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Hashimoto's Thyroiditis (Symptoms (Hair loss from an autoimmune…
Hashimoto's Thyroiditis
Symptoms
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Depression, dementia and memory loss
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Fatigue, constipation, dry skin and weight gain
Pathophysiology
The result is inadequate thyroid hormone production and secretion, although, initially both preformed thyroxine (T4) and T3 may 'leak' into the circulation from damaged cells
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Investigations
Thyroid autoantibodies
- Anti-thyroid peroxidase (anti-TPO)
- Anti-thyroglobulin (anti-Tg) antibodies
Thyroid ultrasound
- Usually not necessary in diagnosing Hashimoto's thyroiditis but it is useful in assessing thyroid size, echo texture and presence of nodules
TSH levels
- Sensitive test of thyroid function
- Levels are usually raised in hypothyroidism due to Hashimoto's thyroiditis
- Radioactive iodine uptake and sac are used to classify a nodule as hot or cold
- Cold = higher risk for malignancy & would need a fine-needle aspiration biopsy
Treatment Plan
Pharmacological
The dose should be titrated to the individual patient's needs. The aim is to restore a clinically and biochemically euthyroid state
Patients who are older than 50 years (and younger patients with cardiac disease) should be started on a low dose 25 micrograms (0.025 mg) per day.
Thyroid hormone replacement - orally administered Levothyroxine sodium, usually for life
Surgical
Indications include:
- A large goitre with obstructive symptoms
- Presence of a malignant nodule
- Presence of a lymphoma diagnosed on fine-needle aspiration
- Cosmetic reasons for unsightly, large goitres
Key Facts
Produces atrophic changes with regeneration that results in GOITRE FORMATION due to lymphocytic and plasma cell infiltration
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