Terry Kotrla, MS, MT(ASCP)BB

Unit 3 AutoimmunityPart 4 Hashimoto’s Thyroiditis

Part 5 Grave’s Disease

Hashimoto's ThyroiditisA type of autoimmune thyroid disease in which

the immune system attacks and destroys the thyroid gland.

CHARACTERIZED BY HYPOTHYROIDSM.Thyroid helps set the rate of metabolism - the

rate at which the body uses energy. Hashimoto’s prevents the gland from producing

enough thyroid hormones for the body to work correctly.

It is the most common cause of hypothyroidism.Have statistically increased risk of developing other

disorders: Diabetes, rheumatoid arthritis, TTP, SLE

Hashimoto's ThyroiditisOrgan specific disease affecting the

thyroid gland.Can occur at any age, most often

seen in women 30 to 40 years old, May be a genetic predisposition.Causes diffuse hyperplasia in the

gland resulting in development of a goiter.

Thyroid autoantibodies are formed.

SymptomsSimilar to those of hypothyroidism in generalOften subtle and not specific.Become obvious as condition worsensThe following are the most common

symptoms. : Goiter (enlarged thyroid gland may cause a bulge

in the neck) FatigueModest weight gainCold intoleranceExcessive sleepiness.Vague aches and painsSwelling of the legs

ThyroidThyroid hormones are produced by the thyroid gland. This

gland is located in the lower part of the neck, below the Adam's apple.

The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus).

A goiter forms due to inflammation of the thyroid.

Goiter

This enlargement is due to the inflammatory cells which destroy thyroid cells, resulting in long term scarring.

When the cells are damaged they cease thyroid hormone production, resulting in hypothyroidism

A goiter only needs to be treated if it is causing symptoms.

The enlarged thyroid can be treated with radioactive iodine to shrink the gland or with surgical removal of part or all of the gland (thyroidectomy).

Small doses of iodine (Lugol's or potassium iodine solution) may help when the goiter is due to iodine deficiency.

Laboratory TestingRoutine thyroid function tests to confirm that a

patient has an underactive thyroid gland. Thyroid stimulating hormone (TSH) - high Free T4 (thyroxine) –low but may be normal early in

diseaseAnti-thyroid antibodies produced and attack

specific portions of the thyroid cells which pinpoint Hashimoto's thyroiditis as the cause of the hypothyroidism.

Anti-microsomal antibodies Anti-thyroglobulin antibodies

The anti-microsomal antibody test is much more sensitive than the anti-thyroglobulin, therefore some doctors use only the former blood test.

Thyroid autoantibodies blood tests are high in about 95% of patients with Hashimoto's thyroiditis, but are not diagnostic.

TreatmentThyroid hormone replacement.Spontaneous remissions have occurred.

Graves’ Disease - ThyrotoxicosisAutoimmune diseaseAntibodies attack thyroid gland causing

overproduction of thyroxine.Thyroxine greatly increases the metabolic

rate.Most common cause of severe

HYPERTHYROIDISM Can occur in children and adolescents but

women more susceptible, occurs most frequently between 30 and 40 years of age.

Genetic link suspected.

Graves’ DiseaseDiagnosis may be straightforward, since

the "classic face" with its triad of hyperthyroidism goiterexophthalmos

Goiter is usually symmetric, smooth, and nontender

The hyperthyroid state can cause a wide variety of multisystem derangements that often result in diagnostic confusion.

ExophthalmosExophthalmos, also called proptosis, is a

characteristic finding in thyroid eye disease, and has been reported to occur in 34% to 93% of patients

Signs SymptomsCauses a number of symptoms

Nervousness and increased activity fast heartbeat fatigue moist skin heat intolerance shakiness anxiety increased appetite weight loss insomnia.

Have at least one of the following: goiter, bulging eyes, or raised areas of skin over the shins.

Laboratory TestingPresence of thyroid-stimulating

hormone receptor antibody, causes release of thyroid hormones.

Key findings are Elevated total and free T3 (triiodothyronine)

Elevated T4 (thyroxineThyroid stimulating hormone (TSH) is

reduced due to antibody stimulation of the thyroid.

TreatmentMedication.Radioiodine therapy to destroy the thyroid.Surgical removal of thyroid

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