About Hashimoto's Disease
Other Names for this Disease
The thyroid gland wraps around the base of the throat in a butterfly shape
and secretes thyroid hormone that affects the body's metabolism.
Hashimoto's disease is an hereditary autoimmune disorder in which the immune
system attacks an organ of its own body, in this case the thyroid.
In Hashimoto’s disease antithyroid peroxidase (anti-TPO) antibodies
are present in blood serum, and lymphocytes infiltrate the thyroid gland.
This often causes enlargement or goiter, yet some patients experience atrophy
or shrinking of the gland. The parenchyma, or functional tissue of
the gland, is progressively destroyed and replaced by lymphocytes or fibrous
tissue. Thyrotropin, secreted from the pituitary gland and known
as thyroid stimulating hormone or TSH, increases in the patients serum
as thyroid reserves are depleted. At some stages of this destruction,
excess thyroid hormone, T3 and T4, may be released
causing temporary hyperthyroid states. If hormone levels rise very high
they can cause Hashimoto’s toxicosis. Eventually enough tissue may
be destroyed that thyroid hormone can no longer be adequately produced,
resulting in a condition called hypothyroidism or in its extreme, life-threatening
myxedema. Medical treatment often involves replacement of thyroid
hormone, levothyroxine or T4. According to Harrison’s
Principles of Internal Medicine, “The treatment of hypothyroidism by
the administration of thyroid hormone is probably as successful as any
therapeutic measure in medicine.”
This disease develops slowly and it may remit or may remain subclinical.
It is estimated to affect in about 3 to 4% of the U.S. population.
It is most common in women over 30, and it occurs frequently among family
members. When it occurs in children it may slow growth, making it especially
important to seek treatment. There is well documented co-occurance
of Hashimoto's with other autoimmune diseases, such as Type 1 diabetes,
rheumatoid arthritis and Lupus erythematosus, in what are termed “autoimmune
polyglandular syndromes.” Both Hashimoto’s and Graves’ Disease are autoimmune
reactions that attack the thyroid and a patient can have both diseases.
Hashimoto’s disease may occur transiently during pregnancy, and recent
studies have investigated co-occurrances with disorders ranging from carpal
tunnel syndrome to thyroid cancer. It has also been suggested that
increased iodine ingestion in the United States may explain its larger
incidence here than in Europe.
Hashimoto’s thyroiditis has been described by many names in the literature
and it may be necessary to use several of these when searching the indexes
and other sources. One note of caution: Hashimoto-Pritzker disease
is a completely distinct disorder discovered by a different Dr. Hashimoto.
Atrophic thyroiditis is a manifestation of this disease described
in the textbook Endocrinology.
Autoimmune thyroiditis is the MeSH term used in MEDLINE
and other NLM indexes. It is commonly used in Science
Citation Index and Biosis Previews and is the term used
in the textbook Endocrinology.
Chronic autoimmune thyroiditis is the name used in AACE's
Clinical Practice Guidelines and is one of those used in Textbook
of Internal Medicine, which then distinguishes the goiterous form
as Hashimoto's disease.
Chronic lymphocytic thyroiditis is found in EMBASE
and Science Citation Index, is the term used in Cecil
Textbook of Medicine and is another of three terms used in Textbook
of Internal Medicine.
Diagnosis code 245.2 in ICD.9.CM, 9th rev. Clinical modification,
4th ed., Hospital ed., 1994. This code is used for statistical and
insurance identification and in searching some databases.
Hashimoto('s) disease is distinguished as the goiterous form of
this disease in some countries, but includes all manifestations in other
countries. It is used in the controlled indexing of EMBASE,
is used inclusively in the textbook Endocrinology, and is the third
term used for this disease in Textbook of Internal Medicine.
Hashimoto('s) struma. “Struma” means goiter.
Hashimoto('s) thyroiditis is used in Harrison's
Principles of Internal Medicine and is commonly used in Science
Struma lymphomatosa is the name applied in Hashimoto's original
M.D. thesis that described the condition.
Subclinical autoimmune thyroiditis is another stage of the disease
described in the textbook Endocrinology.
Medical Sourcebooks and Dictionaries:
Dictionary of Medical Syndromes, 3rd ed. Philadelphia: Lippencott,
Dorland's Illustrated Medical Dictionary, 28th ed. Philadelphia:
E.B. Saunders, 1994.
Firkin, B.G., Whitworth, J.A. "Hashimoto disease, thyroiditis," in Dictionary
of Medical Eponyms, (Park Ridge, NJ, Parthenon, 1987), 170.
Illustrated Stedman's Medical Dictionary, 24th ed. Baltimore:
Williams & Wilkin, 1982.
Online Medical Dictionary [http://www.graylab.ac.uk/omd]
can be very helpful to quickly look up an unfamiliar term.
Rosenthal, Sara M. The Thyroid Sourcebook, 2nd ed.
Los Angeles: Lowell House. 1996.
See also the Consumer Health Links on this
Amino, Nobuyuki and Hisato Tada. “Autoimmune Thyroid Disease/Thyroiditis"
in Endocrinology, (3rd ed. Philadelphia, W.B. Saunders, 1995),
“Chronic Lymphocytic Thyroiditis (Hashimoto's Thyroiditis)," in Cecil
Textbook of Medicine (20th ed. Philadelphia, W.B. Saunders, 1996),
"Endocrinology, Metabolism, and Genetics: Chronic Autoimmune Thyroiditis."
in Textbook of Internal Medicine, (Philadelphia, Lippincott-Raven,
“Endocrinology and Metabolism: Diseases of the Thyroid." in Harrison's
Principles of Internal Medicine, (14th ed. New York, McGraw
Hill, 1998), 2034.
DeGroot, L.J., P.R. Larsen, G. Henneman, et al. The Thyroid and Its
Diseases, 6th ed. New York: Churchill Livingstone, 1996.
Federman, Daniel D. “Section I. Thyroid.” in Chapter 3, "Endocrinology"
of Scientific American Medicine. New York: Scientific American,
Frank, Michael M., et al., eds. Samter’s Immunological Diseases.
5th ed. Philadelphia: Lippincott-Raven, 1995.
Jackson, Richard. “Autoimmune Endocrine Disorders," in Textbook of
Internal Medicine, (3rd ed.; Philadelphia, Lippincott-Raven, 1997),
Rayner, David C. and Brian Champion. Thyroid autoimmunity.
Austin : R.G. Landes, 1995.
Rose, Noel R., et al., eds. Manual of Clinical Laboratory Immunology.
5th ed. Washington, DC: American Society for Microbiology, 1997.
Weetman, Anthony P. “Chronic Autoimmune Thyroiditis.” in Section
B. "Causes of Hypothyroidism," Chapter 55 of Werner and Ingbar’s
The Thyroid: A Fundamental and Clinical Text. 7th ed. Philadelphia:
Lippincott-Raven, 1996, 738-748.
Wilson, Jean D., and Foster, Daniel W., eds. Williams Textbook
of Endocrinology. 9th ed. Philadelphia: Saunders, 1997.
Last updated Dec. 13, 1998
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