Hashimoto's thyroiditis: past, present and future

Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease, occur in young women, early manifestation of hyperthyroidism, wi


Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease, occur in young women, early manifestation of hyperthyroidism, with the course of the development of hypothyroidism. On ~10 April 9, 2016 at the ninth session of the forum China Merck thyroid and diabetes, epidemiology of HT, Professor Duncan Topliss from endocrinology and Diabetes Australia Alfred hospital clinical characteristics were systematically reviewed, and discussed on some hot issues in the field of.

HT and pregnancy

HT if not timely treatment may have serious consequences for pregnancy, subclinical hypothyroidism can reduce the chances of pregnancy, premature birth and abortion rate increased during pregnancy, thyroid hormone therapy can reduce the risk of the corresponding. It is recommended that TSH should be < in the first three months of pregnancy, at mU/L, in the middle and late pregnancy at TSH< at 3 mU/L, the increase in maternal TSH was associated with a reduction in offspring IQ.

The role of iodine in HT

Excessive iodine intake can increase the incidence of HT and hypothyroidism. Iodine supplement can increase the level of circulating TPO antibody, and highly iodinated Tg may has more relevant antigenicity. Iodine can inhibit the synthesis and secretion of thyroid hormone, which is a pathological condition in HT patients. For patients with HT supplementation is not only useless, but may be harmful.

HT processing

The treatment of HT needs to be selected according to the clinical situation in the observation and the replacement therapy of thyroid hormone preparation. Glucocorticoids can improve thyroid function, but its side effects and risks outweigh the benefits.

Thyroid hormone replacement therapy should be considered according to the level of TSH, is still the main choice of levothyroxine treatment, completely replace the dose dependent on age and weight, the treatment should adjust the dose according to TSH levels, excessive substitution may lead to atrial fibrillation, osteopenia and other adverse reactions. Not all are in need of subclinical thyroid hormone replacement therapy, so as not to cause iatrogenic subclinical hyperthyroidism and atrial fibrillation, the risk of osteoporosis, so the treatment of subclinical hypothyroidism to balance the risks and benefits, especially for elderly patients.

HT and PTC

There is no evidence to support the association between HT and papillary thyroid carcinoma (PTC). A number of studies based on thyroid surgical specimens reported an association between the two, and the population based thyroid fine needle aspiration (FNA) study did not find associations. Some scholars believe that the two genes may be associated with PI3K/Akt pathway and RET/PTC gene rearrangement. Some scholars believe that PTC can be used as initial lesion induced lymphocyte infiltration, and thus become Hashimoto's thyroiditis in some patients.



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