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Hyperthyroidism
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Uncommonly, thyrotoxicosis is an initial thyrotoxic phase in patients with Hashimoto’s thyroiditis in which immunologic destruction of thyroid tissue results in the release of preformed thyroid hormone, which leads to elevated T4 levels. In contrast to GD, hyperthyroidism is transient, eye findings are absent, radionuclide uptake is low, and elevated levels of thyroid-stimulating immunoglobulins are not present. This condition can be distinguished from GD by low uptake within the thyroid gland of radionuclides and its transient nature, lasting a few months. Some reserve the term Hashitoxicosis for patients with autoimmune thyroid disease who present with phases of GD and hypothyroidism associated with stimulating and blocking thyroid autoantibodies.
The endocrine system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Hashimoto's thyroiditis is a disease of middle-aged to elderly females. It presents with hypothyroidism and a diffuse, firm, painless goitre (Figure 18.7). Patients usually present as euthyroid, but may show hyperthyroidism initially (so called Hashitoxicosis). Most will eventually become hypothyroid. The gland parenchyma shows oncocytic or Hürthle cell change in follicular epithelial cells and is infiltrated by lymphocytes with germinal centre formation (Figure 18.8). A subgroup of patients may develop fibrosis in the gland.
The laboratory and imaging approaches to thyroid disorders
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Jacqueline Jonklaas, David S. Cooper
In subacute or silent thyroiditis, despite the laboratory evidence of thyrotoxicosis, there is low uptake of radioiodine (or Tc-99m) by the gland (Table 1.5) (139). This decreased uptake may give way to a patchy pattern of uptake as the gland recovers from the thyroiditis. Low radioiodine uptake over the thyroid gland may also be seen in a patient with thyrotoxicosis when the cause of the problem is thyroid hormone ingestion or iodine excess. Low uptake is typically seen in a hypothyroid patient with Hashimoto’s thyroiditis. Rarely, this low uptake may be preceded by a period of diffusely increased uptake and hyperthyroidism in the early stage of Hashimoto’s disease (so called “Hashitoxicosis”) (140). Other rare situations in which there may be low or absent radioiodine uptake in the neck in a hyperthyroid patient include struma ovarii, where there is increased uptake of the tracer in the pelvis, and functioning metastatic thyroid cancer.
Transient T3 toxicosis associated with Hashimoto’s disease
Published in Baylor University Medical Center Proceedings, 2019
Sarah Jaroudi, Meredith Gavin, Kathryn Boylan, Alan N. Peiris
Hashimoto thyroiditis is most commonly associated with hypothyroidism.1 Antibodies to thyroid antigens (usually thyroperoxidase and thyroglobulin) are found in a majority of patients.2 Rarely, thyrotoxicosis can result from Hashimoto’s disease. This can be seen early in the course of the disease and manifests with an elevated free T4 and a suppressed thyroid-stimulating hormone (TSH) level (Hashitoxicosis). This hyperthyroid phase usually results from increased synthesis and release of thyroid hormone. Hashitoxicosis is seen in about 5% of cases of Hashimoto’s thyroiditis.1 Although it usually subsides over time, a small proportion of patients will have waxing and waning of thyroid hormone levels. Some with Hashitoxicosis may need antithyroid treatment pending such resolution.