Hanyang Med Rev.  2012 Nov;32(4):219-226. 10.7599/hmr.2012.32.4.219.

Autoimmune Thyroid Diseases

• Hahm JR

• KMID: 2168213
• DOI: http://doi.org/10.7599/hmr.2012.32.4.219

Abstract

Autoimmune thyroid disease is characterized by the presence of autoantibodies against thyroid peroxidase (TPO), thyroglobulin (Tg), and the thyroid simulating hormone receptor (TSHR). The thyroid gland is a site of autoantibody secretion in autoimmune thyroid disease by the B cells infiltrated into the thyroid. Hashimoto's thyroiditis, a chronic autoimmune thyroid disease, characterized by the occurrence of high levels of serum thyroid antibodies for TPO and Tg and goiter, is the most common type of thyroiditis. A firm, diffuse, painless goiter is the most common initial finding in Hashimoto's thyroiditis. Some patients have atrophic thyroid glands rather than goiter, which may represent the final stage of thyroid failure in Hashimoto's thyroiditis. Levothyroxine is the treatment of choice for Hashimoto's thyroiditis presenting overt hypothyroidism. Patients with Hashimoto's thyroiditis and a thyroid nodule should undergo fine-needle aspiration biopsy to rule out lymphoma and thyroid carcinoma. Graves' disease is the most common cause of spontaneous hyperthyroidism in patients younger than 40 years of age. Patients with Graves' disease reveal heterogeneous lymphocytic infiltration without follicular destruction and also show various clinical presentations.

Keyword

Hashimoto Disease; Graves Disease; Thyroiditis; Autoimmune

MeSH Terms

Antibodies
Autoantibodies
B-Lymphocytes
Biopsy, Fine-Needle
Goiter
Graves Disease
Hashimoto Disease
Humans
Hyperthyroidism
Hypothyroidism
Iodide Peroxidase
Lymphoma
Thyroglobulin
Thyroid Diseases
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule
Thyroiditis
Thyroxine
Antibodies
Autoantibodies
Iodide Peroxidase
Thyroglobulin
Thyroxine

Reference

1. Kim WB. Recent progress in research on autoimmune thyroid diseases. J Korean Soc Endocrinol. 2002. 17:338–357.

2. Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol. 1997. 84:223–243.

3. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996. 335:99–107.

4. Weetman AP. Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol (Oxf). 1992. 36:307–323.

5. Kim By, Lee My, Oh IG, Kim DOH, Kim HC, Kim SE, et al. Three cases of autoimmune thyroid disease in a family through three generation. J Korean Soc Endocrinol. 2001. 16:238–244.

6. Fonseca V, Thomas M, Havard CW. Hashitoxicosis and autoantibody interference with thyroid function tests. J R Soc Med. 1988. 81:546–547.

7. Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol. 2000. 24:623–639.

8. Kong ON, Joo SH, Shin SH, Na MA, An JH, Kang YH, et al. A case of thyroid MALT lymphoma without autoimmune thyroiditis. J Korean Soc Endocrinol. 2005. 20:268–272.

9. Roitt IM, Campbell PN, Doniach D. The nature of the thyroid auto-antibodies present in patients with Hashimoto's thyroiditis (lymphadenoid goitre). Biochem J. 1958. 69:248–256.

10. Doniach D, Hudson RV, Roitt IM. Human auto-immune thyroiditis: clinical studies. Br Med J. 1960. 1:365–373.

11. Tunbridge WM, Brewis M, French JM, Appleton D, Bird T, Clark F, et al. Natural history of autoimmune thyroiditis. Br Med J (Clin Res Ed). 1981. 282:258–262.

12. Robazzi TC, Adan LF. Autoimmune thyroid disease in patients with rheumatic diseases. Rev Bras Reumatol. 2012. 52:417–430.

13. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003. 348:2646–2655.

14. Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev. 2001. 22:605–630.

15. Weetman AP. Graves' disease. N Engl J Med. 2000. 343:1236–1248.

16. Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. Br J Ophthalmol. 1989. 73:639–644.

17. Valente WA, Vitti P, Yavin Z, Yavin E, Rotella CM, Grollman EF, et al. Monoclonal antibodies to the thyrotropin receptor: stimulating and blocking antibodies derived from the lymphocytes of patients with Graves disease. Proc Natl Acad Sci U S A. 1982. 79:6680–6684.

18. Vaidya B, Imrie H, Perros P, Young ET, Kelly WF, Carr D, et al. The cytotoxic T lymphocyte antigen-4 is a major Graves' disease locus. Hum Mol Genet. 1999. 8:1195–1199.

19. Dayan CM, Londei M, Corcoran AE, Grubeck-Loebenstein B, James RF, Rapoport B, et al. Autoantigen recognition by thyroid-infiltrating T cells in Graves disease. Proc Natl Acad Sci U S A. 1991. 88:7415–7419.

20. Mushlin SB, Drazen JM, Samuels MA, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 33-2002. A 28-year-old woman with ocular inflammation, fever, and headache. N Engl J Med. 2002. 347:1350–1357.

21. Rhee EP, Scott JA, Dighe AS. Case records of the Massachusetts General Hospital. Case 4-2012. A 37-year-old man with muscle pain, weakness, and weight loss. N Engl J Med. 2012. 366:553–560.

22. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010. 362:726–738.

23. Bartalena L, Marcocci C, Pinchera A. Graves' ophthalmopathy: a preventable disease? Eur J Endocrinol. 2002. 146:457–461.

24. Bahn RS, Heufelder AE. Pathogenesis of Graves' ophthalmopathy. N Engl J Med. 1993. 329:1468–1475.

25. Woeber KA. Thyrotoxicosis and the heart. N Engl J Med. 1992. 327:94–98.

26. Tran HA. Thyrotoxic periodic paralysis. Mayo Clin Proc. 2005. 80:960–961.

27. Mundlein E, Greten T, Ritz E. Graves' disease and sarcoidosis in a patient with minimal-change glomerulonephritis. Nephrol Dial Transplant. 1996. 11:860–862.

28. Scott GR, Forfar JC, Toft AD. Graves' disease and atrial fibrillation: the case for even higher doses of therapeutic iodine-131. Br Med J (Clin Res Ed). 1984. 289:399–400.

29. Belfiore A, Russo D, Vigneri R, Filetti S. Graves' disease, thyroid nodules and thyroid cancer. Clin Endocrinol (Oxf). 2001. 55:711–718.

30. Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, Dell'Unto E, et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med. 1998. 338:73–78.

31. Ivy HK, Wahner HW, Gorman CA. Triiodothyronine (T 3 ) toxicosis. Its role in Graves' disease. Arch Intern Med. 1971. 128:529–534.

32. Lai KN, Leung JC, Chow CC, Cockram CS. T lymphocyte activation in euthyroid Graves' ophthalmopathy: soluble interleukin 2 receptor release, cellular interleukin 2 receptor expression and interleukin 2 production. Acta Endocrinol (Copenh). 1989. 120:602–609.

33. Cooper DS. Antithyroid drugs. N Engl J Med. 2005. 352:905–917.

34. Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, et al. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab. 2005. 90:6093–6098.

35. Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med. 2011. 364:542–550.

36. Lee JA, Grumbach MM, Clark OH. The optimal treatment for pediatric Graves' disease is surgery. J Clin Endocrinol Metab. 2007. 92:801–803.

37. Franklyn JA. The management of hyperthyroidism. N Engl J Med. 1994. 330:1731–1738.

38. Erbil Y, Ozluk Y, Giris M, Salmaslioglu A, Issever H, Barbaros U, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease. J Clin Endocrinol Metab. 2007. 92:2182–2189.