Autoimmune Thyroiditis

National Organization for Rare Disorders, Inc.

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Important

It is possible that the main title of the report Autoimmune Thyroiditis is not the name you expected.

Disorder Subdivisions

  • None

General Discussion

Autoimmune thyroiditis (AT), also known as Hashimoto's disease, is a chronic inflammatory disorder of the thyroid gland that is caused by abnormal blood antibodies and white blood cells that mistakenly attack and damage healthy thyroid cells. It is a progressive disease that may destroy the thyroid gland, causing thyroid hormone deficiency (hypothyroidism). Autoimmune thyroiditis presents with various combinations of symptoms, making diagnosis difficult. This disease can occur at any age, but is most often seen in middle-aged women. In rare cases, it may be associated with other autoimmune endocrine disorders.

Symptoms

Autoimmune thyroiditis is a common cause of primary hypothyroidism. Affected individuals complain of enlargement of the thyroid gland or fullness in the throat. It causes a non-tender lump (goiter). This abnormal lump on the front of the neck is smooth or nodular, firm and more rubbery in consistency than the normal thyroid. In 90% of cases, it is painless. Thyroid function blood studies initially fall within the normal limits, until the disease has progressed sufficiently to cause the lack of thyroid hormone. It may take months or even years for the disorder to be detected.



Some people don't exhibit any symptoms at all. Others may experience various combinations of intolerance to cold, mild weight gain, fatigue, constipation, presence of a goiter, dry skin, hair loss, irregular or heavy menstrual periods, a small or shrunken thyroid gland (late stage) and difficulty in concentrating or thinking.

Causes

AT is an autoimmune disorder caused by infiltration of the thyroid gland with lymphocytes (white blood cells), resulting in the progressive destruction of the thyroid gland and eventually causing hypothyroidism. Autoimmune diseases begin when the body's natural defenses against disease, such as antibodies, lymphocytes, etc., attack healthy tissue for unknown reasons.



There is a genetic predisposition to develop autoimmune thyroiditis. It occurs more often among people who have a family history of the disease. Mutations in two genes on chromosome 8 and chromosome 2 (8q23-q24 and 2q33) appear to be necessary to establish the tendency for genetic transmission of the disorder.



Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated "p" and a long arm designated "q". Chromosomes are further sub-divided into many bands that are numbered. For example, "chromosome 8q23-q24" refers to a region on the long arm of chromosome 8 between bands 23 and 24. The phrase "chromosome 2q33" refers to band 33 on the long arm of chromosome 2. The numbered bands specify the location of the thousands of genes that are present on each chromosome.







Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.



Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy regardless of the sex of the resulting child.



Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%. The risk is the same for males and females.







All individuals carry a few abnormal genes. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.

Affected Populations

Autoimmune thyroiditis can occur in men and women at any age, but is most frequently seen in women between the ages of 30 and 50. A family history of thyroid disorders is common. The incidence is increased in patients with chromosomal disorders including Turner's, Down's and Klinefelter's syndromes. (For more information about these disorders, choose "Turner", "Down" and "Klinefelter" as your search terms in the Rare Disease Database.)

Diagnosis

Autoimmune thyroiditis is diagnosed in most cases by means of blood tests that measure the amount of various thyroid hormones in the patient's blood. One of these hormones is thyroxine (T4), the level of which may be elevated in persons with this disorder. Thyroxine is a precursor of T3, an active form of thyroid hormone. The blood levels of each of these hormones are regulated by the amount of thyroid stimulating hormone. Accurate tests are available to measure the concentrations of each.



In some cases, a biopsy of the thyroid gland may be necessary for a definitive diagnosis.

Standard Therapies

Treatment



Treatment of autoimmune thyroiditis consists of replacing thyroid hormone in the body. This will alleviate the symptoms and produce a marked reduction in the gland size within 2 to 4 weeks. Once thyroid hormone has been started, it should be continued for life, since it is unlikely that the disease will regress spontaneously.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222



TTY: (866) 411-1010



Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:



www.centerwatch.com

References

TEXTBOOKS



Rose NR. Caturegli P. Chronic Lymphocytic Thyroiditis. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:329.



Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:84-85; 97-98.



Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:953-54.



Scriver CR, Beaudet AL, Sly WS, et al., eds. The Metabolic Molecular Basis of Inherited Disease. 8th ed. McGraw-Hill Companies. New York, NY; 2001:4063.



REVIEW ARTICLES



Fatourechi V. Hashimoto's encephalopathy: myth or reality? An endocrinologist's perspective. Best Pract Res Clin Endocrinol Metab. 2005;19:53-66.



Weetman AP. Cellular immune responses in autoimmune thyroid disease. Clin Endocrinol. (Oxf). 2004;61:405;13.



Mclachlan SM, Rapoport B. Why measure thyroglobulin autoantibodies rather than thyroid peroxidase autoantibodies? Thyroid. 2004;14:510-20.



Punzi L. Betterle C. Chronic immune thyroiditis and rheumatic manifestations. Joint Bone Spine. 2004;71:510-20.



Tomer Y, Greenberg D. The thyroglobulin gene as the first thyroid-specific susceptibility gene for autoimmune thyroid disease. Trends Mol Med. 2004;10:306-08.



Laurent S, Mouthon L, Longchampt E, Roudaire M, et al. Medical care of plasma cell granuloma of the thyroid associated with Hashimoto's thyroiditis: a case report and review. J Clin Endocrinol Metab. 2004;89:1534-37.



Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 204;363:793-803.



Carayanniotis G. The cryptic self in thyroid autoimmunity: the paradigm of thyroglobulin. Autoimmunity. 2003;36:423-28.



Ban Y, Tomer Y. The contribution of Immune regulatory and thyroid specific genes to the etiology of Graves' and Hashimoto's diseases. Autoimmunity. 2003;36:367-79.



FROM THE INTERNET



McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Hashimoto Thyroiditis. Entry Number; 140300: Last Edit Date; 3/15/2005.



Rennert NJ. Chronic thyroiditis (Hashimoto's disease). MedlinePlus. Medical Encyclopedia. Update Date: 4/19/2004.



www.nlm.nih.gov/medlineplus/ency/article/000371.htm



Hashimoto's Thyroiditis. Womenshealth.gov. DHHS. Publication Date: March 2001. 3pp.



www.womenshealth.gov/faq/hashimoto.htm



Hashimoto's Thyroiditis. American Autoimmune Related Diseases Association. Patient Information. nd. 2pp.



www.aarda.org/patient_information.php



Thyroiditis. Thyroid Foundation of Canada. Reviewed 09/01. 4pp.



www.thyroid.ca/HG05.html



About Hashimoto's Disease. Rutgers School of Communication, Information and Library Studies. Last updated Dec 13, 1998. 3pp.



www.scils.rutgers.edu/~mowalker/hashimo2.html

Supporting Organizations

American Autoimmune & Related Diseases

22100 Gratiot Ave.
Eastpointe, MI 48021
Tel: (586)776-3900
Fax: (586)776-3903
Tel: (800)598-4668
Email: aarda@aarda.org
Website: //www.aarda.org/

AutoImmunity Community

Website: https://www.facebook.com/autoimmunityforum

European Society for Immunodeficiencies

1-3 rue de Chantepoulet
Geneva, CH 1211
Switzerland
Tel: 410229080484
Fax: 41229069140
Email: esid@kenes.com
Website: //www.esid.org

Genetic and Rare Diseases (GARD) Information Center

PO Box 8126
Gaithersburg, MD 20898-8126
Tel: (301)251-4925
Fax: (301)251-4911
Tel: (888)205-2311
Website: //rarediseases.info.nih.gov/GARD/

Hormone Health Network Endocrine Society

2055 L Street NW
Suite 600
Washington, DC 20036
Tel: (202)971-3636
Fax: (202)736-9705
Tel: (888)363-6274
Email: hormone@endocrine.org
Website: //www.hormone.org/

Hypoparathyroidism Association, Inc.

PO Box 2258
Idaho Falls, ID 83403
Tel: (208)524-3857
Fax: (205)524-3857
Tel: (866)213-0394
Email: jsanders@hypopara.org
Website: //www.hypopara.org

International Scleroderma Network

7455 France Ave So #266
Edina, MN 55435-4702
Tel: (952)583-5735
Tel: (800)564-7099
Email: isn@sclero.org
Website: //www.sclero.org

March of Dimes

1275 Mamaroneck Avenue
White Plains, NY 10605
Tel: (914)997-4488
Fax: (914)997-4763
Email: AskUs@marchofdimes.org or preguntas@nacersano.org
Website: //www.marchofdimes.org and nacersano.org

NIH/National Institute of Diabetes, Digestive & Kidney Diseases

Office of Communications & Public Liaison
Bldg 31, Rm 9A06
Bethesda, MD 20892-2560
Tel: (301)496-3583
Email: NDDIC@info.niddk.nih.gov
Website: //www2.niddk.nih.gov/

Thyroid Foundation of Canada

P.O. Box 298
Bath ON K0H 1G0,
Canada
Fax: 5146309815
Tel: 8002678822
Website: //www.thyroid.ca

For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.