Hashimoto’s Thyroiditis

In Hashimoto’s thyroiditis (synonyms: Atrophic thyroiditis; autoimmune thyroiditis; autoimmune thyreopathy; chronic lymphoadenoid thyroiditis; chronic lymphocytic thyroiditis; Hashimoto’s disease; Hashimoto’s goiter; Hashimoto’s syndrome; Hashimoto’s thyroiditis; Hashitoxicosis; immune thyroiditis; lymphadenoid goiter; lymphoid thyroiditis; lymphomatous thyroiditis; lymphocytic immune thyroiditis; lymphocytic thyroiditis; Ord’s disease; Ord’s thyroiditis; Ord thyroiditis; Ord thyroiditis; goiter lymphomatosa; goiter lymphomatosa Hashimoto; goiter lymphomatosa Hashimoto, (chronic) lymphocytic thyroiditis, Ord thyroiditis; transitory hashitoxicosis; ICD-10-GM E06. 3: Autoimmune thyroiditis) is an autoimmune disease that leads to chronic inflammation of the thyroid gland. Autoimmune thyroid disease can be divided into two major subtypes:

  • Hashimoto-type autoimmune thyroiditis (AIT) [most common form.]
  • Graves’ disease

Autoimmune thyroiditis of the Hashimoto type is classified according to thyroid volume:

  • Atrophic form – the thyroid volume decreases continuously (“ord thyroiditis”).
  • Hypertrophic form – the thyroid volume increases; a goiter develops; often in younger patients.

Furthermore, the disease can be subdivided according to the metabolic state into:

  • Autoimmune thyreopathy type 1A: Euthyroid metabolic state.
  • Autoimmune thyreopathy type 2A: hypothyroidism

Hashimoto’s thyroiditis represents the most common cause of hypothyroidism (underactive thyroid). Initially, however, occurs in some cases a hyperthyroid metabolic state (hyperthyroidism), which only in the further course, i.e. within months to years, by destruction processes (“destruction”) into a chronic atrophic form (= hypothyroidism). There is often an association with other autoimmune diseases (with certain HLA characteristics):

  • Alopecia areata (circular hair loss).
  • Atrophic gastritis – form of gastritis that leads to a decrease in mucosal thickness and folds.
  • Chronic active hepatitis (inflammation of the liver).
  • Dermatitis herpetiformis (synonyms: Duhring’s disease, Duhring-Brocq disease) – skin disease belonging to the group of blistering autoimmune dermatoses with subepidermal blistering.
  • Diabetes mellitus type 1 – diabetes caused by the absolute lack of insulin.
  • Endocrine orbitopathy (EO) – disease in which there is exophthalmos (protrusion of the eyeballs).
  • Idiopathic thrombocytopenic purpura (ITP, more recently called immune thrombocytopenia, other synonyms: Autoimmune thrombocytopenia, immune thrombocytopenic purpura, purpura haemorrhagica, thrombocytopenic purpura) – increased breakdown of platelets (blood cells) and consequently increased bleeding tendency.
  • Addison’s disease (adrenocortical insufficiency).
  • Rheumatoid arthritis
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
  • Systemic lupus erythematosus (SLE) – systemic disease affecting the skin and connective tissue of the vessels, leading to vasculitides (vascular inflammation) of numerous organs such as the heart, kidneys or brain.
  • Vitiligo (white spot disease) – skin change caused by an increasing lack of pigment.
  • Celiac disease (gluten-induced enteropathy) – chronic digestive insufficiency caused by intolerance of gliadin.

Sex ratio: males to females is 1: 4-10. Frequency peak: the disease occurs mainly in the 3rd and 5th decade of life. The prevalence (disease incidence) is 5-10% (in Germany).The incidence (frequency of new cases) is approximately 70 cases per 100,000 inhabitants per year. Course and prognosis: Patients with Hashimoto’s thyroiditis are usually symptom-free for a long time. Initially, hyperthyroidism may occur (about 10% of cases). But only a goiter diagnosis or even later a manifest hypothyroidism (underactive thyroid) lead to the diagnosis. The disease is not curable. With optimal T4 substitution, life expectancy is normal. The course of the disease is usually mild, in rare cases moderate to severe. Comorbidities: Possible comorbidities are depression and anxiety disorders: In the presence of Hashimoto’s thyroiditis, depression is 3.3 times more likely to develop, and anxiety disorders are more than twice as likely to develop, compared with healthy controls.