Reviewer: Qiang Li (Shenzhen University General Hospital)
Which manifestations may be Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis has a variety of presentations, which can be divided into typical and atypical presentations:
One, typical performance
Goiter: This is the most prominent manifestation of Hashimoto’s thyroiditis and usually develops slowly, often asymptomatic in the early stages, “inadvertently” or on physical examination Thyroid enlargement was found.
Generally, it is a moderate diffuse enlargement that can be 2 to 4 times that of a normal thyroid. The swollen thyroid gland is tough in texture and moves up and down with swallowing. In some patients, the isthmus lobe may be significantly enlarged.
Image source: Zhanku Hailuo
・Systemic symptoms: Patients often feel fatigued. Most patients have no throat discomfort, only a small number of patients have a feeling of pressure, and they feel pain when the thyroid is gently pressed with hands
・Symptoms of hypothyroidism: such as anorexia, memory loss, lethargy, unresponsiveness, dizziness, headache, tinnitus, etc.
About 50% of patients experience recurrent hypothyroidism and hyperthyroidism.
Image source: Tencent Medical Dictionary
Second, atypical performance
Enlarged lymph nodes in the neck: This is not usually the case, and only a small number of people will have enlarged lymph nodes in the neck that are soft to the touch.
Symptoms related to Hashimoto’s hyperthyroidism: The patient suffers from both Hashimoto’s thyroiditis and Graves’ disease, and the symptoms of hyperthyroidism appear in a short period of time, such as irritability, irritability, palpitation , heat intolerance, exophthalmos, weight loss, etc., thyroid function will recover within a few months.
Enlarged thyroid with pain: The patient has both Hashimoto’s thyroiditis and subacute thyroiditis.
Concomitant manifestations related to other autoimmune system diseases: such as alopecia areata, pernicious anemia, diabetes, myasthenia gravis, etc.
Thyroid atrophy: About 10% of patients will experience a thyroid atrophy that is firm to the touch, indicating advanced disease.
Symptoms associated with Hashimoto’s encephalopathy: Very rarely, people experience disturbances of consciousness, confusion, lethargy, or coma.
Image source: Zhanku Hailuo
References:
[1] Chen Jialun. Clinical Endocrinology [M]. Shanghai: Shanghai Science and Technology Press, 2011: 388-392.
[2] Liao Eryuan. Endocrinology and Metabolism [M]. Beijing: People’s Health Publishing House, 2018: 501-506.
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