Hashimoto thyroiditis

 

Hashimoto thyroiditis - Chronic
Rahul Soman, M. Pharm

 

Definition  

An autoimmune inflammatory thyroid disorder characterized by infiltration of the thyroid by lymphocytes and the formation of Hürthle cells; also known as chronic lymphocytic thyroiditis

 

Medical History  

* Family history of Autoimmune thyroiditis

* Autoimmune disease

 

Findings  

* Goiter

* Bradyarrhythmia

* Dry skin

* Constipation - Chronic

* Intolerant of cold

* Weight gain

* Fatigue

* Hypothermia

* Loss of hair

* Periorbital edema

* Hoarse

* Neck pain

* Muscle weakness

* Cramp

* Ataxia

* Reflex finding

* Altered mental status

* Depression - Chronic

* Irregular periods

* Infertility - Chronic

* Amenorrhea - Chronic

* Exophthalmos

* Galactorrhea

 

Tests  

Suspected autoimmune thyroiditis  

* Thyroid stimulating hormone measurement: Suppressed TSH levels in the presence of leukocytosis and elevated T4, T3, erythrocyte sedimentation rate, and thyroglobulin levels is suggestive of subacute thyroiditis in the presence of an unequivocal clinical presentation .

 

Suspected or known hypothyroidism  

* Serum free T4 measurement: Free thyroxine (FT4) is decreased in conjunction with an elevated TSH level in primary hypothyroidism and in conjunction with a low, normal, or slightly elevated TSH level in secondary hypothyroidism .

 

Suspected autoimmune thyroiditis  

* Thyroperoxidase antibody assay: The presence of thyroid peroxidase antibodies strongly suggests chronic autoimmune thyroiditis, particularly Hashimoto thyroiditis .

 

Differential Diagnosis  

* Non-toxic nodular goiter

* Malignant tumor of thyroid gland

* Postpartum thyroiditis

* Subacute lymphocytic thyroiditis

* Subacute thyroiditis

* Iatrogenic thyroiditis

* Suppurative thyroiditis, acute

* Injury of thyroid gland

* Riedel's thyroiditis

 

Treatment  

 

Drug Therapy  

 

Hashimoto thyroiditis with clinical hypothyroidism or goiter  

 

LEVOTHYROXINE SODIUM  

Adults: 1.6 mcg/kg orally once daily

Geriatrics: 12.5 to 25 mcg orally daily; titrate slowly to an average daily dose of 75 to 150 mcg

 

Hashimoto thyroiditis with subclinical hypothyroidism  

 

LEVOTHYROXINE SODIUM  

Adults: Initial dose 25 to 50 mcg orally daily; titrate to TSH level every 6 to 8 weeks until stable

Geriatrics: Initial dose 12.5 to 25 mcg orally daily; titrate to TSH level every 6 to 8 weeks until stable