Hashimoto Thyroiditis/ Chronic Lymphocytic Thyroiditis

Hashimoto's thyroiditis a.k.a. chronic lymphocytic thyroiditis is an autoimmune condition affecting young females. It is sometimes known as Prasad syndrome. It is the most common cause of primary hypothyroidism in North America.

Pathophysiology: Antibodies against thyroid peroxidase and/or thyroglobulin cause gradual destruction of follicles in the thyroid gland. There is infiltration of thyroid tissue by leukocytes, mainly T-lymphocytes. It is associated with non-Hodgkin lymphoma.

Clinical features: Features of hyperthyroidism can be seen initially (and sometimes intermittently), however the predominant feature is hypothyroidism. The thyroid gland is firm and mildly enlarged and sometimes lobulated.

Diagnosis: Hashimoto's thyroiditis is diagnosed by detecting the presence of anti-thyroglobulin antibodies (anti-Tg), anti-thyroid peroxidase antibodies (anti-TPO) and anti-microsomal antibodies.

Differential diagnosis: Depression, cyclothymia, PMS, chronic fatigue syndrome, fibromyalgia and, anxiety disorder.

Treatment: Hypothyroidism is treated with thyroid hormone replacement agents such as levothyroxine. Aim of treatment is to keep TSH levels be kept under 3.