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Chronic thyroiditis (Hashimoto disease)

Chronic thyroiditis is swelling (inflammation) of the thyroid gland that often results in reduced thyroid function (hypothyroidism ).

Alternative Names

Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis

Causes

Chronic thyroiditis or 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. Chronic thyroiditis is most common in women and in people with a family history of thyroid disease.

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

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

Symptoms

Symptoms of Hashimoto disease may include any of the following:

  • Constipation
  • Difficulty concentrating or thinking
  • Dry skin
  • Enlarged neck or presence of goiter
  • Fatigue
  • Hair loss
  • Heavy and irregular periods
  • Intolerance to cold
  • Mild weight gain
  • Small or shrunken thyroid gland (late in the disease)

Exams and Tests

Laboratory tests to determine thyroid function include:

Imaging studies 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

A lack of thyroid hormone may develop. You may receive thyroid hormone replacement therapy (levothyroxine) if your body is not producing enough of the hormone. Or, you may receive it if you have signs of mild thyroid failure (such as elevated TSH). This condition is also known as subclinical hypothyroidism.

If there is no evidence of thyroid hormone deficiency, you may just need to be seen regularly 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 health care 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

Brent GA, Davies TF. Hypothyroidism and thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, et al. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 13.

Garberg JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 22;12:1200-1235.

Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 233.

Updated: 5/10/2014

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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