Hashimoto's Thyroiditis
Course of the Disease





Hashimoto's thyroiditis begins as a gradual enlargement of the thyroid gland and gradual development of hypothyroidism. It is often discovered by the patient, who finds a fullness of the neck or a new lump while self-examining because of a vague discomfort in the neck. Perhaps most often, it is found by the physician during the course of an examination for some other complaint.

In some instances the thyroid gland may enlarge rapidly; rarely, it is associated with dyspnea or dysphagia from pressure on structures in the neck, or with mild pain and tenderness. Rarely, pain is persistent and unresponsive to medical treatment and requires medical therapy or surgery. The goiter of Hashimoto's thyroiditis may remain unchanged for decades, but usually it gradually increases in size. Occasionally the course is marked by symptoms of mild thyrotoxicosis, especially during the early phase of the disease. Symptoms and signs of mild hypothyroidism may be present in 20% of patients when first seen(41), or commonly develop over a period of several years. Progression from subclinical hypothyroidism (normal FT4 but elevated TSH) to overt hypo-thyroidism occurs in a certain fraction (perhaps 3-5%) each year. Eventually thyroid atrophy and myxedema may occur. This assertion is based on the clinical observation that patients with Hashimoto's thyroiditis often develop myxedema, and the knowledge that patients with myxedema due to atrophy of the thyroid have a high incidence of TG Ab in their serum. The disease frequently produces goitrous myxedema in young women, and we have occasionally observed a goitrous and hypothyroid patient who went on to develop thyroid atrophy.

Generally the progression from euthyroidism to hypothyroidism has been considered an irreversible process due to thyroid cell damage and loss of thyroidal iodine stores. However, it is now clear that up to one-fourth of patients who are hypothyroid may spontaneously return to normal function over the course of several years. This sequence may reflect the initial effect of high titers of thyroid stimulation blocking antibodies which fall with time and allow thyroid function to return.

Within the past few years, several unusual syndromes believed to be associated with or part of the clinical spectrum of Hashimoto's thyroiditis have been described. Occasional patients develop amyloid deposits in the thyroid. Shaw et al. described five patients with a relapsing steroid-responsive encephalopathy including episodes like stroke and seizures, high CSF protein, abnormal EEG, and normal CAT scans. Khardon et al. described a steroid responsive lymphocytic interstitial pneumonitis in four patients. It remains uncertain how these illnesses relate to lymphocytic thyroiditis, which has until now been largely identified as an organ specific disease.

Hashimoto's thyroiditis and hypothyroidism are associated with Addison's disease, diabetes mellitus, hypogonadism, hypopara-thyroidism, and pernicious anemia. Such combinations are described as the polyglandular failure syndrome. Two forms of polyglandular autoimmunity have been recognized. In the Type I syndrome patients have hypoparathyroidism, muco-cutaneous candidiasis, Addison's disease, and occasionally hypothyroidism. Type II, more frequent, often includes familial associations of diabetes mellitus, hypothyroidism, hypoadrenalism, and occasionally gonadal or pituitary failure. In these syndromes, antibodies reacting with the affected end organs are characteristically present. Vitiligo, hives, and alopecia are associated with thyroiditis. There is also a clear association with primary and secondary Sjogren's syndrome. Some patients appear to start with Hashimoto's thyroiditis, and progress with time to the picture of Riedel's thyroiditis including the frequently-associated retroperitoneal fibrosis.

Musculoskeletal symptoms, including chest pain, fibrositis, and rheumatoid arthritis, occur in one-quarter of patients, and of course, any of the musculoskeletal symptoms of hypothyroidism may likewise occur.

It has been suggested that thyroiditis predisposes to vascular disease and coronary occlusion. Abnormally elevated titers of thyroid autoantibodies and the morphologic changes of thyroiditis are said to occur with an increased frequency among patients with coronary artery disease. Mild hypothyroidism(51) associated with asymptomatic atrophic thyroiditis could predispose patients to heart disease. Others have failed to find increased TG Ab in-patients with coronary artery disease or increased coronary disease in association with thyroiditis.

In children, retarded growth, retarded bone age, decreased hydroxyproline excretion, and elevated cholesterol levels may be seen. Hashimoto's Thyroiditis Read more about it.
Hashimoto's Thyroiditis Table of Contents



THYROID DISEASE MANAGER "offers an up-to-date analysis of thyrotoxicosis, hypothyroidism, thyroid nodules and cancer, thyroiditis, and all aspects of human thyroid disease and thyroid physiology. It provides physicians, researchers, and trainees (as well as patients) around the world with an authoritative, current, complete, objective, free, and down-loadable source on the thyroid. This website contains a newly revised version of the textbook "The Thyroid and its Diseases," and much supplementary information, all directed toward helping physicians care for their patients with thyroid problems."

The Merck Manual of Diagnosis and Therapy "Thyroid disorders include euthyroid goiter, euthyroid sick syndrome, hyperthyroidism, hypothyroidism, thyroiditis, and thyroid cancers. Discussion of the synthesis and physiology of thyroid hormones and of the laboratory testing of thyroid function are prerequisites to a thorough understanding of these disorders." Site describes each condition in detail as well as signs, symptoms & treatment.

Hashimoto's Disease: Hypothyroidism and Memory Etiology and symptoms of hypothyroidism, especially caused by the autoimmune disease Hashimoto's thyroiditis including effects on memory. Personal story, links and information on nutritional supplements that helps with cognitive deficits.

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