What is Chronic Lymphocytic Thyroiditis?
The thyroid gland is situated at the base of the front portion of the neck and is responsible for producing hormones that control body’s metabolism such as heart rate, burning calories etc. Thyroiditis refers to a group of inflammatory disorders.
Chronic lymphocytic thyroiditis is an autoimmune disorder where immune cells of the body attack the thyroid tissue, causing inflammation of the thyroid. This in turn impairs the ability of the thyroid to produce the thyroid hormone. If the thyroid is destroyed to a point where it cannot produce enough thyroid hormone for the body to function properly, hypothyroidism is developed. In other cases, the thyroid becomes so inflamed and enlarged that a goiter develops. Chronic lymphocytic thyroiditis is also known as Hashimoto’s thyroiditis, named after the Japanese surgeon who discovered it in 1912.
Causes of Chronic Lymphocytic Thyroiditis
Chronic lymphocytic thyroiditis is caused when a large number of damaged lymphocytes invade the thyroid gland. When these cells enter the thyroid, they destroy the gland’s cells, tissues and blood vessels. It is still unclear as to why the guardian cells of the body turn up against the body’s healthy tissues. The research is still ongoing but some of the factors that may cause Chronic lymphocytic thyroiditis are:
Genes Responsible for Causing Chronic Lymphocytic Thyroiditis:
People who have family members who have had this disorder are more likely to develop chronic lymphocytic thyroiditis.
Chronic Lymphocytic Thyroiditis Caused Due to Hormones:
Research says that Chronic lymphocytic thyroiditis is seven times more common in women than in men. This suggests that sex hormone plays an important role in the development of Chronic lymphocytic thyroiditis. Furthermore, some women have problems with thyroid before and after having a baby. Although the problem goes away, as many as 20% of these women develop this disorder.
Excessive Iodine Causing Chronic Lymphocytic Thyroiditis:
Certain drugs and too much Iodine also trigger thyroid disorder in susceptible people.
Radiation Exposure as a Cause of Chronic Lymphocytic Thyroiditis:
Exposure to certain radiations like the radiations after atomic bombing in Japan, the Chernobyl nuclear accident and other radiation exposures can lead to chronic lymphocytic thyroiditis.
Signs and Symptoms of Chronic Lymphocytic Thyroiditis
Chronic lymphocytic thyroiditis is mild in the beginning and might take years to develop. The most evident symptom of chronic lymphocytic thyroiditis is the appearance of a firm, irregular, non-tender goiter. At first, the bulge may be painless, but puts pressure on the lower portion of the neck. In advanced stages, the goiter may interfere with breathing and swallowing.
Other symptoms of chronic lymphocytic thyroiditis may include the following:
- Weight gain
- Paleness or puffiness of the face
- Feeling cold
- Joint and muscle pain
- Dry and thinning of hair
- Heavy or irregular menstrual periods
- Panic disorder
- Slowed heart rate
- Problems getting pregnant and maintaining it.
Epidemiology of Chronic Lymphocytic Thyroiditis
Individuals who develop chronic lymphocytic thyroiditis often have family members who have had either thyroid or some other autoimmune disorder. Though Chronic lymphocytic thyroiditis may affect people of any age group, it mostly shows in middle aged people, typically between the ages 30 to 50, and is seven times more common in women than in men. It affects about 5% of the population at some point in their life and about 1 to 1.5 in 1000 people have this disorder at any point in time.
The incidents of Chronic lymphocytic thyroiditis have grown exponentially in the past 50 years and this increase may be related to the increasing content of Iodine in the regular diet. A rare but serious complication of chronic lymphocytic thyroiditis is thyroid lymphoma, which tends to occur in women of the age group 50-80 and is usually limited to thyroid gland.
Diagnosis of Chronic Lymphocytic Thyroiditis
Diagnosis of chronic lymphocytic thyroiditis is based on the patient’s signs and symptoms. Physical findings vary depending on the extent of hypothyroidism, such as puffy face, periorbital edema, cold and dry skin, peripheral non-pitting edema, thickened and brittled nails, bradychardia, elevated blood pressure, slow speech, ataxia etc. The most evident indication of the disease would be the presence of thyroid stimulating hormone, free T3 and T4, and thyroid specific auto antibodies in the serum. This, along with measurement of serum thyroglobulin levels are required to confirm the diagnosis. Ultrasonography is another diagnostic tool by which an enlarged thyroid gland with a hypoechogenic pattern can be seen. This imaging is useful for assessing thyroid size, texture and the location of the nodules. Fine needle aspiration and biopsy can be done to exclude malignancy.
Treatment of Chronic Lymphocytic Thyroiditis
There is no cure as such for chronic lymphocytic thyroiditis; however, replacing hormones with medication can regulate hormone levels and restore the normal body metabolism. Chronic lymphocytic thyroiditis can be treated with Levothyroxine, regardless of whether or not hypothyroidism is present. Thyroid replacement agents like levothyroxine, triiodothyronine or desiccated thyroid extraction are also used to treat this disorder.
Monitoring of the synthetic hormone intake should be kept in mind as excessive amounts of thyroid can accelerate bone degradation, which may lead to osteoporosis. Over treatment with levothyroxine can also cause heart rhythm disorders (e.g., arrhythmias).
There is no known way to prevent chronic lymphocytic thyroiditis. Being aware of risk factors may allow earlier diagnosis and treatment.
Prognosis of Chronic Lymphocytic Thyroiditis
Chronic lymphocytic thyroiditis does not progress for years. However, if it does progress slowly to hypothyroidism, the condition can easily be treated with thyroid hormone replacement therapy.
Chronic lymphocytic thyroiditis is a condition that affects the thyroid gland and is often under diagnosed due to its widespread spectrum of clinical manifestations. Most commonly, it could be present as multi nodular goiter, diffused goiter, or solitary nodule along with features of hyperthyroidism or euthyroid state. According to statistics, females are more prone to develop Chronic lymphocytic thyroiditis. The diagnosis can be made by positive antibody titres or final histopathology. Treatment for Chronic lymphocytic thyroiditis includes thyroxine replacement therapy or suppression therapy where surgery is rarely required. Diffused goiters respond fairly well to medicinal management as compared multi nodular goiters.
Cytological grading of chronic lymphocytic thyroiditis helps in assessing the severity of the disease and can predict the thyroid’s functional status. Asymptomatic and subclinical hypothyroid cases are associated with grade I and II chronic lymphocytic thyroiditis on cytology, whereas hypothyroid cases are associated with grade II & III chronic lymphocytic thyroiditis. A combined approach of cytological grading of chronic lymphocytic thyroiditis along with ultrasonography and biochemical levels can detest subclinical hypothyroid state and provide a guide to therapy.
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