hashimoto’s thyroiditis can “self-heal” from hyperthyroidism without medication, and this condition can recur.
6. Patients have both hyperthyroid and hypothyroid symptoms.
Main risks
Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is characterized by hyperthyroidism or diffuse goiter in the early stages of the disease.
Dr. Chunbao Jia, a well-known expert in the treatment of thyroid disorders in China, pointed out that hypothyroidism can slow down the overall metabolism of the human body, leaving people in a subhealthy condition for a long time. For some women of childbearing age, they should pay special attention to the balance of thyroid hormones during pregnancy and have regular checkups at hospitals to avoid affecting the development of the fetus.
The relationship between Hashimoto’s thyroiditis and thyroid cancer is still debated. Woo1swan et al. concluded that chronic lymphocytic thyroiditis does result in microscopic cancer. Recently, one case each of microscopic carcinoma, malignant lymphoma and papillary carcinoma was found in 27 cases of chronic lymphocytic thyroiditis examined at Guangzhou Zhongshan Hospital, with a malignancy incidence of 11.1%. So Hashimoto’s thyroiditis is very much related to carcinoma. Therefore, if friends around you have such a condition, you need to be alert and not take it lightly.
III. Medical history and symptoms
The disease is mostly seen in women aged 30 to 50, but in recent years the age of onset has been trending younger, so young women should not neglect their health. The disease starts insidiously, develops slowly and has a long course, mainly manifesting as goiter, mostly diffuse, a few can be limited, part of the face and limbs swollen feeling. The disease can be divided into eight types.
1. Hashimoto hyperthyroidism.
Patients have typical hyperthyroid symptoms and positive laboratory test results. Hyperthyroidism and Hashimoto’s disease may co-exist or occur sequentially, co-exist and transform each other. Patients have concomitant hyperthyroidism, and in some cases, they may also have infiltrative proptosis and mucinous edema. There may be typical hyperthyroid manifestations. Circulating antibody titers are high. The hyperthyroid state may persist for several years in these patients and often requires antithyroid medication, but the dose should not be too high and attention should be paid to the occurrence of pharmacologic hypothyroidism. Surgical resection or radionuclide therapy are not suitable and may lead to permanent hypothyroidism.
2. Pseudohyperthyroidism.
A small number of patients may have clinical manifestations of hyperthyroidism, such as palpitations, excessive sweating and hypersensitivity, but there is no evidence of hyperthyroidism in thyroid function tests, and TGAb and TMAb are positive. Such patients do not need anti-thyroid medication and their symptoms can disappear on their own.
3. Protruding eye type.
This disease may occur as a protruding eye with infiltrative proptosis, and its thyroid function may be normal, hyper or hypothyroid. There is lymphocytic infiltration and edema in the retro-orbital muscle. Serum TGAb and TMAb are positive.
4. Subacute thyroiditis-like type.
The onset is more acute with fever, rapid enlargement of the thyroid gland with local pain and tenderness, accelerated blood sedimentation, but normal or increased 131 iodine uptake rate, and positive thyroid antibody titers.
5. Juvenile type.
Hashimoto’s thyroiditis accounts for about 40% of adolescent goiters with small thyroid glands, normal thyroid function, and low thyroid antibody titers, making clinical diagnosis more difficult. Some patients have a rapidly enlarging goiter, called the juvenile hyperplasia type. Some patients may be combined with hypothyroidism.
6. Fibrotic type.
The course of the disease is longer, and there may be extensive or partial fibrosis of the thyroid gland, thyroid atrophy, and hypothyroidism.
7. With thyroid adenoma or cancer.
Often isolated nodules with high TGAb and TMAb titers. 8. Concomitant with other autoimmune diseases.
Physical examination findings
Diffuse or limited enlargement of the thyroid gland, hard and elastic texture, clear border, no tenderness, smooth surface, some thyroid glands may be nodular, lymph nodes in the neck are not enlarged, some may have mucinous edema of the extremities.
V. Auxiliary tests
1. Anti-thyroid antibody measurement: serum anti-thyroid peroxidase antibody (TMAb) (anti-TPO) and serum thyroglobulin antibody (TGAb) (Anti-tg) are often significantly increased and have diagnostic significance for this disease. Some patients require multiple tests.
Early thyroid function may be normal, and in Hashimoto hyperthyroidism, thyroid function is mildly elevated. As the disease progresses, T3 and T4 may decrease and TSH may increase.
3. Irregular concentrations or sparse areas on radionuclide imaging of the thyroid gland, with a few appearing as “cold nodules”.
4. Positive potassium perchlorate release test.
5. Blood sedimentation may be accelerated, serum globulin (gammaglobulin) may be increased, and albumin may be decreased.
6. Thyroid puncture shows a large number of lymphocytic infiltrates.