Hashimoto's thyroiditis
What is Hashimoto's thyroiditis
Hashimoto’s thyroiditis (aka chronic lymphocytic thyroiditis or autoimmune thyroiditis) is an auto immune disorder where your body’s own immune system attacks the thyroid gland causing thyroiditis (inflammation of the thyroid). This is the most common cause of goitre (thyroid enlargement) and hypothyroidism (insufficient thyroid hormone production) in Australia. It commonly affects young or middle-aged women.
Diagnosis is made by measuring antibodies in your blood. These antibodies are directed to thyroid peroxidase (primarily) and thyroglobulin (less often).
Clinical Manifestations
Diffuse goitre. Slow enlargement of the thyroid gland over many years. Occasionally, thyroid growth can be rapid and cause compression of the trachea (main airway) or oesophagus (food pipe) in the neck.
Neck pain (painful goitre) is rare.
Thyroid overactivity (“Hashitoxicosis”) affects 5%. This is usually self-limiting but may require medication.
Thyroid underactivity (hypothyroidism) is present in 20%. Thyroid hormone replacement will be necessary.
Patients with normal thyroid activity (euthyroid) with Hashimoto’s develop hypothyroidism at a rate of 5% per annum. I recommend yearly thyroid function testing (blood test) in these patients.
Management
The mainstay of treatment is to replace thyroid hormone in those patients who are deficient. Surgery is rarely indicated. Indications include large compressive goitres or occasionally for painful goitres.