Hashimoto thyroiditis (also known as lymphocytic thyroiditis 1 or chronic autoimmune thyroiditis 2) is a sub type of autoimmune thyroiditis. It is one of the commonest of all thyroid disorders.
Typically affects middle aged females (30-50 year age group with a F:M ratio of ~ 10-15:1).
Patients usually present with hypothyroidism +/- a goitre. However a very small proportion of cases (~5%) can present with hyperthyroidism (hashithyrotoxicosis). There is often a gradual painless enlargement of the thyroid gland during the initially phase with atrophy and fibrosis later on in the course.
There is autoimmunity to the thyroid gland which bears both humoral and cell mediated features. This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. May affect the thyroid gland in either a diffuse or focal manner. Cell populations include
- lymphocytic aggregates
- transformed follicular cells (Askanazy/oxyphilic/Hurthle cells)
Later stages show added fibrosis.
- antithyroglobulin antibodies - found in 55-90% of cases 2
- thyroid peroxidase antibodies (TPO) - found in 90-95% of cases 2
- Turner syndrome
- primary thyroid lymphoma 6
- Hashimoto encephalopathy (rare)
- Down syndrome
- Other auto immune disorders
It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending of the severity and phase of disease 1,5.
- a diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation 6.
- the presence of hypoechoic micronodules (1-6mm) with a surroundning echogenic septations is also considered to have a relatively high positive predictive value 3-4.
- colour Doppler study usually shows normal or decreased flow but occasionally there might be hypervascularity similar to thyroid inferno.
In some situations, large nodules may be present - see nodular Hashimoto thyroiditis 10.
- early stages - may show increased uptake
- late stages - single or multiple areas of reduced uptake (cold spots).
It was first described in 1912 by Hikaru Hashimoto, Japanense physician (1881-1934) 7 while working in Germany in 1912.
For ultrasound appearences consider
- lymphoma affecting thyroid gland
- papillary thyroid carcinoma
- sub acute granulomatous (de Quervain) thyroiditis
- 1. Langer JE, Khan A, Nisenbaum HL et-al. Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol. 2001;176 (3): 751-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Intenzo CM, Capuzzi DM, Jabbour S et-al. Scintigraphic features of autoimmune thyroiditis. Radiographics. 21 (4): 957-64. Radiographics (full text) - Pubmed citation
- 3. Yeh HC, Futterweit W, Gilbert P. Micronodulation: ultrasonographic sign of Hashimoto thyroiditis. J Ultrasound Med. 1996;15 (12): 813-9. J Ultrasound Med (abstract) - Pubmed citation
- 4. Set PA, Oleszczuk-raschke K, Von lengerke JH et-al. Sonographic features of Hashimoto thyroiditis in childhood. Clin Radiol. 1996;51 (3): 167-9. - Pubmed citation
- 5. Moon HJ, Kim EK, Kim MJ et-al. Lymphocytic thyroiditis on fine-needle aspiration biopsy of focal thyroid nodules: approach to management. AJR Am J Roentgenol. 2009;193 (4): W345-9. doi:10.2214/AJR.09.2413 - Pubmed citation
- 6. Takashima S, Matsuzuka F, Nagareda T et-al. Thyroid nodules associated with Hashimoto thyroiditis: assessment with US. Radiology. 1992;185 (1): 125-30. Radiology (abstract) - Pubmed citation
- 7. H. Hashimoto: Zur Kenntnis der lymphomatösen Veränderung der Schilddrüse (Struma lymphomatosa). Archiv für klinische Chirurgie, Berlin, 1912, 97: 219−248.
- 8. Takashima S, Fukuda H, Tomiyama N et-al. Hashimoto thyroiditis: correlation of MR imaging signal intensity with histopathologic findings and thyroid function test results. Radiology. 1995;197 (1): 213-9. Radiology (abstract) - Pubmed citation
- 9. Vitti P, Rago T, Mazzeo S et-al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves' disease from Hashimoto's thyroiditis. J. Endocrinol. Invest. 1996;18 (11): 857-61. Pubmed citation
- 10 .Anderson L, Middleton WD, Teefey SA et-al. Hashimoto thyroiditis: Part 2, sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. AJR Am J Roentgenol. 2010;195 (1): 216-22. doi:10.2214/AJR.09.3680 - Pubmed citation
- 11. Anderson L, Middleton WD, Teefey SA et-al. Hashimoto thyroiditis: Part 1, sonographic analysis of the nodular form of Hashimoto thyroiditis. AJR Am J Roentgenol. 2010;195 (1): 208-15. doi:10.2214/AJR.09.2459 - Pubmed citation
Synonyms & Alternative Spellings
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|Chronic autoimmune thyroiditis||✓|