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Hashimotos Thyroiditis Disease

Introduction
Introduction Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States. It is named after the first doctor who described this condition, Dr. Hakaru Hashimoto, in 1912. The thyroid glands of these patients were characterized by diffuse lymphocytic infiltration, fibrosis, parenchymal atrophy, and an eosinophilic change in some of the acinar cells.

What causes Hashimoto's thyroiditis?


Its a condition caused by inflammation of the thyroid gland. it is an autoimmune disease, which means that the body inappropriately attacks the thyroid gland-- as if it was foreign tissue. The underlying cause of the autoimmune process still is unknown. Hashimoto's thyroiditis tends to occur in families, and is associated with a clustering of other autoimmune conditions such as Type 1 diabetes , and celiac disease. Hashimoto's thyroiditis is 5- 10 times more common in women than in men and most often starts in adulthood.

Pathogenesis
a genetically conditioned defect in antigen-specific suppressor T-Cell with formation of auto antibodies; the latter include antibodies to TSH receptor, thyroid microsomes, thyroglobulin, T3, T4 and follicular cell membrane, as well as blocking antibodies to these groups. TSH receptor antibodies include thyroid-stimulating fractions (TSI) and growth-promoting fractions (TGI). TGI activities are more pronounced than TSI effects in this condition. the mechanism of thyroid injury is still uncertain; antibodydependentcell-mediatedcytotoxicity, complement-mediated cytotoxicity and cytotoxic T- Cells are implicated.

Clinical features
Signs and Symptoms : Fatigue Depression Modest weight gain Cold intolerance Excessive sleepiness Dry, coarse hair Constipation

Dry skin Muscle cramps Increased cholesterol levels Decreased concentration Vague aches and pains Swelling of the legs

If hypothyroidism becomes more severe : there may be puffiness around the eyes slowing of the heart rate drop in body temperature, heart failure. In its most profound form, severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a severely hypothyroid individual, a myxedema coma triggered by severe illness : surgery, stress , or traumatic injury. This condition requires hospitalization and immediate treatment with thyroid hormones given by injection.

How is Hashimoto's thyroiditis diagnosed?


1. 2. 3. 4. assess symptoms and complaints examine the neck, and history of family members Blood tests : if hypothyroidism is present, blood levels of thyroid hormones can be measured directly and are usually decreased BUT, in early hypothyroidism, the level of thyroid hormones (T3 and T4) may be normal. Therefore, the main tool for the detection of hyperthyroidism is the measurement of Thyroid-Secreting-Hormone TSH, that are secreted from pituitary gland. If decrease of thyroid hormone occurs, the pituitary gland reacts by producing more TSH and the blood TSH level increases in an attempt to encourage thyroid hormone production. the measurement of TSH should be elevated in cases of hypothyroidism

Treatment
treated with thyroid hormone replacement agents such as levothyroxine or desiccated thyroid extract A tablet taken once a day generally keeps the thyroid hormone levels normal.

In most cases, the treatment needs to be taken for the rest of the patient's life. it is recommended that the TSH levels be kept under 3.0 , As long as the patient's thyroid is active, the body will continue to attack it, and this can wreak havoc on the patient's TSH levels and symptoms.

Prognosis
If untreated for an extended period, Hashimoto's thyroiditis may lead to : 1. muscle failure 2.possible heart failure. 3.extremely rare condition associated with the thyroiditis is Hashimoto's encephalopathy. 4.A rare association is with lymphoma of the thyroid gland. Hashimoto's thyroiditis can disrupt growth in children and adolescents and therefore requires close growth monitoring. Growth hormone therapy may be required if the patient's stature is extreme enough.

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