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Unit 3 Autoimmunity Part 4 Hashimoto’s Thyroiditis Part 5 Grave’s Disease

Unit 3 Autoimmunity Part 4 Hashimoto’s Thyroiditis Part 5 Grave’s Disease. Terry Kotrla, MS, MT(ASCP)BB. Hashimoto's Thyroiditis. A type of autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland. CHARACTERIZED BY HYPOTHYROIDSM.

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Unit 3 Autoimmunity Part 4 Hashimoto’s Thyroiditis Part 5 Grave’s Disease

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  1. Unit 3 AutoimmunityPart 4 Hashimoto’s ThyroiditisPart 5 Grave’s Disease Terry Kotrla, MS, MT(ASCP)BB

  2. Hashimoto's Thyroiditis • A type of autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland. • CHARACTERIZED BY HYPOTHYROIDSM. • Thyroid helps set the rate of metabolism - the rate at which the body uses energy. • Hashimoto’s prevents the gland from producing enough thyroid hormones for the body to work correctly. • It is the most common cause of hypothyroidism. • Have statistically increased risk of developing other disorders: Diabetes, rheumatoid arthritis, TTP, SLE

  3. Hashimoto's Thyroiditis • Organ specific disease affecting the thyroid gland. • Can occur at any age, most often seen in women 30 to 40 years old, • May be a genetic predisposition. • Causes diffuse hyperplasia in the gland resulting in development of a goiter. • Thyroid autoantibodies are formed.

  4. Symptoms • Similar to those of hypothyroidism in general • Often subtle and not specific. • Become obvious as condition worsens • The following are the most common symptoms. : • Goiter (enlarged thyroid gland may cause a bulge in the neck) • Fatigue • Modest weight gain • Cold intolerance • Excessive sleepiness. • Vague aches and pains • Swelling of the legs

  5. Thyroid • Thyroid hormones are produced by the thyroid gland. This gland is located in the lower part of the neck, below the Adam's apple. • The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus). • A goiter forms due to inflammation of the thyroid.

  6. Goiter • This enlargement is due to the inflammatory cells which destroy thyroid cells, resulting in long term scarring. • When the cells are damaged they cease thyroid hormone production, resulting in hypothyroidism • A goiter only needs to be treated if it is causing symptoms. • The enlarged thyroid can be treated with radioactive iodine to shrink the gland or with surgical removal of part or all of the gland (thyroidectomy). • Small doses of iodine (Lugol's or potassium iodine solution) may help when the goiter is due to iodine deficiency.

  7. Laboratory Testing • Routine thyroid function tests to confirm that a patient has an underactive thyroid gland. • Thyroid stimulating hormone (TSH) - high • Free T4 (thyroxine) –low but may be normal early in disease • Anti-thyroid antibodies produced and attack specific portions of the thyroid cells which pinpoint Hashimoto's thyroiditis as the cause of the hypothyroidism. • Anti-microsomal antibodies • Anti-thyroglobulin antibodies • The anti-microsomal antibody test is much more sensitive than the anti-thyroglobulin, therefore some doctors use only the former blood test. • Thyroid autoantibodies blood tests are high in about 95% of patients with Hashimoto's thyroiditis, but are not diagnostic.

  8. Treatment • Thyroid hormone replacement. • Spontaneous remissions have occurred.

  9. Graves’ Disease - Thyrotoxicosis • Autoimmune disease • Antibodies attack thyroid gland causing overproduction of thyroxine. • Thyroxine greatly increases the metabolic rate. • Most common cause of severe HYPERTHYROIDISM • Can occur in children and adolescents but women more susceptible, occurs most frequently between 30 and 40 years of age. • Genetic link suspected.

  10. Graves’ Disease • Diagnosis may be straightforward, since the "classic face" with its triad of • hyperthyroidism • goiter • exophthalmos • Goiter is usually symmetric, smooth, and nontender • The hyperthyroid state can cause a wide variety of multisystem derangements that often result in diagnostic confusion.

  11. Exophthalmos • Exophthalmos, also called proptosis, is a characteristic finding in thyroid eye disease, and has been reported to occur in 34% to 93% of patients

  12. Signs Symptoms • Causes a number of symptoms • Nervousness and increased activity • fast heartbeat • fatigue • moist skin • heat intolerance • shakiness • anxiety • increased appetite • weight loss • insomnia. • Have at least one of the following: goiter, bulging eyes, or raised areas of skin over the shins.

  13. Laboratory Testing • Presence of thyroid-stimulating hormone receptor antibody, causes release of thyroid hormones. • Key findings are • Elevated total and free T3 (triiodothyronine) • Elevated T4 (thyroxine • Thyroid stimulating hormone (TSH) is reduced due to antibody stimulation of the thyroid.

  14. Treatment • Medication. • Radioiodine therapy to destroy the thyroid. • Surgical removal of thyroid

  15. The End • Submit your answers to the 4 questions found in this presentation.

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