Sample Health Care Term Paper on Hashimoto Syndrome

Hashimoto Syndrome

Hashimoto syndrome, or thyroiditis, is an autoimmune disease that causes gland disorder. The ailment can affect persons of any age, although middle-aged women are more vulnerable to Hashimoto disease than any other age-group. Individuals suffering from Hashimoto disease experience fatigue, hair loss, constipation, dry skin, among other symptoms. Doctors can detect the disease through testing the thyroid functioning through imaging tests, antibodies tests, or hormonal tests. Although Hashimoto disease is unpreventable, patient with chronic thyroiditis can be treated through an oral administration of thyroid hormones, which restore normalcy.

Background

Hashimoto syndrome is a clinically described as a commonly occurring, unproblematic, scattered swelling of the thyroid glands, which normally affect middle-aged women. Hashimoto’s syndrome can be referred through different names, which include Hashimoto’s Thyroiditis (HT), struma lymphomatosa, chronic lymphocytic thyroiditis, lymphadenoid goiter, as well as autoimmune thyroiditis (Robinson 251; Akamizu, Amino, and DeGroot 1). HT develops through an autoimmune process that affects the thyroid, which is normally manifested as goiter. In HT, the body accumulates an immune reaction that fights thyroid gland tissue within itself, causing an inflammation in the gland.

Hashimoto’s disease is linked with other autoimmune infections, but the disease affects less than 2% of general population (Kakudo, et al. 176). The disease affects the functioning of thyroid gland, which is positioned in the front of human neck. Additionally, Hashimoto disease interferes with the heart rate, as it depend

History

Hashimoto syndrome was discovered in 1912 by Hakaru Hashimoto, when he referred to four patients that exhibited chronic disorder on their thyroid as suffering from struma lymphomatosa (Akamizu, Amino, and DeGroot 1). The patients exhibited diffuse lymphocytic permeation, parenchymal atrophy, in addition to an eosinophilic transformation among some acinar cells. The disease was normally associated with hypothyroidism while its diagnosis was carried out by surgeons during the time of operation or by pathologists after carrying out thyroidectomy.

The initial sign of an immunologic abnormality resulting from Hashimoto disease was an increase of the plasma-gamma globulin, and this indicated that the disease might have emerged due to a long-continued autoimmune reaction (Akamizu, Amino, and DeGroot 1). Nowadays, Hashimoto disease has become a common thyroid disorder, as new diagnosis tests continue to reveal its frequency.

Causes

Hashimoto disease is a type of thyroid gland disorder that can affect people of all ages. The disease is quite common among women, as well as people whose families have a history of thyroid disease. Hashimoto disease has remained a heterogeneous illness, which incorporates other subtypes, but its pathogenesis is yet to be understood (Kakudo, et al. 175). However, family history, sex hormones, excess iodine, and exposure to radiation, are some of the factors that cause the disease. As an autoimmune illness, HT emerges when the immune system ceases to function effectively as immune cells turn to the healthy tissues to destroy them. The disease has been termed as the most widespread cause of goitrous hypothyroidism, particularly in areas where dietary iodine is plenty (Kakudo, et al. 175).

The disease develops gradually, and may take several months, or years before it is detected. Ultimately, the thyroiditis process may devastate the entire thyroid if actions are not taken to halt the process. Etiologically, Hashimoto disease is assumed to have been caused by a combined effect of multiple vulnerability genes, as well as environmental factors. According to Kakudo, et al., Hashimoto disease has a strong genetic element, which is supported by concordance of disease found in monozygotic twins than what is found in non-identical twins (176). On the other hand, some of the environmental aspects that cause Hashimoto disease include medications, infections, iodine, smoking, as well as stress. Long-term exposure to iodine results in enlarged iodination of thyroglobulin that expands its antigenicity and instigates the autoimmune process within genetically susceptible individuals (Akamizu, Amino, and DeGroot 4).

Diagnostic Methods

Hashimoto’s disease is normally diagnosed on the basis of the symptoms, as well as the blood tests that indicate the levels of thyroid hormone in the gland. Blood testing and radiography are utilized to reveal the presence of antibodies, which react with thyroid tissue. Some of the common methods that doctors use to diagnose Hashimoto disease include:

Hormone test: A thyroid-stimulating hormone (TSH) examination incorporates blood test, which is a requirement for diagnosing hypothyroidism. The hormone is not tapped directly from the thyroid, but rather emanate from the pituitary gland that is found in human brain. The aim of carrying out TSH test is to ascertain whether the TSH levels fall within the acceptable range.

Antibody test:  Anti-thyroid antibody (ATA) examinations are commonly carried out to identify whether Hashimoto’s thyroiditis is present in the gland. Since Hashimoto disease is termed as an autoimmune disorder, its cause would incorporate production of abnormal antibodies after blood test. ATA tests identify the antibodies, in addition to measuring their levels.

Imaging Tests

Thyroid scintigraphy (or scan) is normally utilized to detect sections of the thyroid that produce normal amount of hormone (Harvey and Zieve n.p). The patient is requested to take a little amount of radioactive iodine while the doctor waits for the substance to be diffused in the thyroid. The images from scintigraphy depict homogeneous levels of absorption if the thyroid is operating normally.

The most practical method of generating the image of thyroid gland is through thyroid ultrasonography. An ultrasound is utilized as an image test to visualize thyroid, as well as other abnormalities. The extensive use of ultrasonography has assisted in enhancing the diagnosis of visible nodules, in addition to exposing clinically imperceptible thyroid nodules (Blum 1). Although sonography has the capacity to offer clinically useful evidences concerning the nature of thyroid, it cannot be relied in differentiating lesions and cancer. According to Blum, ultrasonography is quite helpful in:

  • Depicting precisely the structure of the neck particularly around the thyroid region
  • Assisting students in learning thyroid palpation
  • Explicate cryptic findings on physical examination
  • Assessing the size of nodules, or goiter in patients
  • Detecting non-palpable thyroid lesions in patients exposed to therapeutic irradiation
  • Identifying the solid elements of complex nodules

In sonography, high frequency sound waves are established to generate an image. The procedure does not make patients uncomfortable, as it takes only a few minutes and no other preparations are required. The patient can remain in a seated position or extend his/her neck forward. A transducer is applied on the section of the neck before fixing it to the skin by using a gel (Blum 3). A signal is directed electronically towards numerous shades of gray, which is then processed to generate an image instantaneously. Each image forms a static picture, but rapid sequential frames work out electronically to create motion.

How Pathology may affect Imaging Procedures

In the understanding of how pathology may affect the imaging procedures, I opted to seek clarification from a qualified radiologist, who emphasized the need for effective imaging. Diagnostic imaging allows radiologists to observe the patient’s body for any clue of thyroid illness. The radiologist can use X-ray, nuclear scans, CT scans, Ultrasound, or MRI scans, to carry out imaging tests, which are usually painless. In a radioactive test, the radiologist explained that patients are offered a dosage of radioactive iodine 123 in pill form, and after several hours, the concentration of iodine in the thyroid is measured together and an X-ray image is taken.

However, when patients have taken excess amount of iodine in their food, they can hamper the test results. Thus, radiologists always recommend patients to fast before taking the tests. Additionally, the radiologist underlined the importance of informing the doctor about medications that the patient may be taking, or even supplements, because they may increase the level of iodine in the body. When using ultrasound, radiologists may experience problems when some tissues or calcific deposits obstruct the passage of ultrasound leading to very bright signals. Another problem with ultrasonography is that it is unsuitable for large-bodied patients because greater amount of tissue can distort the sound waves as they enter deeper into the person’s body.

Treatment and Prognosis

Treatment of Hashimoto’s thyroiditis involves use of medicine, as the thyroid gland cannot perform its hormonal function without medication. The only choice of medicine that doctors recommend for thyroid hormone replacement psychotherapy is Levothyroxine (Randolph 43). Medicinal pills are available in different strengths, based on age, weight, seriousness of hypothyroidism, as well as other medical problems. The treatment also incorporates lifelong hormone replacement, analgesics, as well as anti-inflammatory drugs to calm acute inflammation (Tamparo 257). For patients suffering from goiter, extra medical evaluation is necessary.

Since it is quite difficult to understand the duration of the autoimmune process, regular supervision of thyroid hormone levels is absolutely necessary. Hashimoto’s thyroiditis has no cure, but replacing hormones with medicines can assist in adjusting hormonal levels. The prognosis can proceed effectively with appropriate diagnosis and treatment. HT creates a permanent loss of thyroid function; hence, lifelong thyroid replacement therapy is necessary while medical examination should continue even after patients show signs of recovery (Tamparo 257). A lapse in hormone replacement therapy may not have any significant metabolic consequence, but for noncompliant, cumulative weekly dose is appropriate when administered to young patients as single week dose.

Conclusion

Hashimoto disease is among the most widespread thyroid disorders, which is unpreventable, but can be treated using thyroid hormone replacement therapy, which also incorporates lifelong replacement remedy to adjust hormonal levels. Chronic thyroiditis, which is another name for Hashimoto syndrome, occurs when immune cells opt to harass healthy tissues in the thyroid gland, rather than protect the tissues. Image tests are among the most appropriate form of diagnosing Hashimoto’s thyroiditis. However, doctors have experienced difficulties in differentiating Hashimoto disease from other thyroid pathology after using ultrasonography. Pathology can also affect the imaging of Hashimoto thyroiditis, particularly when patient have taken excess iodine or are under some medications. Doctors are yet to discover ways to prevent Hashimoto’s disease, but early detection of the disease can assist in eradicating the illness.

Works Cited

Akamizu, Takashi, Nobuyuki Amino, and Laslie J. DeGroot. “Hashimoto’s Thyroiditis.” Thyroid Disease Manager, Jan. 1, 2012. Web. 11 Mar. 2016. http://www.thyroidmanager.org/wp-content/uploads/chapters/hashimotos-thyroiditis.pdf

Blum, Manfred. “Ultrasonography of the Thyroid.” Thyroid Disease Manager, Sept 1, 2015. Web. 11 Mar. 2016. http://www.thyroidmanager.org/wp-content/uploads/chapters/ultrasonography-of-the-thyroid.pdf

Harvey, Simon, and David Zieve. “Chronic Thyroiditis (Hashimoto’s Disease).” The New York Times. Health Guide, June 25, 2013. Web 11 March 2016. http://www.nytimes.com/health/guides/disease/chronic-thyroiditis-hashimotos-disease/diagnosis.html

Kakudo, Kennichi, et al. “Diagnosis of Hashimoto’s Thyroiditis and Igg4-Related Sclerosing Disease.” Pathology International 61.4 (2011): 175-183. Academic Search Premier. Web. 10 Mar. 2016.

Knipe, Henry and Yuranga Weerakkody. “Hashimoto thyroiditis.” Radiopaedia.org (2016).Web. 11 Mar. 2016.   http://radiopaedia.org/articles/hashimoto-thyroiditis

Randolph, Gregory. Surgery of the Thyroid and Parathyroid Glands. Philadelphia, PA: Saunders/Elsevier, 2013. Print.

Robinson, Robert A. Head and Neck Pathology: Atlas for Histologic and Cytologic Diagnosis. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010. Print.

Tamparo, Carol D. Diseases of the Human Body. Philadelphia, PA: F.A. Davis Company, 2016. Internet resource.

Appendix

One of the imaging tests is the ultrasound, which is utilized to detect thyroid, but ultrasound has no capacity to gauge the thyroid’s gland function.

Figure 1: Thyroid ultrasound [Source: “Chronic Thyroiditis (Hashimoto’s Disease).” The New York Times]

Radiographic image of Hashimoto’s Thyroditis is as shown in Figure 2 below.

Figure 2: Ultrasound image of Hashimoto thyroiditis (Source: Hashimoto thyroiditis. Radiopaedia.org)