Unit 3 Autoimmunity
Part 4 Hashimoto’s Thyroiditis
Part 5 Grave’s Disease
Terry Kotrla, MS, MT(ASCP)BB
Hashimoto's Thyroiditis
 A type of autoimmune thyroid disease in which the
immune system attacks and destroys the thyroid gland.
 CHARACTERIZED BY HYPOTHYROIDSM.
 Thyroid helps set the rate of metabolism - the rate at
which the body uses energy.
 Hashimoto’s prevents the gland from producing enough
thyroid hormones for the body to work correctly.
 It is the most common cause of hypothyroidism.
 Have statistically increased risk of developing other
disorders: Diabetes, rheumatoid arthritis, TTP, SLE
Hashimoto's Thyroiditis
 Organ specific disease affecting the thyroid
gland.
 Can occur at any age, most often seen in women
30 to 40 years old,
 May be a genetic predisposition.
 Causes diffuse hyperplasia in the gland resulting
in development of a goiter.
 Thyroid autoantibodies are formed.
Symptoms
 Similar to those of hypothyroidism in general
 Often subtle and not specific.
 Become obvious as condition worsens
 The following are the most common symptoms. :
 Goiter (enlarged thyroid gland may cause a bulge in the neck)
 Fatigue
 Modest weight gain
 Cold intolerance
 Excessive sleepiness.
 Vague aches and pains
 Swelling of the legs
Thyroid
 Thyroid hormones are produced by the thyroid gland. This gland is located in
the lower part of the neck, below the Adam's apple.
 The gland wraps around the windpipe (trachea) and has a shape that is similar
to a butterfly - formed by two wings (lobes) and attached by a middle part
(isthmus).
 A goiter forms due to inflammation of the thyroid.
Goiter
 This enlargement is due to the inflammatory cells which destroy
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thyroid cells, resulting in long term scarring.
When the cells are damaged they cease thyroid hormone production,
resulting in hypothyroidism
A goiter only needs to be treated if it is causing symptoms.
The enlarged thyroid can be treated with radioactive iodine to shrink
the gland or with surgical removal of part or all of the gland
(thyroidectomy).
Small doses of iodine (Lugol's or potassium iodine solution) may help
when the goiter is due to iodine deficiency.
Laboratory Testing
 Routine thyroid function tests to confirm that a patient has an
underactive thyroid gland.
 Thyroid stimulating hormone (TSH) - high
 Free T4 (thyroxine) –low but may be normal early in disease
 Anti-thyroid antibodies produced and attack specific portions
of the thyroid cells which pinpoint Hashimoto's thyroiditis as the
cause of the hypothyroidism.
 Anti-microsomal antibodies
 Anti-thyroglobulin antibodies
 The anti-microsomal antibody test is much more sensitive than the
anti-thyroglobulin, therefore some doctors use only the former
blood test.
 Thyroid autoantibodies blood tests are high in about 95% of
patients with Hashimoto's thyroiditis, but are not diagnostic.
Treatment
 Thyroid hormone replacement.
 Spontaneous remissions have occurred.
Graves’ Disease - Thyrotoxicosis
 Autoimmune disease
 Antibodies attack thyroid gland causing overproduction
of thyroxine.
 Thyroxine greatly increases the metabolic rate.
 Most common cause of severe HYPERTHYROIDISM
 Can occur in children and adolescents but women more
susceptible, occurs most frequently between 30 and 40
years of age.
 Genetic link suspected.
Graves’ Disease
 Diagnosis may be straightforward, since the "classic face"
with its triad of
 hyperthyroidism
 goiter
 exophthalmos
 Goiter is usually symmetric, smooth, and nontender
 The hyperthyroid state can cause a wide variety of
multisystem derangements that often result in diagnostic
confusion.
Exophthalmos
 Exophthalmos, also called proptosis, is a characteristic
finding in thyroid eye disease, and has been reported to
occur in 34% to 93% of patients
Signs Symptoms
 Causes a number of symptoms
 Nervousness and increased activity
 fast heartbeat
 fatigue
 moist skin
 heat intolerance
 shakiness
 anxiety
 increased appetite
 weight loss
 insomnia.
 Have at least one of the following: goiter, bulging eyes, or
raised areas of skin over the shins.
Laboratory Testing
 Presence of thyroid-stimulating hormone
receptor antibody, causes release of thyroid
hormones.
 Key findings are
 Elevated total and free T3 (triiodothyronine)
 Elevated T4 (thyroxine
 Thyroid stimulating hormone (TSH) is reduced
due to antibody stimulation of the thyroid.
Treatment
 Medication.
 Radioiodine therapy to destroy the thyroid.
 Surgical removal of thyroid
The End
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