Thursday, 28 November 2013

Thyroid Disease : Diseases associated to Hashimoto’s thyroiditis

Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones. Thyroid cancer is defined as condition in which the cells in the thyroid gland have become cancerous.
Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis)
Hashimoto’s thyroiditis is an autoimmune disease in which the immune system attacks the thyroid gland of that mostly often leads an underactive thyroid gland (hypothyroidism). According to the study by the University of Pisa, Women with Hashimoto’s thyroiditis (HT) suffer from a high symptom load independently from hypothyroidism, which results just a contributing factor to the development of the clinical syndrome. In agreement with these results, we recently reported on the presence of symptoms and signs consistent with fibromyalgia (FM) in patients with HT regardless thyroid dysfunction, focusing to the weight of anti-thyroid autoimmunity in the HT-associated clinical syndrome(a).
C.2. Diseases associated to Hashimoto’s thyroiditis
1. Hashimoto’s encephalopathy (HE)
Hashimoto’s encephalopathy (HE) is a rarely recognized neurocognitive syndrome that is associated with thyroid autoimmunity. It is more common in women(14).
2. Neurofibromatosis Type 1
Hashimoto’s thyroiditis is a common form of chronic autoimmune thyroid disease (AITD) and often coexists with other autoimmune diseases, but Hashimoto’s thyroiditis associated with an autosomal dominant neurofibromatosis type 1 is exceedingly rare. There is a report of a case of a 30-year-old Bengali woman presented to the OPD with complaints of aching pain and tingling sensation in her hands and feet. Physical examination revealed dysmorphic facies, nodular swelling in the neck, cafe-au-lait spots, and neurofibromas covering the entire surface of her body. Her thyroid hormones were within normal limits. Thyroid ultrasound revealed a cystic area in the left lobe of the gland, and ultrasound-guided fine needle aspiration cytology revealed lymphocytic infiltration of the gland, suggesting Hashimoto’s thyroiditis. High levels of autoimmune antibodies such as antithyroglobulin and antimicrosomal antibodies confirmed the diagnosis(15).
3. Chronic hepatitis C
In the study to investigate the relation of thyroid function with hashimoto thyroiditis (HT, an autoimmune disease of unknown etiology also known as chronic lymphocytic thyroiditis) in patients with chronic hepatitis C (CHC), showed that he incidence of thyroid dysfunction is significantly higher among CHC patients with HT than among CHC patients without HT. If suspected, these patients should be carefully monitored because the clinical symptoms of thyroid dysfunction are not obvious and the drug therapy(16).
4. Reactive thrombocytosis
According to our literature review, this is the first reported case of reactive thrombocytosis due to Hashimoto’s thyroiditis and/or subclinical hypothyroidism. A 31-year-old man without any complaint was admitted to the Hematology Department for thrombocytosis which was detected in his routine follow-up. He had been using thyroid hormone replacement for 2 years because of hypothyroidism as Hashimoto’s thyroiditis was earlier diagnosed. Due to miscommunication, he stopped his medication levothyroxine 0.1 mg/day 2 weeks in advance and he was still off-drug on admission. Platelet count was 715 × 10/l in the first admission center. Subclinical hypothyroidism diagnosis was made with the present findings and thyroid hormone replacement therapy was again commenced gradually. Platelet counts and thyroid-stimulating hormone value were normal 6 weeks later(17).
5. Thyroid papillary carcinoma
In a retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases, found that there is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size(18).
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