Terry Kotrla, MS, MT(ASCP)BB Unit 3 Autoimmunity Part 4 Hashimoto’s Thyroiditis Part 5 Grave’s Disease Terry Kotrla, MS, MT(ASCP)BB

Hashimoto's Thyroiditis A type of autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland. CHARACTERIZED BY HYPOTHYROIDSM. Thyroid helps set the rate of metabolism - the rate at which the body uses energy. Hashimoto’s prevents the gland from producing enough thyroid hormones for the body to work correctly. It is the most common cause of hypothyroidism. Have statistically increased risk of developing other disorders: Diabetes, rheumatoid arthritis, TTP, SLE

Hashimoto's Thyroiditis Organ specific disease affecting the thyroid gland. Can occur at any age, most often seen in women 30 to 40 years old, May be a genetic predisposition. Causes diffuse hyperplasia in the gland resulting in development of a goiter. Thyroid autoantibodies are formed.

Symptoms Similar to those of hypothyroidism in general Often subtle and not specific. Become obvious as condition worsens The following are the most common symptoms. : Goiter (enlarged thyroid gland may cause a bulge in the neck) Fatigue Modest weight gain Cold intolerance Excessive sleepiness. Vague aches and pains Swelling of the legs

Thyroid Thyroid hormones are produced by the thyroid gland. This gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus). A goiter forms due to inflammation of the thyroid.

Goiter This enlargement is due to the inflammatory cells which destroy thyroid cells, resulting in long term scarring. When the cells are damaged they cease thyroid hormone production, resulting in hypothyroidism A goiter only needs to be treated if it is causing symptoms. The enlarged thyroid can be treated with radioactive iodine to shrink the gland or with surgical removal of part or all of the gland (thyroidectomy). Small doses of iodine (Lugol's or potassium iodine solution) may help when the goiter is due to iodine deficiency.

Laboratory Testing Routine thyroid function tests to confirm that a patient has an underactive thyroid gland. Thyroid stimulating hormone (TSH) - high Free T4 (thyroxine) –low but may be normal early in disease Anti-thyroid antibodies produced and attack specific portions of the thyroid cells which pinpoint Hashimoto's thyroiditis as the cause of the hypothyroidism. Anti-microsomal antibodies Anti-thyroglobulin antibodies The anti-microsomal antibody test is much more sensitive than the anti-thyroglobulin, therefore some doctors use only the former blood test. Thyroid autoantibodies blood tests are high in about 95% of patients with Hashimoto's thyroiditis, but are not diagnostic.

Treatment Thyroid hormone replacement. Spontaneous remissions have occurred.

Graves’ Disease - Thyrotoxicosis Autoimmune disease Antibodies attack thyroid gland causing overproduction of thyroxine. Thyroxine greatly increases the metabolic rate. Most common cause of severe HYPERTHYROIDISM Can occur in children and adolescents but women more susceptible, occurs most frequently between 30 and 40 years of age. Genetic link suspected.

Graves’ Disease Diagnosis may be straightforward, since the "classic face" with its triad of hyperthyroidism goiter exophthalmos Goiter is usually symmetric, smooth, and nontender The hyperthyroid state can cause a wide variety of multisystem derangements that often result in diagnostic confusion.

Exophthalmos Exophthalmos, also called proptosis, is a characteristic finding in thyroid eye disease, and has been reported to occur in 34% to 93% of patients

Signs Symptoms Causes a number of symptoms Nervousness and increased activity fast heartbeat fatigue moist skin heat intolerance shakiness anxiety increased appetite weight loss insomnia. Have at least one of the following: goiter, bulging eyes, or raised areas of skin over the shins.

Laboratory Testing Presence of thyroid-stimulating hormone receptor antibody, causes release of thyroid hormones. Key findings are Elevated total and free T3 (triiodothyronine) Elevated T4 (thyroxine Thyroid stimulating hormone (TSH) is reduced due to antibody stimulation of the thyroid.

Treatment Medication. Radioiodine therapy to destroy the thyroid. Surgical removal of thyroid

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