Fast Five Quiz: Test Yourself on Key Thyroid Conditions

Romesh Khardori, MD, PhD

Disclosures

August 06, 2018

Hashimoto thyroiditis is a histologic diagnosis. Typically, the thyroid gland shows diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles from follicular hyperplasia and damage to the follicular basement membrane. Atrophy of the thyroid parenchyma is usually evident. Correlation with the presence of thyroid autoantibodies, namely anti-TPO and antithyroglobulin (anti-Tg), is helpful in confirming the diagnosis.

Iodine uptake and scan are usually not indicated for the diagnosis of Hashimoto thyroiditis. The usefulness of radioactive iodine and scan is in classifying a nodule as either hot or cold. A cold thyroid nodule indicates a higher risk for malignancy and therefore a need for fine-needle aspiration.

The treatment of choice for Hashimoto thyroiditis (or hypothyroidism from any cause) is thyroid hormone replacement. The drug of choice is orally administered levothyroxine sodium, usually for life. Tailor and titrate the dose of levothyroxine sodium to meet the individual patient's requirements. The goal of therapy is to restore a clinically and biochemically euthyroid state. The standard dose is 1.6-1.8 µg/kg lean body weight per day, but the dose is patient dependent. The free T4 and TSH levels are within reference ranges in the biochemically euthyroid state, with the TSH level in the lower half of the reference range.

Patients younger than 50 years who have no history or evidence of cardiac disease can usually be started on full replacement doses. Start patients older than age 50 years and younger patients with cardiac disease on a low dose of 25 µg (0.025 mg) per day, with clinical and biochemical reevaluation in 6-8 weeks. Carefully titrate the dose upward to achieve a clinical and biochemical euthyroid state.

For more on Hashimoto thyroiditis, read here.

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