The Diagnosis of Hashimoto's Thyroiditis

Abstract

Computer methods were used to estimate the usefulness of several clinical signs and laboratory tests in the diagnosis of chronic lymphocytic (Hashimoto's) thyroiditis. Information was drawn from the records of 217 patients with this disease seen at two hospitals in Southern California. The parameters studied included the physical characteristics of the thyroid gland; the appearance of the radioisotope thyroid scan; the response to a perchlorate discharge test; the serum antithyroglobulin antibody titer; the serum TSH concentration measured by radioimmunoassay; the thyroid radioiodine uptake response to exogenous TSH stimulation; and the serum PBI-T4I difference. Of the above, the PBI-T4I difference was deleted, being of limited value. The TSH stimulation test and serum TSH measurement were considered as alternative ways to evaluate thyroid reserve. Therefore, five diagnostic markers remained, all useful but not definitive. Computer and rule-of-thumb methods (two or more of the five markers positive) were tested for successful diagnosis of 145 patients with Hashimoto's thyroiditis proven by pathological examination of biopsied tissue; 23 of these were patients not used in the original pool of data. As a rule of thumb, it was found that Hashimoto's thyroiditis is the likely diagnosis if two or more out of the five useful markers are in its favor. For best results, four and preferably all of the five criteria should be tested. If this is done, the expected diagnostic accuracy for patients with Hashimoto's disease is by the rule-of-thumb method 67% correct, 21% indecisive, and 12% false negative; by computer methods it is 88% correct, 4% indecisive, and 8% false negative. By each method the number of false positive diagnoses was equivalent to 25% of the total number of patients with this disease. The false positive results nearly all occurred in patients with goiter associated with a defect in thyroid hormone synthesis.

Association of HLA Alleles with Autoimmune Thyroid Disease in Korean Children

“…HD was diagnosed when at least three of Fisher’s criteria [7] were met: (1) goiter, (2) diffuse goiter and decreased uptake at thyroid scan, (3) the presence of circulating thyroglobulin and/or microsomal autoantibodies, and (4) hormonal evidence of hypothyroidism. GD diagnosis was based on confirmation of clinical symptoms and biochemical confirmation of hyperthyroidism, including the observation of goiter, elevated 131 I uptake by the thyroid gland, positive TSH-receptor antibodies and elevated thyroid hormone levels.…”

Primary Hodgkin’s Disease of the Thyroid

“…In this case we have some evidence for the diagnosis of Hashimoto thyroiditis: pri mary hypothyroidism developed 6 months postoperatively and a positive perchlorate test at that moment was suggestive for the diagnosis [30], Also on pure morphological grounds the criteria of Hashimoto are ful filled: 'the histology of the thyroid is char acterized by diffuse lymphocytic infiltration, atrophy of the parenchymal cells and eosi nophilic change in some of the parenchymal cells' [31]. The immunohistochemical stain ing is not conclusive since Taylor and Burnes [32,33] reported a polyclonal immunoproliferation in Hashimoto's disease, Hodgkin's disease and reactive lymph node hyperplasia.…”

Sarcoidosis and Hashimoto’s Thyroiditis – A Chance Occurrence?

“…A 67Ga scan failed to show any patho logical uptake of the tracer in the lung, mediastinum and the thyroid gland. The diagnosis of Hashimoto's thyroiditis could now be considered established in our case by finding three out of five criteria set forth by Fisher et al [5] for diagnosis of the disease, namely, a firm and bosselated thyroid gland, circula tory antithyroid antibodies of the antimicrosomal and antithyroglobulin types and a radioisotopic scan of the thyroid gland showing an irregular distribu tion of the radioiodine. These diagnostic criteria were supported by the characteristic morphologic features found upon examining the excised thyroid nodule.…”