Chronic autoimmune thyroiditis: a challenging clinical entity in surgical practice

Abstract

IntroductionChronic autoimmune thyroiditis is frequently encountered in surgical practice. However clinical data on chronic autoimmune thyroiditis has limited publications arising from Sri Lanka. This study presents our experience of this clinical entity which has differing thyroid morphologies and thyroid functional status at presentation. ObjectiveThe objective of this study was to analyse the spectrum of clinical profiles in patients with chronic auto immune thyroiditis attending at a surgical clinic. The clinical profiles analysed were the age and gender distribution, clinical presentation, thyroid functional status, thyroid peroxidase antibody (TPO Ab) status, Fine Needle Aspiration Cytology (FNAC) findings, Ultrasonographic (USS) assessment and association of thyroid malignancies. Formulation of a diagnostic guideline was also considered. Study designThis is an observational study using the clinical profiles of patients with thyroid diseases registered in the surgical clinic from January 2009 to December 2018. Patients diagnosed to have chronic auto immune thyroiditis were included in this study. Different clinical profiles of these patients were analyzed. ResultsOut of 226 patients with thyroid diseases registered to the surgical clinic over a decade, 89 (39.4%) had chronic auto immune thyroiditis confirmed by either TPO Ab or FNAC or by both. Thyroid morphology and thyroid functional states of patients with chronic auto immune thyroiditis at presentation varied widely; 57.3%, 27% and 15.7% had diffuse goitre, multinodular goitre and solitary nodule respectively and 66.3%, 28.1% and 5.6% were hypothyroid, euthyroid and hyperthyroid state respectively. An USS of thyroid gland performed on 83 patients revealed sonographic features suggestive of thyroiditis in 67 patients (75.2%). The association between USS detected chronic autoimmune thyroiditis and the presence of hypothyroid state at presentation was statistically significant (p= 0.027). Associated thyroid malignancies were detected in thyroidectomy specimens of 6 patients; 5 were papillary and one was follicular carcinoma. ConclusionThe thyroid morphology and functional status are not unique in patients with chronic autoimmune thyroiditis. There is a risk of having associated thyroid malignancy. USS evaluation of patients could be included in the guideline for diagnosis to mitigate the challenges faced in the surgical management of chronic autoimmune thyroiditis.