Hashimoto’s Thyroiditis : Definition, Etiopathogenesis, Symptoms, Treatment And MCQs for NEET, GPAT, CSIR NET JRF

” Hashimoto thyroiditis is an autoimmune disease a disorder in which the immune system turns against the body’s own tissues.”

1.] Hashimoto thyroiditis also referred to as struma lymphomatso or lymphadenoid goiter.

2.] It is characterized by three principal features :

• Diffuse goitrous enlargement of the thyroid.
• Lymphocytic infiltration of the thyroid gland
• Occurrence of thyroid autoantibodies.

3.] This disease is more frequent between the age of 30 and 50 years.

4.] Hashimoto’s thyroiditis is the most common cause of goitrous hypothyroidism in regions where iodine supplies are adequate.

ETIOPATHOGENESIS :-

1.] Hashimoto’s thyroiditis is an autoimmune disease.

2.] Autoimmune pathogenesis of Hashimoto’s thyroiditis is explained by the following observations :

A.] Other autoimmune disease association : Like other autoimmune disease, Hashimoto’s disease is also associated with other disease such as Grave’s disease, rheumatoid arthritis, Type – 1 diabetes mellitus etc.

B.] Immune destruction of the thyroid cell : There is an activation of CD4+ T helper cells, which then induce infiltration of CD8+T cytotoxic cell in the thyroid parenchyma. IN this process, B cells are also activated to form autoantibodies, which bring about immune destruction of thyroid parenchyma.

C.] Detection of autoantibodies : The following autoantibodies against different cell antigens are detectable in the sera of most patients with Hashimoto’s thyroiditis :

• Thyroid microsomal autoantibodies.
• Thyroglobuline autoantibodies.
• TSH receptors.
• Less constantly found are thyroid autoantibodies.

D.] Inhibitory TSH – receptor antibodies : TSH – receptor antibody seen on the surface of the thyroid cells in Hashimoto’s thyroiditis is inhibitory to TSH, which producing hypothyroidism.

SYMPTOMS :-

Signs and symptoms of Hashimoto’s thyroiditis are as follows :-

• Fatigue and sluggishness.
• Increased sensitivity to cold.
• Constipation.
• Pale and dry skin.
• A puffy face.
• Brittle nails.
• Hair loss.
• Enlargement of tongue.
• Unexplained weight gain.
• Muscles aches, tenderness and stiffness.
• Joint pain and stiffness.
• Muscle weakness.
• Excessive or prolonged menstrual bleeding.

TREATMENT :-

There is no cure of Hashimoto’s but replacing hormones with the medications can regulate hormone level and restore your normal metabolism. The pills are available in several different strengths. The dose of the drugs will depend upon many factors like ages, weight, severity of hypothyroidism, other health problems and other medicines that may interact with synthetic thyroid hormone. However, in case of large goiter that do not improve by medication, may make it necessary to remove the thyroid gland.

MULTIPLE CHOICE QUESTIONS :-

1.] All are true about Hashimoto’s thyroiditis except ?

a. Follicular destruction

b. Lymphocytic infiltration

c. Oncocytic metaplasia

d. Orphan annie eye nuclei

2.] Hurthe cells are seen in ?

a. Granulomatous thyroid disease

b. Hashimoto’s thyroiditis

c. Papillary carcinoma of thyroid

d. Thyroglossal cyst

3.] In Hashimoto’s thyroiditis, there is infiltration of  ?

a. Macrophages

b. Neutrophils

c. Leukocytes

d. Eosinophils

4.] A condition of a chronic inflammation of the thyroid, which lead to under activity ?

a. Goiter

b. Thyroiditis

c. Hypothyroidism

d. Hyperthyroidism

5.] The four small glands in the thyroid gland are known as ?

a. Adrenal gland

b. Pineal gland

c. Parathyroid gland

d. Endocrine or Exocrine glands

6.] Sometimes the thyroid symptoms are mistaken for which condition ?

a. Menopause

b. Postraumatic stress

c. Pregnancy

d. Crohn’s disease

7.] Medications for hypothyroidism include treatment that ?

a. Replaces insulin

b. Replaces ADH

c. Replaces TH

d. Replaces surfactant

8.] This condition of chronic inflammation of the thyroid leading to under – activity is ?

a. Thyroiditis

b. Goiter

c. Hypothyroidism

d. Hyperthyroidism

9.] Thyroid disorders are sometimes mistaken for which disease or condition ?

a. Crohn’s disease

b. Menopause

c. Pregnancy

d. Post – traumatic stress disorder

10.] Hashimoto’s thyroiditis is an ?

a. Auto – immune disorder

b. Reverse auto immune disease

c. Both (a) and (b)

d. None of the above

SOLUTIONS :-

1.] (d) Orphan annie eye nuclei

2.] (b) Hashimoto’s thyroiditis

3.] (c) Leukocytes

4.] (b) Thyroiditis

5.] (c) Parathyroid gland

6.] (a) Menopause

7.] (c) Replaces TH

8.] (a) Thyroiditis

9.] (b) Menopause

10.] (a) Auto – immune disorder

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 795.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 1126 – 1127.