Hashimoto Thyroiditis

Alternative Names

  • HT
  • Hashimoto Struma
  • Hypothyroidism, Autoimmune
  • Thyroid Autoantibodies
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WHO-ICD-10 version:2010

Endocrine, nutritional and metabolic diseases

Disorders of thyroid gland

OMIM Number

140300

Mode of Inheritance

Autosomal dominant

Gene Map Locus

8q23-q24

Description

This condition is named after Dr. Hakaru Hashimoto who first described it in 1912. Hashimoto's thyroiditis is an organ specific autoimmune disease. This chronic inflammatory glandular autoimmune disease develops when the immune system attacks protein expressed on the surface of the thyroid gland. It is characterized by infiltration of the thyroid gland by lymphocytes causing gradual destruction of the gland. Hashimoto's thyroiditis patients have positive serum antibody titres to thyroperoxidase, while thyroglobulin antibodies are positive in approximately half of the patients. When both tests are used, approximately 95% of patients are detected with the disease.

Hashimoto's thyroiditis is the most common cause of thyroiditis, and as in the case with other autoimmune disorders, more common among middle aged women. The onset of the disease is slow, and it may take months or even years for the condition to be detected. Enlargement of the thyroid gland, local tenderness and thyroid function disorder are the common clinical features of the disease. Hashimoto's thyroiditis accounts for many of the enlarged thyroids formerly designated as adolescent or simple goiter.

The incidence of Hashimoto's thyroiditis seen in practice is unknown but is roughly equal to that of Graves' disease (on the order of 0.3 - 1.5 cases per 1,000 population per year). It is estimated to affect between 0.1% and 5% of all adults in Western countries. The disease is 15-20 times as frequent in women as in men. It occurs especially during the decades from 30 to 50, but may be seen in any age group, including children.

It is not uncommon for patients with autoimmune thyroid disease to have other coinciding autoimmune disorders. Approximately 25 percent of patients with Hashimoto's thyroiditis may develop pernicious anemia, diabetes, adrenal insufficiency, or other autoimmune diseases.

There is evidence of a genetic predisposition in the development of Hashimoto's thyroiditis. Hashimoto's thyroiditis is reported to occur in two forms: an atrophic variety, perhaps associated with HLA-DR3 gene inheritance, and a goitrous form associated with HLA-DR5.

Molecular Genetics

There is evidence of a genetic predisposition in the development of Hashimoto's thyroiditis. Hashimoto's thyroiditis is reported to occur in two forms: an atrophic variety, perhaps associated with HLA-DR3 gene inheritance, and a goitrous form associated with HLA-DR5.

Epidemiology in the Arab World

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Other Reports

Kuwait

El Kordy and Ashmawi (1995) published the case of a 13-year-old Kuwaiti girl with Hashitoxicosis (Graves disease and Hashimoto's thyroiditis) who was suffering from hypertension. The subject experienced Hashitoxicosis that occurs due to the comorbid association of Hashimoto's thyroiditis and Graves disease, and this diagnosis was confirmed through the occurrence of high titer of antithyroid antibodies and elevated levels of thyroxin. The patient underwent consequent analysis of hypertension which revealed the occurrence of right focal renal artery stenosis produced as a result of fibromuscular dysplasia. Furthermore, percutaneous transluminal angioplasty was employed resulting in the reduction of the blood pressure within 24 hours following angioplasty and this reduced level was preserved for 18 months without the use of any drugs. El Kordy and Ashmawi (1995) indicated that this case presented the first case of comorbidity between Hashitoxicosis and renal artery stenosis. [El Kordy, AM, Ashmawi, AW. Hashitoxicosis with renal artery stenosis. Kuwait Med J. 1995; 27(2):132-4.]

Kapila et al. (1995) conducted an eight year (1986-1993) retrospective analysis of 4,185 consecutive fine needle aspirates of the thyroid to confirm the idea which states that in Kuwait, chronic lymphotyic (Hashimoto's) thyroiditis (HT) occurs at an earlier age and that the superior percentage of its patients were represented with solitary nodules. Subjects were grouped into having diffuse goiter (DG), multinodular goiter (MNG), and solitary thyroid nodule (STN) based on clinical examination. Patients underwent diagnosis of fine needle aspirates as follicular neoplasm, carcinoma, Hashimoto's thyroiditis (HT) or other benign lesions of the thyroid. Throughout the study period, HT comprised 14.3% of all thyroid aspirates. 76.7% of patients were aged 16 to 35 years, with a majority of females, and the highest prevalence of HT was found in females aged 16 to 35 years. Kapila et al. (1995) found that with increasing age, the percentage of HT patients representing DG decreased while the percentage of subjects portraying MNG or STN enhanced. Furthermore, it was found that young patients portraying "cold" solitary nodules of the thyroid suffered from HT as a common cause rather than thyroid carcinoma.

Alfadhli and Nizam (2013) studied 22 Kuwaiti patients with Hashimoto thyroiditis and compared the spliced variants in the CTLA4 gene in these patients with those in 22 healthy controls. Patients with Hashimoto thyroiditis showed a reduced frequency of the N-CTLA4-292 variants. Alfadhli and Nizam (2013) concluded that the expression pattern of the CTLA4 gene could also be playing a role in autoimmunity.

Palestine

During the academic year 2001-2002, Mabrouk and Eapen (2004) examined the clinical and laboratory profile of 10,549 girls with Hashimoto's thyroiditis diagnosed in the Pediatric clinic of the School Health Department in Al Ain, United Arab Emirates (UAE). During the study period, 11 girls were diagnosed as having Hashimoto's thyroiditis including three Palestinians [For details, see also: United Arab Emirates > Mabrouk and Eapen (2004)].

Somalia

During the academic year 2001-2002, Mabrouk and Eapen (2004) examined the clinical and laboratory profile of 10,549 girls with Hashimoto's thyroiditis diagnosed in the Pediatric clinic of the School Health Department in Al Ain, United Arab Emirates (UAE). During the study period, 11 girls were diagnosed as having Hashimoto's thyroiditis including two Somalians [For details, see also: United Arab Emirates > Mabrouk and Eapen (2004)].

Sudan

During the academic year 2001-2002, Mabrouk and Eapen (2004) examined the clinical and laboratory profile of 10,549 girls with Hashimoto's thyroiditis diagnosed in the Pediatric clinic of the School Health Department in Al Ain, United Arab Emirates (UAE). During the study period, 11 girls were diagnosed as having Hashimoto's thyroiditis including one Sudanese [For details, see also: United Arab Emirates > Mabrouk and Eapen (2004)].

Syria

During the academic year 2001-2002, Mabrouk and Eapen (2004) examined the clinical and laboratory profile of 10,549 girls with Hashimoto's thyroiditis diagnosed in the Pediatric clinic of the School Health Department in Al Ain, United Arab Emirates (UAE). During the study period, 11 girls were diagnosed as having Hashimoto's thyroiditis including one Syrian [For details, see also: United Arab Emirates > Mabrouk and Eapen (2004)].

Tunisia

Hadj Kacem et al. (2003) analyzed polymorphic microsatellite markers around the SLC26A4 gene, which encodes pendrin, an apical transporter of iodide to the thyroid, to investigate the role of SLC26A4 in the genetic control of autoimmune thyroid diseases. Using case-control and family-based designs in a sample from Tunisia, Hadj Kacem et al. (2003) found evidence that SLC26A4 may be a susceptibility gene for autoimmune thyroid diseases, with varying contributions in Graves disease and Hashimoto thyroiditis.

United Arab Emirates

During the academic year 2001-2002, Mabrouk and Eapen (2004) examined the clinical and laboratory profile of 10,549 girls with Hashimoto's thyroiditis diagnosed in the Pediatric clinic of the School Health Department in Al Ain, United Arab Emirates (UAE). During the study period, 110 girls were identified to have enlargement of the thyroid gland either because of simple or adolescent goiter. Of these 110 female students, 11 (10%) were diagnosed as having Hashimoto's thyroiditis, on the basis of thyroid antibody tests. Four were UAE nationals, in addition to three Palestinians, two Somalians, one Syrian and one Sudanese national. Four patients gave family history of thyroid disease. On mental state examination, six patients showed features of depression and these patients were further evaluated using Hamilton depression rating scale. The scores suggested the severity of depression to be mild in three, moderate in two, and severe in one. Mabrouk and Eapen (2004) suggested that Hashimoto's thyroiditis should be suspected in all young people referred for evaluation of diffuse goiter.

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