Symptoms Chronic thyroiditis is

In rare cases, Hashimoto disease may be related to other hormone problems caused by the immune system. This condition can occur with adrenal insufficiency and type 1 diabetes. In these cases, the condition is called type 2 polyglandular autoimmune syndrome (PGA II).

Less commonly, Hashimoto disease occurs as part of a condition called type 1 polyglandular autoimmune syndrome (PGA I), along with:

  • Adrenal insufficiency (poor function of the adrenal glands)
  • Fungal infections of the mouth and nails
  • Hypoparathyroidism (underactive parathyroid gland)


Symptoms of Hashimoto disease may include any of the following:

  • Constipation
  • Difficulty concentrating or thinking
  • Dry skin
  • Enlarged neck or presence of goiter
  • Fatigue
  • Hair loss
  • Heavy and irregular periods
  • Intolerance to cold
  • Mild weight gain
  • Small or shrunken thyroid gland (late in the disease)

Exams and Tests

Laboratory tests to determine thyroid function include:

  • Free T4 test
  • Serum TSH
  • T3
  • Thyroid autoantibodies

Imaging studies are generally not needed to diagnose Hashimoto thyroiditis.

This disease may also change the results of the following tests:

  • Complete blood count
  • Serum prolactin
  • Serum sodium
  • Total cholesterol


A lack of thyroid hormone may develop. You may receive thyroid hormone replacement therapy (levothyroxine) if your body is not producing enough of the hormone. Or, you may receive it if you have signs of mild thyroid failure (such as elevated TSH). This condition is also known as subclinical hypothyroidism.

If there is no evidence of thyroid hormone deficiency, you may just need to be seen regularly by a health care provider.

Outlook (Prognosis)

The disease stays stable for years. If it does slowly progress to thyroid hormone deficiency (hypothyroidism), it can be treated with thyroid replacement therapy.

Possible Complications

This condition can occur with other autoimmune disorders. In rare cases, thyroid cancer or thyroid lymphoma may develop.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of chronic thyroiditis.


There is no known way to prevent this disorder. Being aware of risk factors may allow earlier diagnosis and treatment.


Brent GA, Davies TF. Hypothyroidism and thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, et al. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 13.

Garberg JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 22;12:1200-1235.

Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 233.

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Content 12

It is caused by a reaction of the immune system against the thyroid gland.





  • Hashimoto's thyroiditis (Hashimoto's disease) is an autoimmune disease in which the body's immune system attacks the thyroid gland.
  • Hashimoto's thyroiditis is a common cause of hypothyroidism.
  • Symptoms of Hashimoto's thyroiditis are numerous. Common symptoms include
  • Enlargement of the thyroid gland (goiter) may be a sign of Hashimoto's thyroiditis.
  • Blood tests that measure levels of thyroid hormones, regulatory hormones, and auto-antibodies to the thyroid gland are done to establish the diagnosis of Hashimoto's thyroiditis.
  • Treatment involves the administration of thyroid hormone taken in pill form.


Alternative Names

Chronic lymphocytic thyroiditis; Autoimmune thyroiditis





Chronic thyroiditis or Hashimoto disease is a common thyroid gland disorder. It can occur at any age, but is most often seen in middle-aged women.

in people with a family history of thyroid disease.




Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.


Content 3

Content 13

Content 11


A 45-year-old healthy businessman just returned from a trip to Vietnam where he was traveling on vacation. Five days after his return, he developed fever and a headache followed 12 hours later by diarrhea and abdominal pain. The next day, he had >10 bowel movements in 12 hours, the final two with gross blood in the stool, prompting his presentation to the emergency department. His vital signs are as follows: temperature 37.8°C, HR 90 bpm, RR 14 breaths/min, and oxygen saturation 98% on room air. Gram stain of a stool specimen identifies a small curved helical-shaped gram-negative rod. You suspect a Campylobacter spp. Which of the following statements regarding his most likely infection is true?

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The correct answer is A. You answered C.

The answer is A. (Chap. 192) This patient is suffering from classic traveler’s diarrhea (of which, Campylobacter is a common cause). A prodrome of fever, headache, myalgia, and/or malaise often occurs 12–48 hours before the onset of diarrheal symptoms. The most common signs and symptoms of the intestinal phase are diarrhea, abdominal pain, and fever. The degree of diarrhea varies from several loose stools to grossly bloody stools; most patients presenting for medical attention have ≥10 bowel movements on the worst day of illness. Abdominal pain usually consists of cramping and may be the most prominent symptom. Pain is usually generalized but may become localized; Campylobacter jejuni infection may cause pseudoappendicitis. Fever may be the only initial manifestation of C jejuni infection, a situation mimicking the early stages of typhoid fever. Even among patients presenting for medical attention with Campylobacter enteritis, not all clearly benefit from specific antimicrobial therapy. Indications for therapy include high fever, bloody diarrhea, severe diarrhea, persistence for >1 week, and worsening of symptoms. Macrolides are generally the empirical treatment of choice with <10% of isolates demonstrating resistance. A single dose of azithromycin 500 mg is effective and is the regimen of choice; a 5- to 7-day course of erythromycin (250 mg orally four times daily or—for children—30–50 mg/kg/d in divided doses) is also effective. Resistance to quinolones as well as to tetracyclines is substantial; approximately 22% of U.S. isolates in 2010 were resistant to ciprofloxacin. Except in infection with Campylobacter fetus, bacteremia is uncommon, developing most often in immunocompromised hosts and at the extremes of age. Due to its proclivity to cause bacteremia and distant organ involvement, C fetus has a far worse prognosis than other subtypes. Systemic infection with C fetus is much more often fatal than that due to related species; this higher mortality rate reflects in part the population affected.


A 75-year-old triathlete complains of gradually worsening vision over the past year. It seems to be involving near and far vision. The patient has never required corrective lenses and has no significant medical history other than diet-controlled hypertension. He takes no regular medications. Physical examination is normal except for bilateral visual acuity of 20/100. There are no focal visual field defects and no redness of the eyes or eyelids. Which of the following is the most likely diagnosis?

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The correct answer is A. You answered A.

Age-related macular degeneration is a major cause of painless, gradual bilateral central visual loss. It occurs as nonexudative (dry) or exudative (wet) forms. Recent genetic data have shown an association with the alternative complement pathway gene for complement factor H. The mechanism link for that association is unknown. The nonexudative form is associated with retinal drusen that leads to retinal atrophy. Treatment with vitamin C, vitamin E, beta-carotene, and zinc may retard the visual loss. Exudative macular degeneration, which is less common, is caused by neovascular proliferation and leakage of choroidal blood vessels. Acute visual loss may occur because of bleeding. Exudative macular degeneration may be treated with intraocular injection of a vascular endothelial growth factor antagonist (bevacizumab or ranibizumab). Blepharitis is inflammation of the eyelids usually related to acne rosacea, seborrheic dermatitis, or staphylococcal infection. Diabetic retinopathy, now a leading cause of blindness in the United States, causes gradual bilateral visual loss in patients with long-standing diabetes. Retinal detachment is usually unilateral and causes visual loss and an afferent pupillary defect.


Mr. Jenson is a 40-year-old man with a congenital bicuspid aortic valve who you have been seeing for more than a decade. You obtain an echocardiogram every other year to follow the progression of his disease knowing that bicuspid valves often develop stenosis or regurgitation requiring replacement in middle age. Given his specific congenital abnormality, what other anatomic structure is important to follow on his biannual echocardiograms?

Next Question
You will be able to view all answers at the end of your quiz.

The correct answer is A. You answered A.

The answer is A. (Chap. 282) Bicuspid aortic valve is among the most common of congenital heart cardiac abnormalities. Valvular function is often normal in early life and thus may escape detection. Due to abnormal flow dynamics through the bicuspid aortic valve, the valve leaflets can become rigid and fibrosed, leading to either stenosis or regurgitation. However, pathology in patients with bicuspid aortic valve is not limited to the valve alone. The ascending aorta is often dilated, misnamed “poststenotic” dilatation; this is due to histologic abnormalities of the aortic media and may result in aortic dissection. It is important to screen specifically for aortopathy because dissection is a common cause of sudden death in these patients.



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