Hashimoto's thyroiditis diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made on laboratory and pathological findings after the clinical suspicion. It includes the presence of TPO antibodies, hypothyroidism, reduced echogenicity on the ultrasound, the presence of germinal centers and lymphocytic infiltration of the thyroid gland.
Diagnostic Criteria
There are no established criteria for the diagnosis of Hashimoto's thyroiditis. The diagnosis of Hashimoto's thyroiditis is made based on laboratory, ultrasound, and pathological findings after the clinical suspicion:[1][2][3][4]
- Laboratory findings
- Presence of TPO antibodies
- Low T3 and T4
- High TSH
- Ultrasound findings
- Reduced echogenicity
- Pathological findings
- Germinal centers
- Lymphocytic infiltration
Stepwise clinical diagnosis of Hashimoto's thyroiditis
The following flowchart describes the clinical approach to the diagnosis of Hashimoto's thyroiditis.
| Neck pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RAIU* | Presenting symptoms and TFTs‡ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increased | Decreased | Hyperthyroid | Hypothyroid | Euthyroid | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RAIU* | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suppurative thyroiditis | De Quervain's thyroiditis | Increased | Decreased | Hashimoto's thyroiditis | Riedel's thyroiditis†† | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Grave's disease† | Silent thyroiditis
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‡TFT; Thyroid function tests(TSH, T4, and T3), †Grave's disease is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of Riedel's thyroiditis presents with hypothyroidism.
Table modified from [5]
References
- ↑ Dong YH, Fu DG (2014). "Autoimmune thyroid disease: mechanism, genetics and current knowledge". Eur Rev Med Pharmacol Sci. 18 (23): 3611–8. PMID 25535130.
- ↑ Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.
- ↑ Giannini, AJ (1986). The Biological Foundations of Clinical Psychiatry. New Hyde Park, NY: Medical Examination Publishing Company. pp. 193–198. ISBN 0-87488-449-7.
- ↑ Simmons, PJ (1998). "Antigen-presenting dendritic cells as regulators of the growth of thyrocytes: a role of interleukin-1beta and interleukin-6". Endocrinology. 139 (7): 3158–3186. doi:10.1210/en.139.7.3148. PMID 9645688.
- ↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".