![]() Hashimoto Thyroiditis: Correlation of MR Imaging Signal Intensity with Histopathologic Findings and Thyroid Function Test Results. ![]() Takashima S, Fukuda H, Tomiyama N, Fujita N, Iwatani Y, Nakamura H. Hashimoto: Zur Kenntnis der lymphomatösen Veränderung der Schilddrüse (Struma lymphomatosa). Patients are at higher risk for papillary thyroid carcinoma, so a discrete nodule should be considered for biopsy Subacute granulomatous (de Quervain) thyroiditis In his original description, he called it "struma lymphomatosa" 13. It was first described in 1912 by Hakaru Hashimoto (1881-1934), a Japanese physician 7, while working in Germany. Life-long oral administration of L-thyroxine (T4) is often required ref. Superimposed focal high uptake should raise concern for a thyroid nodule including the possibility of carcinoma Late stages: single or multiple areas of reduced uptake (cold spots)ĭiffuse high uptake throughout the thyroid is consistent with chronic thyroiditis (or a normal variant) 14,15 In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis 10. ![]() Prominent reactive cervical nodes may be present, especially in level VI, but they have normal morphologic features The hypervascularity does not reflect thyrotoxicosis indeed it appears to be more common in hypothyroid Hashimoto patients 11 The presence of hypoechoic micronodules (1-6 mm) with surrounding echogenic septations is also considered to have a relatively high positive predictive value 3,4 this appearance may be described as pseudonodular or a giraffe patternĬolor Doppler study usually shows normal or decreased flow, but occasionally there might be hypervascularity similar to a thyroid inferno The glands may be atrophic and small in chronic cases Ultrasound features can be variable depending on the severity and phase of disease 1,5:ĭiffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation (especially initial phase) 6 It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Thyroid peroxidase antibodies (TPO): found in 90-95% of cases 2 MarkersĪntithyroglobulin antibodies: found in ~70% of cases 2 Transformed follicular cells (Askanazy/oxyphilic/Hurthle cells) This is followed by lymphocytic infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. This may affect the thyroid gland in either a diffuse or focal manner. Cell populations include: There is autoimmunity to the thyroid gland which bears both humoral- and cell-mediated features. The Hashitoxicosis phase, if present, usually only lasts 1-2 months. There is often a gradual painless enlargement of the thyroid gland during the initial phase with atrophy and fibrosis later on in the course. However, a very small proportion of cases (~5%) can present with hyperthyroidism (also known as Hashitoxicosis). Patients usually present with hypothyroidism +/- a goiter. Typically affects middle-aged females (30-50 year age group with an F:M ratio of 10-15:1).
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