Hashimoto’s Thyroiditis

Abstract

Hashimoto's thyroiditis is best defined as an organ-specific autoimmune disease, characterized by autoimmune-mediated destruction of the thyroid gland. Diagnostic criteria have changed dramatically since the first description in 1912; they now include the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin, hypoechogenicity on thyroid ultrasound, and often but not always hypothyroidism. Distinct pathologic phenotypes are recognized: goitrous and atrophic variants but also an IgG4-related variant, hashitoxicosis, juvenile thyroiditis, and silent or painless thyroiditis. With a prevalence of 10-12% in the general population, it is the most common autoimmune disease. The prevalence is higher in females than in males, increases with advancing age, and is highest in Whites and lowest in Blacks. The incidence of autoimmune hypothyroidism is about 350 cases/100,000/year for women and 60 cases/100,000/year for men in iodine-sufficient regions and 44 (females) and 12 (males) per 100,000 per year in iodine-deficient areas. Breakdown of self-tolerance against thyroid antigens may lead to thyroid autoimmunity. Loss of T reg inhibitory actions and gain of Th17 proinflammatory actions (reflected by a shift to higher values of Th17/Th10 ratio in peripheral blood) play a crucial role in the loss of tolerance against thyroid antigens. Cytotoxic CD8+ T cells directed against TPO and Tg mediate thyroid gland destruction, either by the granule exocytosis pathway or apoptosis (programmed cell death). TPOAb and TgAb may cause antibody-dependent cellmediated cytotoxicity (ADCC) via complement-mediated lysis of thyrocytes. Hashimoto's thyroiditis often runs in families as evident from a high sibling risk ratio of 28. Twin studies suggest genes contribute about 73% of the liability to the development of TPOAb and TgAb; environmental factors would thus

Gender differences in symptoms of hypothyroidism: a population‐based DanThyr study

“…Several other studies have reported on the individual symptom presentation in patients diagnosed with overt hypothyroidism, [13][14][15] subclinical hypothyroidism [16][17][18] or hypothyroidism with no further specification. 19,20 However, none of the studies investigated whether women and men are affected to the same extent at disease onset. The fourfold female preponderance in autoimmune hypothyroidism incidence is in accordance with several other studies.…”

Actualización en el manejo preoperatorio en pacientes con hipotiroidismo.

“…Entre las causas de hipotiroidismo primario se encuentran la deficiencia de yodo, la tiroiditis de Hashimoto, causas iatrogénicas (cirugía, radioterapia, amiodarona, litio y rifampicina), infiltrativas (amiloidosis, sarcoidosis) y congénitas, como defectos anatómicos en la glándula, deficiencia de yodo o un error del metabolismo de la tiroide [6]. Específicamente, la tiroiditis de Hashimoto es la principal causa de hipotiroidismo en las áreas del mundo con suplencia de yodo adecuado [31], con una incidencia de aproximadamente 350 casos por cada 100.000 habitantes al año para mujeres y 60 casos por cada 100.000 habitantes al año para hombre [32].…”

What about TSH and Anti-Thyroid Antibodies in Patients with Autoimmune Thyroiditis and Celiac Disease Using a Gluten-Free Diet? A Systematic Review

“…Chronic autoimmune thyroiditis (CAIT) is the most common autoimmune disease worldwide and is characterized by a high prevalence in females [1]. CAIT is characterized by a peculiar ultrasound pattern, thyroid-specific autoantibodies (T-Ab), and a variable degree of thyroid functional impairment at the time of diagnosis.…”