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Chronic thyroiditis (Hashimoto disease)

Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis; Chronic autoimmune thyroiditis; Lymphadenoid goiter - Hashimoto; Hypothyroidism - Hashimoto; Type 2 polyglandular autoimmune syndrome - Hashimoto; PGA II - Hashimoto

Chronic thyroiditis is caused by a reaction of the immune system against the thyroid gland. It often results in reduced thyroid function (hypothyroidism).

The disorder is also called Hashimoto disease.

The thyroid gland is located in the neck, just above where your collarbones meet in the middle.

Causes

Hashimoto disease is a common thyroid gland disorder. It can occur at any age, but is most often seen in middle-aged women. It is caused by a reaction of the immune system against the thyroid gland.

The disease begins slowly. It may take months or even years for the condition to be detected and for thyroid hormone levels to become lower than normal. Hashimoto disease is most common in people with a family history of thyroid disease.

In very rare cases, the disease may be related to other hormone problems caused by the immune system. It can occur with poor adrenal function and type 1 diabetes. In these cases, the condition is called type 2 polyglandular autoimmune syndrome (PGA II).

Sometimes, Hashimoto disease occurs as part of a condition called type 1 polyglandular autoimmune syndrome (PGA I), along with:

  • Poor function of the adrenal glands
  • Fungal infections of the mouth and nails
  • Underactive parathyroid gland

Symptoms

Symptoms of Hashimoto disease may include any of the following:

Exams and Tests

Laboratory tests to determine thyroid function include:

Imaging studies and fine needle biopsy are generally not needed to diagnose Hashimoto thyroiditis.

This disease may also change the results of the following tests:

  • Complete blood count
  • Serum prolactin
  • Serum sodium
  • Total cholesterol

Treatment

If you have findings of an underactive thyroid, you may receive thyroid replacement medicine.

Not everyone with thyroiditis or goiter has low levels of thyroid hormone. You may just need regular follow-up by a health care provider.

Outlook (Prognosis)

The disease stays stable for years. If it does slowly progress to thyroid hormone deficiency (hypothyroidism), it can be treated with thyroid replacement therapy.

Possible Complications

This condition can occur with other autoimmune disorders. In rare cases, thyroid cancer or thyroid lymphoma may develop.

When to Contact a Medical Professional

Call your provider if you develop symptoms of chronic thyroiditis.

Prevention

There is no known way to prevent this disorder. Being aware of risk factors may allow earlier diagnosis and treatment.

References

Amino N, Lazarus JH, De Groot LJ. Chronic (Hashimoto's) thyroiditis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 86.

Brent GA, Weetman AP. Hypothyroidism and thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 13.

Garber JR, Cobin RH, Gharib H; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028. PMID: 23246686 www.ncbi.nlm.nih.gov/pubmed/23246686.

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Thyroid enlargement - scintiscan

      Thyroid enlargement - scintiscan - illustration

      This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

      Thyroid enlargement - scintiscan

      illustration

    • Hashimoto's disease (chronic thyroiditis)

      Hashimoto's disease (chronic thyroiditis) - illustration

      Chronic thyroiditis (Hashimoto's disease) is a slowly developing persistent inflammation of the thyroid which frequently leads to hypothyroidism, a decreased function of the thyroid gland. Middle-aged women are most commonly affected.

      Hashimoto's disease (chronic thyroiditis)

      illustration

    • Thyroid gland

      Thyroid gland - illustration

      The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

      Thyroid gland

      illustration

      • Endocrine glands

        Endocrine glands - illustration

        Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

        Endocrine glands

        illustration

      • Thyroid enlargement - scintiscan

        Thyroid enlargement - scintiscan - illustration

        This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

        Thyroid enlargement - scintiscan

        illustration

      • Hashimoto's disease (chronic thyroiditis)

        Hashimoto's disease (chronic thyroiditis) - illustration

        Chronic thyroiditis (Hashimoto's disease) is a slowly developing persistent inflammation of the thyroid which frequently leads to hypothyroidism, a decreased function of the thyroid gland. Middle-aged women are most commonly affected.

        Hashimoto's disease (chronic thyroiditis)

        illustration

      • Thyroid gland

        Thyroid gland - illustration

        The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

        Thyroid gland

        illustration

      Review Date: 2/3/2016

      Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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