Hashimoto's Disease

Primer

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]
Prognosis
  • Early identification of autoimmune thyroiditis is important to initiate both endocrinological and psychotherapeutic treatments.
Comorbidity

Diagnostic Criteria

Hashimoto's Encephalitis

Hashimoto's Encephalopathy (HE) (also known as Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]), is a rare, clinically heterogeneous autoimmune encephalitis that is associated with Hashimoto's disease and positive thyroid autoantibodies.

Pathophysiology

Differential Diagnosis

Investigations

  • 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 autoimmune thyroiditis will have elevated thyrotropin (TSH) 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]

Treatment

  • 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]

Resources

For Patients

For Providers

Articles
Research

References

1) Mincer, D. L., & Jialal, I. (2017). Hashimoto thyroiditis.
2), 3), 4), 5) Siegmann, E. M., Müller, H. H., Luecke, C., Philipsen, A., Kornhuber, J., & Grömer, T. W. (2018). Association of depression and anxiety disorders with autoimmune thyroiditis: a systematic review and meta-analysis. JAMA psychiatry, 75(6), 577-584.