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Hashimoto’s thyroiditis (lymphadenoid or autoimmune thyroiditis)

Hashimoto’s thyroiditis is a chronic autoimmune mediated inflammatory disease of the thyroid which generally involves females in the age group of 40- 50 years. There is diffuse enlargement of the gland which may be firm and sometimes rubbery to hard in consistency.

Sometimes the gland enlarges asymmetrically with the pyramidal lobe enlargement. Histologically there is infiltration of gland with lymphocytes and formation of germinal centers. Depending on the duration of illness fibrosis sets in which may finally end up in atrophy of the gland.

Patient may be hypothyroid or euthyroid. Thyroid microsomal antibodies are seen in high titres and antithyroglobulin antibodies are present.

Hashimoto’s thyroiditis may coexist with other autoimmune disorders like chronic active hepatitis, SL erythematosis, rheumatid arthritis, Sjogren’s syndrome and myasthenia gravis. Since it is part of systemic autoimmune disease antinuclear factor (ANF) may be present.

In the beginning patients T3, T4, TSH levels are normal but with the progress of disease, thyroid failure sets in. TSH levels rise and frank hypothyroidism develops. Thyroid iodinel3l uptake level is low. Sometimes a needle biopsy of the gland is done to confirm the diagnosis of thyroiditis.

Since hypothyroidism is present in large number of cases along with goitre, treatment of such a case is by Levo thyroxin (0.1-0.2 mg/day). There is regression of the gland along with fall in TSH levels.

Sometimes hyperthyroidism may coexist with HashimotO’s thyroiditis. Such patients are treated on the lines of Graves’ disease and to a large extant are benefited by Hashimoto’s disease which predisposes the patient to develop hypo-functioning of the thyroid gland.

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