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Hashimoto thyroiditis

Last updated: May 4, 2020


Hashimoto disease is the most common form of autoimmune thyroiditis and the leading cause of hypothyroidism in the United States. Although currently thought to be due to chronic autoimmune-mediated lymphocytic inflammation of the thyroid tissue, the exact pathophysiology remains unclear. Patients are initially asymptomatic or hyperthyroid, progressing to hypothyroidism as the organ parenchyma is destroyed. Diagnosis is based on a combination of specific antibodies, thyroid function tests, and sonography of the thyroid. Treatment involves lifelong hormone replacement therapy with levothyroxine (L-thyroxine).


  • Prevalence
  • Sex: > (7:1)
  • Age of onset: occurs in all age groups; , most prevalent in women aged 30–50 years


Epidemiological data refers to the US, unless otherwise specified.



Clinical features



Anti-TPO antibodies are also elevated in 70% of patients with Graves disease!




Differential diagnoses


The differential diagnoses listed here are not exhaustive.


  • Levothyroxine (T4) replacement therapy
    • Life-long oral administration of L-thyroxine (T4)
    • Commence at a lower and more slow-acting dose with increasing severity of hypothyroidism because of the risk of cardiac side effects.
  • Life-long monitoring
    • Due to decline in T4 production with increasing age
    • Life-long monitoring of thyroid parameters (primarily TSH) is necessary to adjust treatment accordingly and avoid hyperthyroidism




We list the most important complications. The selection is not exhaustive.


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