Hashimoto's Thyroiditis

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Step 1: View clinicals

A 39 year old woman presents with a slowly enlarging lump in the front of her neck, which she first noticed around an year ago. No other symptoms are present, and she has not sought medical advice in this respect earlier, due to the fear that she would be asked to undergo surgery. Her medical, surgical, and family histories are unremarkable, and she is not on any medications. She only drinks socially and does not smoke. She also consumes a well-rounded diet, which includes seafood, and red meat. A complete blood count is found to be within normal parameters.


Step 2: Order all relevant investigations

Thyroid Ultrasound

The thyroid gland is diffusely enlarged, measuring 4.8 x 4.2 x 2.3cm in size, with hypoechoic heterogeneous changes involving the entire gland. There is no evidence of nodules or increased vascularity. The cervical lymph nodes are not enlarged.

Thyroid Profile

TSH: 12.9 mIU/L (0.4-4.5) Free T4: 0.9 ng/dL (0.7-1.9) Free T3: 2.5 pg/mL (2.3-4.2)

Thyroid Antibody Assay

Anti-Thyroid Peroxidase Antibodies: 65 IU/mL (<35) Anti-Thyroglobulin Antibodies: 30 IU/mL (<20) Anti-TSH Receptor Antibodies: 1.5 IU/L (<1.75)

Radioactive Iodine Uptake Scan

The uptake scan demonstrates a 24-hour iodine uptake of 34%, with a mixed pattern of areas showing hypo- and hyper-uptake.


Step 3: Select appropriate management

Iodine Supplementation
Glucocorticoids
Levothyroxine
Total Thyroidectomy


Score: ★★☆