History –

Hashimoto’s thyroiditis is named after popular Japanese physician Hakaru Hashimoto (1881−1934) studied at medical school of Kyushu University,he was first to describe the symptoms of persons with struma lymphomatosa.

Despite Dr.Hashimoto’s discovery and publication, the disease was unfortunately not recognized as different from Reidel’s Thyroiditis which was a similar disease at that. Although many other articles were reported and published by other researcher. Allen Graham et al from Cleveland reported its symptoms and presentation in the same detailed manner as Hakuru in 1931

In 1957, it was recognized as an autoimmune disorder and was the first organ-specific autoimmune disorder identified.

The disease was able to become so well known from that moment and Hashimoto’s disease became to appear more frequently in textbooks.

Hashimoto’s thyroidits is a potential cause of hypothyroidism. It is an auto immune disorder
Two factors are responsilble for it.

A) Genetic factors – due to presence of autoreactive lymphocytes

B) Environmental factors – like some infection, antigenicity of thyroid tissue is altered and autoimmunity is activated against thyroid cells-

1} T lymphocytes differentiate into CD4+T lymphocytes. It releases cytokine to activate macrophage which destroy the thyroid tissue

2} T lymphocytes differentiate into CD4+T Lymphocytes known as CTL, which causes apoptosis in thyroid cells

3} lymphocytes produce auto anti bodies.
This is known as antibody dependant cell mediated cytotoxicity

GROSS MORPHOLOGY

-thyroid gland is enlarged due to inflammation in the initial stages
-later thyroid decreases in size due to tissue destruction and fibrosis

MICROSCOPIC CHANGES

-mononuclear cells infiltration composed of lymphocytes, plasma cells and macrophages.
-thyroid follicles are atrophic which are lined by specific cells known as hurthle cells which have eosinophilic granular cytoplasm.
Granularity of the cell is due to the presence of numerous mitochondria.
Hurthle cells are metaplastic due to ongoing injury.
Thyroid cells try to maintain function by more hormone synthesis

CLINICAL FEATURES –

• 20 % more common in females. Incidence decreases with age

• anemia but weight gain

• cold intolernace but skin is dry

• increased thickness of skin causing puffiness of face and non pitting edema of lower limb

• thick tounge and hoarseness of voice

• deafness due to fluid in middle ear

• bradycardia, BP decreases or increases

• pericardial effusion, pleural effusion

• constipation

• menstrual irregularity like amenorrhea

• poor concentration sometimes psychosis, dimentia

COMPLICATIONS –

Ignored or untreated hypothyroidism can lead to a number of health problems:

Mental health issues : Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.

Peripheral neuropathy : Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves. These are sensory and motor nerves carrying impulses from brain to body and body to brain respectively — for example, your arms and legs. Peripheral neuropathy may cause pain, numbness and tingling in diseased areas.

Myxedema : This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include i cold intolerance and drowsiness followed by marked lethargy and unconsciousness.

Infertility : Low levels of thyroid hormone can disturb ovulation, which impairs fertility in women

Birth defects : Babies born to women with untreated thyroid disease may have a higher risk of birth defects compared to babies born to healthy mothers. These children are also more susceptible to serious mental and physical problems

TREATMENT

As of now there is no cure for Hashimoto Thyroiditis and treatment is only aimed at managing the symptoms of this disease. This is done with regular intake of medications. Rarely a thyroid surgery is required to treat a condition like Hashimoto Thyroiditis.

Medications include intake of levothyroxine which is synthetic thyroxine [t-4] hormone

Contributor – Medico Shashank Gupta

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