Natural history of autoimmune thyroiditis.

Tunbridge, W. M. G.; Brewis, M; French, Joyce M.; Appleton, David R.; Bird, T.; Clark, F.; Evered, David; Evans, John Grimley; Hall, R.; Smith, Pamela Alethea; Stephenson, John L.; Young, E. T.

doi:10.1136/bmj.282.6260.258

Cited by 252 publications

(87 citation statements)

References 20 publications

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“…1,2 However, in the present study, among all patients who underwent FNA of the thyroid over an eight year period in Kuwait, the highest prevalence of HT was found in women between the ages of 16 and 35. This shows that HT is more often encountered in the younger age group in Kuwait.…”

Section: Discussionmentioning

confidence: 64%

Chronic Lymphocytic (Hashimoto's) Thyroiditis in Kuwait Diagnosed by Fine Needle Aspirates

et al. 1995

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A retrospective analysis of 4185 consecutive fine needle aspirates (FNA) of the thyroid over an eight year period at a teaching hospital in Kuwait revealed that 14.3% of all the aspirates had features of chronic lymphocytic (Hashimoto's) thyroiditis (HT). The proportion of patients with HT showed a slight increase in the last two years but the pattern of clinical presentation has remained unchanged. Hashimoto's thyroiditis was most prevalent in the age group from 16 to 35 and the majority of young patients with Hashimoto's thyroiditis presented with diffuse goiter (DG) whereas multinodular goiter (MNG) and solitary thyroid nodule (STN) were more common in the older age group. Of patients who presented with STN, the most common abnormality on thyroid scan was a "cold nodule". Functional disturbances (hypo and hyperthyroidism) occurred less frequently in patients presenting as STN than in patients presenting with DG or MNG. We conclude that FNA is indicated in all young patients with diffuse goiter in this region in order to facilitate early detection and initiation of suppressive thyroxine therapy. Further, when young patients present with "cold" solitary nodules of the thyroid, HT is a more common cause than a thyroid carcinoma in Kuwait. Ann Saudi Med 1995;15(4) It has been our impression over the last two years that in Kuwait, chronic lymphocytic (Hashimoto's) thyroiditis (HT) presents at an earlier age and that a relatively greater proportion of patients with this disorder present as solitary nodules. In order to verify these impressions, we performed a retrospective analysis of all the fine needle aspirate (FNA) reports and the relevant clinical information from January 1986 to December 1993. We felt that such an analysis would give us information on the spectrum of HT in Kuwait, whether it differs from the spectrum of HT in other parts of the world and whether it has changed over the years. MethodsMubarak Al Kabeer Hospital is a tertiary care university teaching hospital in Kuwait and one of the major centers for fine needle aspiration cytology in this country. Information on all thyroid FNAs performed in this hospital was available from January 1986. The relevant clinical information available in the request forms and in the cytology registry was collected and analyzed. On the basis of clinical examination, patients were diagnosed to have a) diffuse goiter; b) multinodular goiter; and c) solitarythyroid nodule. Fine needle aspirates on these patients were diagnosed as follicular neoplasm, carcinoma, Hashimoto's thyroiditis or other benign lesions of the thyroid. When the FNA smears showed moderate to abundant lymphoid infiltrate with a variable degree of Hurthle cell metaplasia and follicular destruction, the diagnosis of Hashimoto's thyroiditis was suggested. The diagnosis of a follicular neoplasm was made when numerous follicular cells were seen in a microfollicular pattern with scant colloid. FNA smears were categorized as carcinoma when cytologic features suggestive of a papillary or undifferentiated c...

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Section: Discussionmentioning

confidence: 64%

Chronic Lymphocytic (Hashimoto's) Thyroiditis in Kuwait Diagnosed by Fine Needle Aspirates

et al. 1995

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“…The causes of SCH resemble the causes of HYPO, where autoimmune thyroiditis is the most frequent cause (9). Table 1 lists studies of the natural history of SCH (10)(11)(12)(13)(14)(15)(16)(17)(18). Progression of SCH to HYPO is in the order of 5-8%/year.…”

Section: Introductionmentioning

confidence: 99%

“…Progression of SCH to HYPO is in the order of 5-8%/year. Normalisation of thyroid function is another possible outcome, and many patients have stable SCH and do not experience systematic deterioration in thyroid function for years (10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

Karmisholt

Andersen

Laurberg

2011

European Journal of Endocrinology

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Subclinical hypothyroidism (SCH) is a common condition that is often observed without therapy. However, no evidence-based recommendation exists with regards to how patients with untreated SCH should be monitored. Monitoring involves regular assessment of symptoms and signs of hypothyroidism (HYPO) and biochemical tests of thyroid function. An important question when repeated tests of thyroid function are performed is how large a difference in test results is needed to be confident that the change is real and not just due to chance variation. Recent data show that the least significant difference between two tests in SCH is 40% for TSH and 15% for free thyroxine and free triiodothyronine, with 90% confidence. Furthermore, monitoring has to be based on biochemical function testing because serial evaluation of symptoms and signs related to HYPO is rather insensitive in detecting worsening of thyroid insufficiency. When the presence of thyroid peroxidase auto-antibodies (TPO-Ab) in serum has been demonstrated, repeated measurements do not add much useful information in the monitoring of individual subclinical hypothyroid patients, as levels of TPO-Ab vary in parallel with TSH in these patients. Lastly, we discuss how differences in the monitoring procedure influence the diagnostic outcome, and we suggest a follow-up approach for untreated subclinical hypothyroid patients.

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“…In longitudinal studies of thyroid autoimmunity 19,20 Effects of L-thyroxine therapy on goiter size, serum TSH, and antithyroid antibody levels in HD Since early studies in the 1950s (Table 1), a generation or longer elapsed before additional research confirmed that thyroxine treatment was associated with reduced thyroid size 21,22 and decreased antithyroid antibody levels 21 in either adult 21 or juvenile 22 patients with HD. A longitudinal study of goitrous HD and idiopathic myxedema 23 also found that L-thyroxine therapy for 2 to 4 years reduced goiter size (p < 0.050) as well as antibody levels (p < 0.001) in HD, in both hypothyroid HD and idiopathic myxedema, but not in patients with euthyroid HD.…”

Section: Hypothesis Raised: Could Thyroxine Treatment Diminish Risk Omentioning

confidence: 99%

A 50-year Revisit of the Initiation and Associations of Hashimoto’s Disease: Might Findings Conform to a Concept of Multifactorial Physiopathologic Transitions?

Masi

2013

J Rheumatol

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Natural history of autoimmune thyroiditis.

Cited by 252 publications

References 20 publications

Chronic Lymphocytic (Hashimoto's) Thyroiditis in Kuwait Diagnosed by Fine Needle Aspirates

Chronic Lymphocytic (Hashimoto's) Thyroiditis in Kuwait Diagnosed by Fine Needle Aspirates

Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

A 50-year Revisit of the Initiation and Associations of Hashimoto’s Disease: Might Findings Conform to a Concept of Multifactorial Physiopathologic Transitions?

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