Clinical Manifestations of Hashimoto’s Thyroiditis (HT)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Patients with HT:
    • May present in a:
      • Euthyroid state:
        • With normal thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels
      • Subclinical hypothyroidism:
        • With mild TSH elevations (5 to 10 uIU/
          mL), and a paucity of symptoms
      • Significant / overt hypothyroidism:
        • With TSH > 10 uIU/mL
  • Although a goiter may be noted during a
    physical examination:
    • Thyroid morphology associated with HT varies widely and ranges from:
      • Atrophic, barely palpable glands to slightly
        enlarged glands to very large goiters
  • The gland texture:
    • May be smooth as in“simple” goiters or contain numerous nodules as seen with multinodular goiters
  • Although the euthyroid state may persist
    for many years:
    • About 4% to 5% of initially euthyroid patients with HT will develop hypothyroidism each year:
      • The rate of progression is somewhat dependent on the intensity of the inflammatory reaction and the concomitant rate of induced thyroid follicle destruction
  • HT is usually not associated with any neck discomfort:
    • But there are instances where individuals will present with anterior neck pain or tenderness:
      • So HT should be considered in the differential diagnosis of patients with neck discomfort
  • Episodes of more acute thyroiditis:
    • With the development of transient thyrotoxicosis have been reported
      and been referred to as Hashitoxicosis
  • Changes from HT noted by thyroid ultrasound, such as:
    • Heterogeneous parenchyma:
      • May become evident before the ability to measure thyroid antibody titers in the patient’s serum
  • Although thyroid nodules certainly can be present in the context of HT:
    • Focal inflammatory changes due to HT may give the false impression of thyroid nodules:
      • The term pseudonodule refers to instances where there is the appearance of a thyroid nodule in at least one ultrasound view, but it cannot be reproduced on the additional complementary views:
        • Such lesions may not be evident upon future imaging at a later point in time
      • Therefore in patients with HT, the possibility of a pseudonodule should be considered before proceeding with FNA sampling
  • Thyroid enlargement associated with HT:
    • May regress with LT4 therapy:
      • Particularly if TSH elevation is present at the time of diagnosis:
        • However, some goiters associated with HT will persist or even grow whether or not LT4 suppression is used:
          • If such patients exhibit progressive goiter growth or develop compressive type symptoms thyroidectomy may need to be considered
    • If the goiter is large and especially if
      tracheal deviation or substernal extension is present:
      • Then preoperative imaging with computed tomography (CT) of the neck is warranted to
        better define the anatomy and help plan the surgical approach
  • Histopathology is typically notable for:
    • Prominent lymphocytic infiltration, foci of lymphoid germinal centers, and follicle destruction.
  • Controversy exists if HT patients have an increased risk for thyroid cancer and, if so, whether or not HT is associated with a more aggressive disease pattern
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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