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Thursday, 28 November 2013

Thyroid Disease : Hashimoto’s thyroiditis – The diagnosis

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).
D.2. Diagnosis
After recording the past and present history and completing a physical exam, including assessing symptoms and complaints commonly seen in hypothyroidism and neck examination. The tests which your doctor orders may include
1. Blood test
The aim of the test is to determine the level of thyroid function. Underactive thyroid gland is presented with the low level of thyroid hormone is low with elevated TSH as your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.
2. An antibody test
The aim of the test is to check for the presence of antibodies against thyroid peroxidase, the an enzyme which plays an important role in the production of thyroid hormones.
3. Thyroid scan
In the study to review the experience over the past 5 years of 32 thyroid scans in Hashimoto’s thyroiditis, showed that wide variety of images were obtained, the most common finding being that of an enlarged gland with diffusely increased tracer uptake, a pattern identical to that found in Graves’ disease (eight patients). Of the remainder, four scans were normal, four showed an enlarged gland with normal tracer uptake, five a multinodular gland with normal tracer uptake, five a multinodular gland with high tracer uptake, five a single non-functioning nodule and in one patient there was low tracer uptake by the gland. It is apparent that the thyroid scan in Hashimoto’s thyroiditis can mimic a wide range of thyroid disorders(23).
4. Fine needle aspiration cytology
FNAC plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost. It can accurately diagnose Hashimoto’s thyroidits in most patients. However, a small percentage of cases may be missed due to the inherent limitations of this procedure and the varied cytomorphology of this lesion. Therefore thorough cytological evaluation and an integrated approach are necessary to pick up correct diagnosis and to avoid unnecessary surgery(24).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/22147633
(23) http://www.ncbi.nlm.nih.gov/pubmed/2847097
(24) http://www.ncbi.nlm.nih.gov/pubmed/22090699