Abstract
We retrospectively studied 454 patients with Hashimoto’s disease (69 males and 385 females) at the Health Service Association (Kenko Life Plaza) between 2003 and 2016.
Fluctuating thyroid function, ultrasonographic findings of the thyroid and antithyroid antibodies in Hashimoto’s disease were examined.
Of the 454 patients, 252 (Group A) had had a thyroid function test only once in our facility, of whom148 were referred to a thyroid specialist for detailed examination and treatment and their patient referral document replies were investigated. The remaining 202 patients (Group B) were followed up periodically with thyroid function tests during studies.
The Follow-up studies of thyroid function of 350 patients with Hashimoto’s disease demonstrated that 73% of them were euthyroid and 27% had thyroid dysfunction, consisting of 6.6% with hypothyroidism at the initial testing. The final thyroid state was as follows: euthyroid 76% and thyroid dysfunction 24%, with 10.6% developing hypothyroidism.
An Ultrasonographic study (US) was performed in 427 patients with Hashimoto’s disease. A heterogeneous distribution was found in 312 patients (73.1%) and homogeneous distribution in 115 patients (26.9%). Of the 286 patients with Hashimoto’s disease, 198 (69.2%) had an enlarged thyroid gland (≥20g).
The detection rate of TgAb was 93.1%, which was higher than the 71.2% for TPOAb in 333 patients who had both TgAb and TPOAb examinations.
The detection rate of TgAb was 95.7% in 258 patients with heterogeneous echogenicity while 84% of 75 patients with a homogeneous distribution of thyroid were positive.
Of 164 nodules, 13 (3.0%) had papillary carcinoma and 151 (35.4%) had benign thyroid nodules. On the other hand, Hashimoto’s disease was concomitantly seen in 16 (24.6%) of 65 patients with papillary carcinoma and in 98 (19.6%) of 501 patients with benign nodules.
We conclude that most patients with Hashimoto’s disease asymptomatically progress slowly over years in the euthyroid state. However, thyroid dysfunction occasionally appears and returns to euthyroid or develops to overt hypothyroidism.
We devised a flowchart for the management of patients with Hashimoto’s disease.
Ultrasound images of the thyroid and nodules of the patients and chest X-rays of myxedema heart are presented.
