Hashimoto’s Thyroiditis CHT 101: The First sign may be a firm “bumpy” thyroid on examination.This is conformed by thyroid ultrasound.
It may take years to become severely hypothyroid but the disease is slowly progressing anyway and needs to be treated when first diagnosed before you are sick and looking like this face picture. First degree Family of someone with CHT needs blood and ultrasound studies. It is not screening but indicated case finding.
1.The US appearance is highly variable and correlates with the progression of histopathologic changes along the course of the disease.
2. The lymphoid and oncocytic Hurthle cell appear homogeneous on US, and fibrosis elements as hyperechoic septa.
3.Early in the course of the disease, the gland appears diffusely enlarged and profound hypoechoic. which correlates with lymphocytic infiltration and colloid depletion without fibrosis.
4. Subclinical thyroid dysfunction is common at this stage.
5. As the disease progresses, there is mild hyperechogenicity, heterogeneity, and pseudo-micronodularity (“moth-eaten·· or cotton weave) that is the result of destruction of thyroid tissue.
6. Poorly outlined hypoechoic pseudonodules may be variably present, often transient. and may represent coalescent aggregates of lymphoid cell-rich tissue. which may be surrounded by echogenic septa.
7. A Swiss-cheese” appearance on US. the result of small cystic lesions.may be seen in the course of the disease.
8. Hyperechogenic pseudonodules may be seen in·regenerative” nodules or as a result of aggregated fibrous tissue (“white knight “).
9. Some things look like nodules on US but are not seen in 3 dimensions. These are pseudonodules and DO NOT NEED BIOPSY.
9. Blood flow is variable: it range from absent to normal to increased on Doppler examination.
10.The gland is small, atrophic, hypoechoic, and heterogeneous in end-stage disease.
11. True distinct thyroid nodules with or without calcifications may be seen.
12. They need USG-FNA to rule out PTC or lymphoma.
13. Cytologic material for confirmatory flow-cytometry ( lymphoma) studies can be easily obtained by this means.
14. Molecular Marker studies on indeterminate nodules can be obtained during the biopsy or off slides after.
Typical Hurtle cell changes in CHT is not Hurthle Cell cancer or neoplasm.
15. Prominent lymph nodes in the central and lateral neck are almost always present with CHT.