Chronic thyroiditis (Hashimoto's disease) [http://www.healthanswers.com/health_answers/search_get_answer/index.htm] This sites server will not allow direct access to the disease pages. When you reach the site select the letter "C" from the top of the index. Then select "Chronic thyroiditis" from the index. The information provided includes Alternative names; Definition; Causes, incidence, and risk factors; Prevention; Symptoms; Signs and tests; Treatment; Expectations (prognosis); and Complications. The presentation is concise and well written. There are many links to additional information at all levels, for instance how a caregiver may prepare a child of, say, 8 years to have his blood drawn for a test. HealthAnswers from Orbis Broadcast Group, Interactive Media, presents this information and lists several of its sources including medical associations and Medline. The pages are updated frequently, and communication with the service is invited through the links provided.
Hypothyroidism [http://www.rxmed.com/illnesses/hypothyroidism.html] This patient handout from RXmed concisely describes this common consequence of Hashimoto's thyroiditis; its causes, symptoms, risk factors, therapy and prognosis. Neither this page nor its site is dated or attributed, but RXMed's homepage is linked to Coalition of Family Physicians of Ontario.
For a brief, peer reviewed discussion of diagnosis and treatment of
hypothyroidism, including Hashimoto's, see "Hematologic, Electrolyte, and
Metabolic Disorders: Hypothyroidism,"
University of Iowa Family Practice Handbook, 3rd Edition, Chapter
5, James Schlichtmann, M.D. and Mark A. Graber, M.D., Department of Family
Medicine, University of Iowa.
Important
information for thyroid patients [http://www.thyroid-fed.org/intro/patients.html]
This page from Thyroid Foundation International provides a symptom questionnaire
to aid in diagnosis of hypothyroidism. Its copyright date is 1988.
ROLE OF FAS IN HASHIMOTO'S THYROIDITIS. SCIENCE NEWS DIGEST FOR PHYSICIANS AND SCIENTISTS February 97 [http://www.bioscience.org/news/scientis/hashimo.htm] See this page for a photo image of a goiter caused by Hashimoto's thyroiditis. The associated article is for professionals knowledgeable about the biochemistry of the immune system. This Digest is from Frontiers in Bioscience, a nonprofit online journal for and by scientists that is cited in Medline, Chem Abstracts and Biosis.
Thyroid Disease. [http://thyroid.miningco.com/] From this page select "A Basic Introduction" for a page of annotated links to additional introductory information. Mary Shomon who authors this site is a communications consultant and writer who has thyroid disease and has taken a special interest in finding and disseminating information about it. Her personal page with a short bio is linked to these pages which consist of a frequently updated annotated Webliography of links and short essays of personal experience and opinion. Ms Shomon consults Thyroid Society for Education & Research, Thyroid Foundation of America. CDC, alternative medicine expert Dr. Andrew Weil and others in forming her opinion about some topics presented here. This site is presented by Miningcompany which screens and trains site authors for 500 various topics.
To Confirm the Clinical Diagnosis [http://home.ican.net/~thyroid/Guides/HG02.html] is also about the tests used. Thyroid Foundation of Canada presents this health guide which was revised in October of 1994.
AACE Clinical Practice Guidelines for Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. [http://www.aace.com/clin/guides/thyroid_guide.html] A task force of the American Association of Clinical Endocrinologists has assembled these guidelines. The Web page is copyrighted in 1996 and well attributed, with the task force members listed and its references cited.
Treatment
Guidelines for patients with thyroid nodules and well-differentiated thyroid
cancer
[http://www.ama-assn.org/sci-pubs/journals/archive/inte/vol_156/no_19/60162.htm]
These guidelines are by Peter A. Singer, M.D., David S. Cooper, M.D., Gilbert
H. Daniels, M.D., Paul W. Ladenson, M.D.,Francis S. Greenspan, M.D.,
Elliot G. Levy, M. D., Lewis E. Braverman, M.D., Orlo H. Clark, M.D.,
I. Ross McDougall, M. B., Ch.B., Ph.D., Kenneth V. Ain, M. D., Steven G.
Dorfman, M.D., a Standards of Care committee of the American
Thyroid Association. They are published in Archives of Internal
Medicine 156: 2165-2172, 1996 and appear on the website of the American
Medical Association.
AACE Clinical Practice Guidelines for the Diagnosis and Management of Thyroid Nodules. [http://www2.nsysu.edu.tw/hclam/nodule.htm] These Guidelines were assembled by a task force of the American Association of Clinical Endocrinologists. The most recent Reference listed is to the publication of the Hyper- and Hypothyroidism Guidelines, above, in Endocrinology Practice in 1995. Neither that article nor that journal is indexed in MEDLINE.
Sources for doctor recommendations include The Best Doctors in America. Northeast Region, by Gregory W. Smith and Steven W. Naifeh, Woodward/White, 1996-97, which is reproduced, in part, in special issues of regional magazines such as "Top Docs" in New Jersey Monthly, Morristown, NJ. November, 1998, 72-. For more information about a particular physician, you may want to look in your region's Questionable Doctors Disciplined by State and Federal Governments by Sidney Wolfe, Kathryn M. Franklin, Phyllis McCarthy, et al,Public Citizen Health Research Group, 1998, for offenses ranging from overcharging to criminal convictions.
For more information about selecting a doctor visit the American Autoimmune Related Disease Association's (AARDA) Website.
Thyroid Disease in Childhood [http://home.ican.net/~thyroid/Guides/HG09.html] gives an overview of thyroid diseases that affect infants and children, and discusses diagnostic, therapeutic and emotional considerations. Thyroid Foundation of Canada presents this health guide including contact information for the author, published in March of 1993.
Click here to see abstracts of related articles from the medical literature
on Children.
Click here to see suggested videos
for children with questions about their disease.
Title: Thyroiditis. A disease with many faces. [Review] [8 refs]
Authors: Schubert MF. Kountz DS .
Institution: Section of General Internal Medicine, Temple University
School of Medicine, Philadelphia, USA.
Source: Postgraduate Medicine. 98(2):101-3, 107-8, 112, 1995 Aug.
Country of Publication: United States
Abstract:
Inflammatory conditions of the thyroid are commonly
encountered in clinical practice. Older and middle-aged women are most
often affected, and the clinical course may be acute, subacute, or chronic.
Differentiating the various forms of thyroiditis can be difficult, because
they often mimic other disease processes and each other. Diagnosis requires
an awareness of the distinguishing characteristics of each type of thyroiditis
as well as the overlapping features. [References: 8]
Title: The epidemiology of thyroid disease and implications for screening.
[Review] [142 refs]
Authors: Wang C. Crapo LM .
Institution: Department of Medicine, Stanford University School of
Medicine, California, USA.
Source: Endocrinology & Metabolism Clinics of North America. 26(1):189-218,
1997 Mar.
Abstract
The burden of thyroid disease in the general population is enormous.
As many as 50% of people in the community have microscopic nodules, 3.5%
have occult papillary carcinoma, 15% have palpable goiters, 10% demonstrate
an abnormal thyroid-stimulating hormone level, and 5% of women have overt
hypothyroidism or hyperthyroidism. Despite this high prevalence of thyroid
disease, screening for these disorders is not recommended by any major
health agency. This article explores the epidemiologic issues surrounding
this complex problem by analyzing prevalence, incidence, and mortality
data from a worldwide variety of sources. [References: 142]
Title: Prevalence of thyroid antibodies among healthy middle-aged
women. Findings from the thyroid study in healthy women.
Authors:Massoudi MS. Meilahn EN. Orchard TJ. Foley TP Jr. Kuller LH.
Costantino JP. Buhari AM .
Institution: University of Pittsburgh Graduate School of Public Health,
PA, USA.
Source: Annals of Epidemiology. 5(3):229-33, 1995 May.
Abstract:
Autoimmune thyroiditis is the most common cause
of subclinical hypothyroidism in North America, is more common in women
than men, and is a risk factor for the development of coronary heart disease
(CHD). We measured thyroid-stimulating hormone (TSH) and two thyroid antibodies,
thyroid peroxidase and thyroglobulin, in stored sera of the participants
(aged 44 to 54 years) of the Healthy Women Study. We selected 254 samples
from the premenopausal baseline examination in 1983 to 1985 and from a
follow-up examination that occurred an average of 5.7 years later (range,
3 to 7.7 years). At follow-up, 95 women remained premenopausal, 98 had
ceased menstruating for at least 12 months, and 61 were taking postmenopausal
hormone therapy. Overall, the prevalence of the thyroid antibodies in this
healthy population was high at both time points (21 to 26%). Women with
antibodies had higher TSH concentrations than did those with no antibodies
(2.68 +/- 1.3 versus 1.51 +/- .73 mU/L, P < 0.001); this relationship
was statistically significant even after excluding those with subclinical
hypothyroidism (TSH > 6.0 mU/L). TSH and antibody levels did not differ
by menopausal status or hormone therapy use at follow-up. Given the high
prevalence of thyroid antibodies among healthy middle-aged women, long-term
follow-up is warranted to ascertain whether the presence of antibodies
is associated with subsequent excess risk of disease, in particular, CHD.
Title: Ten-year follow-up study of thyroid function in euthyroid
patients with simple goiter or Hashimoto's thyroiditis.
Authors: Sato A. Aizawa T. Koizumi Y. Komiya I. Ichikawa K. Takemura
Y. Yamada T .
Institution: Department of Medicine, School of Medicine, Dokkyo University,
Koshigaya Hospital, Koshigaya.
Source: Internal Medicine. 34(5):371-5, 1995 May.
Abstract:
In an attempt to study the natural course of Hashimoto's
thyroiditis and simple goiter, 74 euthryroid patients with Hashimoto's
thyroiditis and 212 patients with simple goiter were followed for 10 years.
In 204 patients with simple goiter (96.2%) it remained as a simple goiter
throughout the observation period, whereas 8 patients (3.8%) later had
Hashimoto's thyroiditis as evidenced by the appearance of circulating thyroid
autoantibodies. These 8 patients had HLA typing significantly different
from that of control subjects. None of the patients with simple goiter
had hyperthyroid Graves' disease despite the fact that 17.5%
of those patients had mild to moderate exophthalmos with either Moebius'
sign or von Graefe's sign. In contrast, 12 patients with Hashimoto's thyroiditis
(16.2%) had exophthalmos with Moebius' sign and/or von Graefe's sign, and
4 of 12 such patients later had hyperthyroid Graves' disease. TSH binding
inhibitory immunoglobulin was detected in 3 of 4 such patients with hyperthyroid
Graves' disease. Forty-nine patients with Hashimoto's thyroiditis (66.2%)
still remained euthyroid but 20 of those (27.0%) turned into hypothyroidism
during the 10-year follow-up.
Title: Outcome of hypothyroidism caused by Hashimoto's thyroiditis.
Authors: Comtois R. Faucher L. Lafleche L .
Institution: Department of Medicine, Notre-Dame Hospital, University
of Montreal, Quebec.
Source: Archives of Internal Medicine. 155(13):1404-8, 1995 Jul 10.
Abstract:
BACKGROUND: Hypothyroidism is a common condition
that is frequently irreversible and requires lifelong thyroid replacement
therapy.
OBJECTIVE: To assess the incidence and factors that
can predict reversibility of hypothyroidism caused by Hashimoto's thyroiditis.
METHODS: We studied 79 patients in whom Hashimoto's
thyroiditis was diagnosed according to suggestive cytologic features and/or
the presence of thyroid antibodies (antimicrosomal antibody titer, > or
= 1:1600; antiglobulin antibody titer, > or = 1:400). All patients were
initially hypothyroid (serum total thyroxine level, 83.5 +/- 28.6 nmol/L
[6 +/- 2 micrograms/dL]; thyrotropin level, 24.7 +/- 28.3 mU/L). Levothyroxine
sodium was then administered for 1 year to normalize results of thyroid
blood tests. Thereafter, the treatment was stopped for 3 weeks and serum
thyrotropin and total thyroxine concentrations were determined.
RESULTS: After withdrawal of levothyroxine treatment,
thyroid blood tests showed that the degree of hypothyroidism worsened in
20 patients, remained unchanged in 40, and improved in 19. Nine patients
(11.4%) did show normalization of the thyroid blood tests. Before
treatment, the presence of the following in a patient--of a goiter that
is 35 g or larger, thyrotropin levels greater than 10 mU/L, and an anamnestic
familial incidence of thyroid disease--was clearly associated with an increased
incidence of recovery of normal thyroid function (relative risk, 5.4; 95%
confidence interval, 2.8 to 10.7; P < .0002).
CONCLUSIONS: Our results confirm that hypothyroidism
caused by Hashimoto's thyroiditis is not always permanent. The presence
of a larger goiter and high thyrotropin levels at the time of diagnosis,
associated with a familial incidence of thyroid disease, may be related
to an increased incidence of hypothyroidism remission.
Title: Clinical significance of measurements of antithyroid antibodies
in the diagnosis of Hashimoto's thyroiditis: comparison with histological
findings.
Authors: Kasagi K. Kousaka T. Higuchi K. Iida Y. Misaki T. Alam MS.
Miyamoto S. Yamabe H. Konishi J .
Institution: Department of Nuclear Medicine, Kyoto University School
of Medicine, Japan.
Source: Thyroid. 6(5):445-50, 1996 Oct.
Abstract:
Measurements of antithyroglobulin and antimicrosomal
(antiperoxidase) antibodies have been performed widely for the clinical
diagnosis of autoimmune thyroid diseases. The present study was designed
to compare these antibody titers with histological findings of the thyroid
in patients with diffuse goiter who were suspected of having Hashimoto's
thyroiditis. One hundred and ten euthyroid or hypothyroid patients (10
males and 100 females; age 48 +/- 15 (SD) years old) with diffuse goiter
were studied for the measurement of antithyroglobulin and antimicrosomal
or antiperoxidase antibodies by a hemagglutination technique (TGHA and
MCHA, respectively) and by a newly developed radioassay (TgAb and TPOAb,
respectively). The antibody titers were compared with the histological
findings obtained by needle biopsy. TgAb, TPOAb, TGHA, and MCHA were detected
in 80 (96.4%), 61 (73.5%), 37 (44.6%), and 54 (65.1%) of 83 patients with
histologically proven Hashimoto's thyroiditis, respectively, but in only
one (3.7%) of 27 patients without any inflammatory changes in the biopsy
specimen. In 55 patients with negative TGHA and MCHA, the TgAb positivity
was more closely associated with the histological diagnosis of Hashimoto's
thyroiditis than the TPOAb positivity was, the incidence of each antibody
in Hashimoto's thyroiditis being 89.7% (26/29) and 27.6% (8/29), respectively.
In conclusion, the histological diagnosis of Hashimoto's thyroiditis can
most precisely be predicted by the newly developed radioassay for TgAb.
Title: Micronodulation: ultrasonographic sign of Hashimoto thyroiditis.
Authors: Yeh HC. Futterweit W. Gilbert P .
Institution: Department of Radiology, Mount Sinai Hospital, City University
of New York 10029, USA.
Source: Journal of Ultrasound in Medicine. 15(12):813-9, 1996 Dec.
Abstract:
The purpose of this work is to assess the validity
of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto
thyroiditis. Among 101 patients found to have ultrasonographic features
of micronodulation, 57 patients had autoantibody test results available.
Fifty-four patients were positive and three were negative for the autoantibodies.
Therefore, the positive predictive value for micronodulation in diagnosing
Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.65 cm in size,
hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated
lobulation on the pathologic specimen. Although micronodulation is highly
diagnostic of Hashimoto thyroiditis, the ultrasonographic features of eight
biopsy-proved masses caused by Hashimoto thyroiditis varied and were not
specific for the disease.
Title: Hashimoto thyroiditis: correlation of MR imaging signal intensity
with histopathologic findings and thyroid function test results.
Authors: Takashima S. Fukuda H. Tomiyama N. Fujita N. Iwatani Y. Nakamura
H .
Institution Department of Radiology, Osaka Teishin Hospital, Japan.
Source: Radiology. 197(1):213-9, 1995 Oct.
Abstract:
PURPOSE: To assess the clinical usefulness of magnetic
resonance (MR) imaging of the thyroid gland in Hashimoto thyroiditis.
MATERIALS AND METHODS: Signal intensity ratios on spin-echo T1-, proton-density-,
and T2-weighted images were measured prospectively in 37 patients with
Hashimoto thyroiditis (33 women, four men; mean age, 51 years) and in 10
patients with thyroid lymphoma (six women, four men; mean age, 68 years).
Signal intensity ratios were correlated with histopathologic findings and
thyroid function test results with stepwise regression analysis. Diagnosis
of lymphoma with signal intensity ratios was compared with morphologic
diagnosis by using receiver operating characteristic curves.
RESULTS: A proton-density-weighted signal intensity
ratio of 1.54 or higher indicated hypothyroidism (R = .445, P = .008; 29%
sensitivity [two of seven patients]). A T2-weighted signal intensity ratio
of 5.08 or higher suggested advanced glandular destruction (R = .677, P
< .001). Diagnosis by each observer was better than diagnosis with signal
intensity ratios.
CONCLUSION: MR imaging results can reflect thyroid
function and histopathologic findings in the thyroid gland and help discriminate
malignant lymphoma from Hashimoto thyroiditis.
TITLE: Problems in diagnosis and management of goitre in childhood
and adolescence.
AUTHORS: Webb AJ; Brewster S; Newington D
AUTHOR AFFILIATION: Bristol Royal Infirmary, UK.
SOURCE: Br J Surg. 1996 Nov;83(11):1586-90.
ABSTRACT:
This study is a retrospective review of 17 patients aged 16 and under
with a total of 18 goitres, who were investigated and treated at Bristol
Children's Hospital and Bristol Royal Infirmary between 1967 and 1994.
There were five neoplasms, comprising follicular adenoma (three) and papillary
carcinoma (two). Other benign causes of goitre included nodular goitre
(four), non-toxic hyperplasia (three) and chronic lymphocytic thyroiditis
(three). The authors suggest some guidelines to help in the diagnosis and
management of goitre in young patients, as a consequence of significant
difficulties encountered in 12 of the 17 patients in this series.
Title: Cardiovascular effects of long-term L-thyroxine therapy for
Hashimoto's thyroiditis in children and adolescents.
Authors: Radetti G. Paganini C. Crepaz R. Pittscheider W. Gentili L
.
Institution: Department of Paediatrics, Regional Hospital of Bolzano,
Italy.
Source: European Journal of Endocrinology. 132(6):688-92, 1995 Jun.
Abstract:
Morphology and function of the left ventricle were
evaluated by echo and Doppler examination in 16 females affected by Hashimoto's
thyroiditis, aged 13.3 (4.5) years (range 7.9-24.6). They were on L-thyroxine
(L-T4) treatment for a period of 2.8 (2.8) years (range 0.8-7.6) with a
mean daily dose of 77 (18) micrograms/m2. Left ventricular mass, systolic
and diastolic function, cardiac output and systemic vascular resistance
did not differ from a control group matched for age, sex and body size.
A further analysis of the patients according to thyrotrophin serum levels
(less or more than 0.1 mU/l) gave similar results. Moreover, no relationship
was found between echocardiographic findings and age, L-T4 daily doses,
duration of treatment and serum level of thyroid hormones. We can therefore
conclude that chronic L-T4 treatment for Hashimoto's thyroiditis at the
given doses did not affect cardiac function and morphology in children
and adolescents; however, a longer follow-up is needed before confirming
the safety of this therapy in the long term.
Title: Bone mineral density in adolescent females treated with L-thyroxine:
a longitudinal study.
Authors: Saggese G. Bertelloni S. Baroncelli GI. Costa S. Ceccarelli
C .
Institution: Adolescent Medicine Section, Endocrine Unit, II Paediatric
Clinic, University
of Pisa, Italy.
Source: European Journal of Pediatrics. 155(6):452-7, 1996 Jun.
Abstract
It has been suggested that chronic treatment with
L-thyroxine (L-T4) could be implicated in reducing bone mineral density
(BMD). The purpose of this longitudinal study was to determine whether
appendicular and axial BMD is decreased by L-T4 treatment in adolescent
girls. Thirteen adolescent girls with subclinical hypothyroidism caused
by chronic lymphocytic thyroiditis were enrolled in the study at the median
age of 13.4 years (range 9.2-18.1 years). L-T4 was administered in a single
dose of 1-5 micrograms/kg daily. BMD was evaluated at the distal one-third
of the non-dominant radius by single photon absorptiometry (SPA) and at
the lumbar spine (L2-4) by dual energy X-ray densitometry (DEXA). Osteocalcin
levels were measured to assess bone turnover before and during L-T4 treatment.
Before the start of therapy, mean BMD at both the radial and lumbar level
was not significantly different from that of a control group (median age
13.0 years; range 9.0-18.5 years). during L-T4 therapy for 2-5 years, BMD
did not change at any site. Before treatment, osteocalcin levels were not
significantly different from those of controls and did not change during
follow up. CONCLUSION: Long-term L-T4 therapy in adolescent girls has no
adverse effect on BMD and bone turnover. Our data indicate that attainment
of peak bone mass is not impaired by L-T4 administration.