1. 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

2. 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

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. Treatment Thyroid hormone replacement.
Spontaneous remissions have occurred.

9. 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.

10. 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.

11. 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

12. 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.

13. 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.

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

15. The End
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