A Study on Clinical Profile of Hashimoto's Thyroiditis Patients at Government Stanley Hospital

Subburaj, D (2013) A Study on Clinical Profile of Hashimoto's Thyroiditis Patients at Government Stanley Hospital. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Hashimoto’s thyroiditis, a well known condition affecting the thyroid gland is often under diagnosed due to its wide spectrum of clinical manifestations. As such it could present as a multinodular goitre, a diffuse goitre or a solitary nodule with features of hypothyroidism, hyperthyroidism or in a euthyroid state. It is the commonest cause of goitre with hypothyroidism in iodine sufficient areas. Since Hakaru Hashimoto discovered chronic lymphocytic infiltration in the thyroid in 1912, a sea change has occurred in our knowledge of this autoimmune process. It is now well documented that not all cases with histological features of lymphocytic infiltration are due to Hashimoto’s thyroiditis. This histological picture of lymphocytic infiltration is also seen in some other conditions affecting the thyroid. The bio-chemical evaluation of autoantibody titres (AMA, ATG) together with the clinical, FNAC and hormone assay guides the clinician towards making a diagnosis of Hashimoto’s thyroiditis. This condition is managed conservatively and surgery is rarely required. AIM & OBJECTIVES: 1. To study the clinical profile of hashimoto’s thyroiditis patients at Stanley hospital. 2. To assess thyroid status and clinical relation in these patients. 3. To determine the demographic profile of hashimoto’s thyroiditis in North Chennai population. 4. To assess the sensitivity of thyroid auto antibodies and its correlation with hypothyroidism. MATERIALS AND METHODS: Sixty cases of Hashimoto’s thyroiditis were studied from January 2012 to November 2012. Data was collected from sixty patients, both outpatients and Inpatients in this period, treated at Stanley medical college hospital, Chennai. Patients were informed about the study, the relevance of the Investigations, the “non operable” treatment modality, the requirement of daily Thyroxine supplements presumably for an indefinite period of time and the Need for regular follow up. All the investigations required for the study were usually done on an outpatient basis. Patient who underwent surgery were investigated during their admission period prior to surgery. All Patients with goitrous enlargement referred to our endocrinological op were subjected to a hormonal assay and FNAC. If FNAC showed features of lymphocytic infiltration, then thyroid autoantibody estimation were ordered for. However, if FNAC showed no features of lymphocytic Infiltration, but the patient was in subclinical or overt hypothyroidism, even then antibody estimation was done. This investigation protocol has been Figuratively represented below. Patients,who had lymphocytic infiltration in FNAC and Thyroid function test showed hyper thyroidism/subclinical hyperthyroidism further subjected to thyroid Doppler to grade the vascularity. Thyroid colour Flow Doppler differentiates graves disease from hashimoto’s thyroiditis. In hashimoto’s thyroiditis, vascularity is mostly normal or slightly increased. In Graves disease, vascularity always increased. In Patients with MNG, those who were diagnosed as hashimoto’s Thyroiditis postoperatively by post op biopsy of resected thyroid specimen, also included in this study. Their symptoms & presentation were studied retro Spectively from case records and by taking history. Inclusion Criteria: All patients diagnosed as Hashimoto’s thyroiditis were included. Diagnosing could be on the basis of FNAC, positive antibody status or Final histopathology report. Exclusion Criteria: 1. Patients who are not willing to get investigated in complete. 2. Paediatric patients. 3. Patients of acute thyroiditis and other causes of chronic. 4. Thyroiditis such as reidels thyroiditis. 5. Patients of previously treated cases of hashimotos thyroiditis. 6. Patients diagnosed as thyroid malignancies SUMMARY: Sixty patients were diagnosed to have Hashimoto’s thyroiditis in the study period from January 2012 – November 2012. The study was conducted at Stanley Medical College, Chennai. The findings of our study were compared with that of the available literature. The findings of our study are as follows: 1. The occurrence of Hashimoto’s thyroiditis was maximum in the 20-30 year age group. 2. Females outnumbered the males with a male to female ratio of 1: 29. 3. All the sixty patients presented with complaints of swelling in front of the neck. Two patients presented with obstructive symptoms as well. 4. Duration of the swelling ranged from 1 month to one and half years, however, most of the patients presented within 6 months of noticing the swelling. 5. Consistency of the gland was firm in all cases. 6. In our study, 4 patients were multinodular goiter (6.6%), 54 were diffuse. Goiters (90%) and 2 was solitary nodule (3.3%). 7. 5 patients were hypothyroid (8 %), 30 patients were Euthyroid (50%) and 3 patients were hyperthyroid (5%). 13 patients had subclinical hypothyroidism (21%), 9 patients had subclinical hyperthyroidism (15%). 8. FNAC was positive in 60 patients (100 %). 9. Antibodies were positive in 55 patients (92 %). 10. Anti TPO antibody levels also correlates with severity of the disease. Average anti TPO level in hypo thyroid patients is 85 units which is significantly higher than euthyroid patients. Anti thyroglobulin levels does not correlates with severity. 11. ANA (1:40 Dillution) positive in 14 (23%). 12. 46% patients had normal BMI. 21% of the patients were over weight. 15% were under weight. 16% were obese. 13. 28 patients were treated conservatively and monitored regularly every 3 months. Eventually, at the time of writing this article, all 28 patients were clinically Euthyroid. All diffuse goiters and solitary nodules regressed in size with Thyroxine therapy. The multinodular goiters showed no increase or decrease in Size of the gland. All but two patients were treated conservatively. Two patients underwent surgery for Obstructive symptoms histopathology revealed to be Hashimoto’s thyroiditis. 14. Other auto immune disease commonly associated with hashimoto’s thyroiditis is segmental vitiligo & type 1 DM. CONCLUSION: Hashimoto’s thyroiditis is a commonly present as diffuse euthyroid goitrous enlargement. • Females are more prone to develop Hashimoto’s thyroiditis. The proportion of younger age group females more commonly involved in our study group (North Chennai). • Hashimoto’s thyroiditis has a varied clinical presentation and as such couldPresent as a diffuse goiter, a multinodular goitre or a solitary nodule.Diffuse goiter is more common. • Hashimoto’s thyroiditis could present in a hypothyroid state, an euthyroid State, subclinical hypothyroidism, subclinical hyperthyroidism and in a small proportion of the patients in a hyperthyroid state. • Diagnosis of Hashimoto’s thyroiditis could be done by FNAC, positiveAntibody titres or final histopathology. • Anti TPO levels correlates with severity of the disease. • Treatment is primarily medical with thyroxine replacement or suppression. • Surgery is rarely required. • Diffuse goiters and solitary nodules respond better to the medical line of management, than do multinodular goiters.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Hashimoto's Thyroiditis Patients ; Government Stanley Hospital ; Clinical Profile.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 25 Mar 2018 08:53
Last Modified: 26 Mar 2018 16:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/6583

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