Hashimoto's Disease

Hashimoto's Disease (Hashimoto's Thyroiditis) is an autoimmune thyroiditis (AIT) that is a common cause of hypothyroidism.

Epidemiology

Hashimoto's is the most common cause of hypothyroidism in the United States and in those areas of the world where iodine intake is adequate. The incidence is 0.8 per 1000 per year in men, and 3.5 per 1000 per year in women.[1]

Comorbidity

Depression and anxiety disorders have close to 50% co-morbidity with autoimmune thyroiditis.[2] Early identification of autoimmune thyroiditis is important to initiate both endocrinological and psychotherapeutic treatments. In rare cases, Hashimoto's thyroiditis can be associated with a Hashimoto's Encephalitis (Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]).

  • Thyrotropin level (TSH)
  • Free triiodothyronine (T3) and free thyroxine (T4)
  • Thyroid peroxidase antibodies (TPO)

Why Order All The Thyroid Tests?

About 4%-5% of patients with AIT will have elevated thyrotropin levels, but 13%-23% will be positive for thyroid peroxidase antibodies. Thus, if only a thyrotropin level is measured, patients with AIT will be missed.[3]
  • Typical levothyroxine treatment, plus selenium supplementation can help to reduce the amount of thyroid antibodies and improve mood or well-being.[4]
    • In some cases, thyroidectomy may be indicated
  • Early treatment with antidepressants may shorten the chronic course of autoimmune thyroiditis, as thyroid metabolism is associated with the serotonin system in the brain[5]
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