HASHIMOTO’S THYROIDITIS, PRESENTING PATTERNS IN SULAIMANI

Authors

  • Faruk H. Faraj Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Ronak I. Mohiadeen Maternity Teaching Hospital, Sulaimai Directorate of Health, Kurdistan Region, Iraq.
  • Aween B. Majed Surgical Teaching Hospital, Sulaimani Directorate of Health, Kurdistan Region, Iraq.
  • Dara A. Mohammed College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10251

Keywords:

Hashimoto’s thyroiditis, autoimmune thyroiditis, autoimmune thyroiditis with the anti-TPO antibody

Abstract

Background 

Hashimoto’s thyroiditis (HT) is a common chronic autoimmune thyroid disease, affecting mostly young and middle-aged females. It causes painless, firm, diffusely enlarged thyroid gland. The clinical presentations and thyroid status are variable. The anti-thyroid autoantibodies and fine-needle aspiration (FNA) cytology with lymphocytic infiltration with Hurthle’s cells are pathognomonic.

Objectives 

To assess the pattern of Hashimoto’s thyroiditis in Sulaimani city, investigating the patients’ characteristics, clinical presentations, thyroid status and diagnosis and if these are mosaic, i.e. a mess or proper and organized like Messi.

Patients and Methods

A cross-sectional, descriptive study was carried out in Sulaimani Teaching Hospital, Iraq, from October 2014, to October 2015. The study enrolled eighty patients with Hashimoto’s thyroiditis.

Results

The mean age of the patients was 36.7 years. There was only one male patient. Only a quarter of patients had weight gain, but more than that (30%) had weight loss. The firmly diffuse enlarged gland was found in 64 (80%) patients. Over one-third of patients (36.25%) had high ESR. The majority (92.5%) had high anti-thyroid peroxidase antibodies. Variable thyroid status was detected, slightly over half of them were hypothyroid, 30 (37.5%) patients had euthyroid status, and 7 (8.75%) were in hyperthyroid status. Ultrasound scan revealed; hypo-echogenicity (87.5%), enlarged thyroid gland (82.5%), increased vascularity (52.5%) and psuedonodules in (85%) of the patients. Seventy-six patients (95%) had lymphocytic infiltration, and 58 (72.5%) had Hürthle cells. 

Conclusion

Hashimoto’s thyroiditis has variable clinical presentations and thyroid status, but it causes: Hypothyroidism, it is an Autoimmune disease, mainly affect women (sex distribution), of Middle age, with Enlarged thyroid gland, with characteristics ultrasound Scan findings, with raised Serum antibodies and characteristic lymphocytic cell Infiltration, therefore, HAS MESSI.

References

-Anca Staii, Sara Mirocha. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state. Thyroid research 2010.3:11-17 DOI: https://doi.org/10.1186/1756-6614-3-11

-Blair A. Wormer,Christopher R. Hashimoto’s thyroiditis: Outcome of surgical research for patients with thyromegaly and compressive symptoms. The American Journal of Surgery (2011)201,416-419

-Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity reviews. 2014 May 31; 13(4):391-7. DOI: https://doi.org/10.1016/j.autrev.2014.01.007

-McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012 Oct 1; 42(2):252-65. DOI: https://doi.org/10.1007/s12020-012-9703-2

-Golden SH, Robinson KA, Saldanha I. Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. The Journal of Clinical Endocrinology & Metabolism. 2009 Jun; 94(6):1853-78. DOI: https://doi.org/10.1210/jc.2008-2291

-Hilal Bektas Uysal, Mediha Ayhan. Autoimmunity affects health-related quality of life in patients with Hashimoto’s thyroiditis.KJMS (2016)32,427-433 DOI: https://doi.org/10.1016/j.kjms.2016.06.006

-Takashi Akamizu ,Nobuyuki Amino et al. Hashimoto’s Thyroiditis..Endotext-NCBI ,Bookshelf (updated 2017 Jul 17.MD Text,com,Int;2002-2019

-Zaletel K. Determinants of thyroid autoantibody production in Hashimoto’s thyroiditis. Expert review of clinical immunology. 2007 Mar 1;3(2):217-23.. DOI: https://doi.org/10.1586/1744666X.3.2.217

-Gasbarri A, Sciacchitano S, Marasco A, et al Detection and molecular characterisation of thyroid cancer precursor lesions in a specific subset of Hashimoto's thyroiditis. British journal of cancer. 2004 Sep 13; 91(6):1096-104. DOI: https://doi.org/10.1038/sj.bjc.6602097

- LiVOLSI VA. The pathology of autoimmune thyroid disease: a review. Thyroid. 1994; 4(3):333-9. DOI: https://doi.org/10.1089/thy.1994.4.333

-Garber JR, Cobin RH, Gharib H,et al; the American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec 1;22(12):1200-35. DOI: https://doi.org/10.1089/thy.2012.0205

-Harvey AM, Truong LD, Mody DR. Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta cytologica. 2012 Jul 25;56(4):352-60.. DOI: https://doi.org/10.1159/000338738

-RK Marwaha, ANAndon. Evaluation of the role of Ultrasonography in Diagnosis of Autoimmune thyroiditis in Goiterous children.Indian Pediatrics. April,2008.V0l. 45- 279-284

-McConahey WM, Keating FR Jr, On the increasing occurrence of Hashimoto’s thyroiditis. J Clin Endocrinol Metab. 1962 May; 22 (5): 542/4. DOI: https://doi.org/10.1210/jcem-22-5-542

-Jacobson DL, Gange SJ, Rose NR. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clinical immunology and immunopathology. 1997 Sep 1; 84(3):223-43. DOI: https://doi.org/10.1006/clin.1997.4412

-Delemer B, Aubert JP, Nys P, An observational study of the initial management of hypothyroidism in France: the ORCHIDÉE study. European journal of endocrinology. 2012 Dec 1; 167(6):817-23. DOI: https://doi.org/10.1530/EJE-11-1041

-Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011; 99:39–51 DOI: https://doi.org/10.1093/bmb/ldr030

-McManus C, Luo J,Sippel R.Is thyroidectomy in patients with Hashimoto's thyroiditis more risky? Journal of surgical research. 2012 Dec 31; 178(2):529-32 DOI: https://doi.org/10.1016/j.jss.2012.09.017

–Akas G, et al. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto’s thyroiditis. Rev Assoc Med Bras .2017Dec:63(12),1065-1066 DOI: https://doi.org/10.1590/1806-9282.63.12.1065

- ErdenS. Et al .Acute phase reactants in Hashimoto’s thyroiditis. Int Immunopharmacol Vol 8, Issue 13-14,20 Dec, 2008 Pages 1863-1865 DOI: https://doi.org/10.1016/j.intimp.2008.09.007

-Wasniewska M, Corrias A, Salerno M,. Outcomes of children with hashitoxicosis. Horm Res Paediatr 2012;77:36-40. DOI: https://doi.org/10.1159/000334640

-Wormer BA, McHenry CR. Hashimoto's thyroiditis: Outcome of surgical resection for patients with thyromegaly and compressive symptoms. The American Journal of Surgery. 2011 Mar 31; 201(3):416-9 DOI: https://doi.org/10.1016/j.amjsurg.2010.08.021

-Roitt IM, Doniach D, Campbell PN, Auto-antibodies in Hashimoto's disease (lymphadenoid goitre). The Lancet. 1956 Oct 20; 268(6947):820-1. DOI: https://doi.org/10.1016/S0140-6736(56)92249-8

-Gordin A, Maatela J, Miettinen A, Serum thyrotrophin and circulating thyroglobulin and thyroid microsomal antibodies in a Finnish population. Acta endocrinological. 1979 Jan 1;90(1):33-42. DOI: https://doi.org/10.1530/acta.0.0900033

-Tunbridge WM, Evered DC, Hall R, The spectrum of thyroid disease in a community: the Whickham survey. Clinical endocrinology. 1977 Dec 1;7(6):481-93. DOI: https://doi.org/10.1111/j.1365-2265.1977.tb01340.x

-Rose NR. Autoimmune escalation: through the crystal ball. Clin Exp Immunol 2007;147:9.

-Hutfless S, Matos P, Talor MV, Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease. The Journal of Clinical Endocrinology & Metabolism. 2011 Jun 29;96(9):E1466-71. DOI: https://doi.org/10.1210/jc.2011-0228

-Rotondi M, De Martinis L, Coperchini F,. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto's thyroiditis. European Journal of Endocrinology. 2014 Jul 1; 171(1):31-6. DOI: https://doi.org/10.1530/EJE-14-0147

- Stephine L.Lee,MD,PhD,ECNU.Hashimoto’s thyroiditis & giraffe pattern on Thyroid ultrasound. Endocrine today.May 2015

-Pandit AA, Vijay Warde M, Menon PS. Correlation of the number of intrathyroidal lymphocytes with anti-microsomal antibody titer in Hashimoto's thyroiditis. Diagnostic cytopathology. 2003 Feb 1;28(2):63-5. DOI: https://doi.org/10.1002/dc.10235

-Serkan Yener, Firat Bayraktar et al. Roles of ultrasound and power Doppler ultrasound for the diagnosis of Hashimoto's thyroiditis in anti-thyroid marker positive euthyroid subjects. Quant Imaging Med Surgery. 2014 August; 4(4): 232-238

-Tötterman TH, Mäenpää J, Gordin A, Blood and thyroid-infiltrating lymphocyte subclasses in juvenile autoimmune thyroiditis. Clinical and experimental immunology. 1977 Nov; 30(2):193.

-Cipolla C, Sandonato L, Graceffa G. Hashimoto thyroiditis coexistent with papillary thyroid carcinoma. Am Surg 2005; 71:874. DOI: https://doi.org/10.1177/000313480507101018

-Singh B, Shaha AR, Trivedi H, Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery. 1999 Dec 31;126(6):1070-7. DOI: https://doi.org/10.1067/msy.2099.101431

Published

2020-09-21

How to Cite

1.
Faraj F, Mohiadeen R, Majed A, Mohammed D. HASHIMOTO’S THYROIDITIS, PRESENTING PATTERNS IN SULAIMANI. JSMC [Internet]. 2020 Sep. 21 [cited 2024 Jun. 14];10(2):149-56. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10251

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