Hashimoto’s Thyroiditis

Organ-specific autoimmune disease

Target tissue is the thyroid

Anterior region
Of the neck 12-20g

THYROID

Follicles Colloid
Thyrotropin-releasing hormone
(TRH)

Thyroid-stimulating hormone (TgAb)

Antithyroglobulin
(TSH)

Antithyroperoxidase (TPO Abs)

Thyroglobulin

Triiodothyronine Thyroxine
T3 T4
Hashimoto’s Thyroiditis
Chronic Autoimmune Thyroiditis

Combination of GOITER or
ENLARGED THYROID,
HYPOTHYROIDISM and
THYROID AUTOANTIBODIES

Thyroid gland
enlarged or rubbery
 Hashimoto’s Thyroiditis
Puffy face with
edematous eyelids
Sweating

Dry skin Symptoms

Dry and brittle
hair

Pallor with a yellow tinge

 Weight
Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis
Genetic Predisposition

Associated with HLA antigens

( HLA-DR4 and HLA-DR5 )

HLA DR antigens are expressed on the

cell surface of Thyroid Epithelial Cells
during the progress of the disease

DQA1 and DQB1

Hashimoto’s Thyroiditis
Clinical Manifestations

Low levels of T3 and T4

High TSH levels

 Hashimoto’s Thyroiditis
Immunologic Findings

Lymphocytic infiltration within the thyroid gland

QuickTime™ and a QuickTime™ and a

TIFF (LZW) decompressor TIFF (LZW) decompressor
are needed to see this picture. are needed to see this picture.

Photomicrographs of (a) normal thyroid gland show-

ing a follicle lined by cuboidal follicular epithelial cells and (b) gland in
Hashimoto’s thyroiditis showing intense lymphocyte infiltration. [From
Web Path, courtesy of E. C. Klatt, University of Utah.]
Hashimoto’s Thyroiditis
Immunologic Findings

Cellular types present :

• T and B cells (↑ T cell)
• macrophages
• plasma cells

Autoantibodies are found

( AB to Thyroglobulin and to Thyroid Peroxidase)
Hashimoto’s Thyroiditis
Immunologic Findings

Characterized by both
CELLULAR AND HUMORAL response
( ↑T cell mediated )

Destroys the Thyroid Gland

 Hashimoto’s Thyroiditis
Laboratory Testing

Anti-Thyroglobulin Antibody

Anti- Thyroid Peroxidase Antibody

 Hashimoto’s Thyroiditis
Laboratory Testing

Peroxidase Ab

• IIF
• Particle Agglutination Assay
• EIA Thyroglobulin
• Passive agglutination Ab

• Indirect Immunofluorescent Assay

• Passive Agglutination
• Enzyme Immunoassay (EIA)
Hashimoto’s Thyroiditis
Laboratory Testing

Indirect Immunoflourescent Assay

Thyroglobulin antibodies –
floccular or puffy staining pattern

CA2 antibodies –
diffuse or ground glass appearance
Hashimoto’s Thyroiditis
Laboratory Testing

Negative result does not necessarily

rule out the disease

Titer is higher
Thank You!