Philippine E-Journals

Hashimoto’s Thyroiditis in a Patient Living in Iodine Deficient Area

Husodo Utoyo

 

Abstract:

Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones, which in turn results in generalized slowing down of metabolic processes. The clinical recognition is typically complicated by the insidious onset of nonspecific symptoms and signs that are often poorly appreciated by patients and initially misinterpreted by physicians. In most patient populations, the common prevalence of complaints potentially attributable to thyroid hormone deficiency makes it essential to maintain a high index of suspicion for hypothyroidism. This is a case of a 48 year old male who presented with symptoms and signs of hypothyroidism with decreased FT4, elevated TSH consistent with primary hypothyroidism and a positive titer of TMA indicating an autoimmune thyroid disease. Thus a diagnosis of Autoimmune Hypothyroidism (Hashimoto’s Disease) was entertained. The clinical history presented by the patient showed subtle manifestations of hypothyroidism such as dry skin, weakness, hoarseness, dysphagia, cold intolerance and somnolence. There was no evidence of bradycardia, weight gain, hyporeflexia, or other pertinent physical examination to support the diagnosis of overt hypothyroidism except for the presence of a goiter as documented by the thyroid scan. The thyroid function test is consistent with primary hypothyroidism and an elevated thyroid autoantibodies indicate an autoimmune thyroid disease as the etiology. Since the patient has no other setting for primary hypothyroidism such as neck surgery and denied exposure to endemic areas, the diagnosis of Autoimmune thyroiditis, the goitrous type (Hashimoto’s disease was the most likely cause of the primary hypothyroidism in this patient. The fact that hypothyroidism is more common in females than in males and, Autoimmune thyroiditis is more common in Iodine sufficient countries not like in our setting. In Iodine deficient countries like the Philippines, endemic goiters or Iodine deficiency goiter is the more common cause of hypothyroidism. Hypothyroidism like any other chronic conditions requires education and counseling. Patients with hypothyroidism may be inclined to discontinue medication once eurothyroidism has been attained. Therefore, the following points must be stressed.

1. Thyroid hormone replacement therapy is life long.

2. Insidious multiple organ deterioration occurs if hypothyroidism remains untreated

3. Any new physician must be informed of the patient’s condition.