Spectrum of Hashimoto's thyroiditis: clinical, biochemical & cytomorphologic profile.
Year: 2014
Type: article
Abstract: Hashimoto's thyroiditis (HT), first described in 1912 by Hakaru Hashimoto, is the most common autoimmune thyroid disease and the commonest cause of hypothyroidism1. With 5-10 times predominance over men, reported prevalence in women is 1-2 per cent2. HT or chronic lymphocytic or autoimmune thyroiditis is characterized by infiltration of lymphocytes and formation of Askanazy (Hurthle) cells. HT typically presents with hypothyroidism, painless enlargement of thyroid gland (goiter), or both; 90 per cent of HT patients have high anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibody. Cytomorphological diagnosis may be superior in children and initial stages of HT as antibody production may be confined to intrathyroidal lymphocytes or localized areas of HT3. Staii et al4 reported high prevalence (13.4%) of HT diagnosed by ultrasound-guided FNA (fine needle aspiration) analysis with 7.4 per cent euthyroid and 6 per cent clinically hypothyroid4. There was a lack of cytological correlation with TPO autoantibody positivity4. The hallmark of diagnosis of HT is the presence of TPO autoantibodies. Yet, only about half of the patients tested positive for anti-TPO in the euthyroid subgroup of HT4. Cytological diagnosis of HT may precede clinical diagnosis, inspite of the fact that in most organ specific autoimmune diseases humoral immunity heralds tissue infiltrative damage. Given the wide range of normal values for thyroid stimulating hormone (TSH) and the variability of presence of TPO autoantibodies in HT, it is conceivable that early Hashimoto's autoimmune process might be clinically missed. Moreover, subclinical and clinical hypothyroidism is associated with cardiovascular and neuropsychiatric morbidities, thus finding high prevalence of HT on cytology, especially in euthyroid patients is clinically significant. Most of HT patients are pre-menopausal women and the risk of poor obstetrical and foetal outcome is increased with even relatively mild or subclinical thyroxine deficiency.
Source: Europe PMC (PubMed Central)
Author: Debmalya Sanyal
Institution: KPC Medical College and Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2015278165