Atrophic Thyroiditis

  • Luis J. Jara
  • Olga Vera-Lastra
  • Gabriela Medina

Abstract

Atrophic thyroiditis is an organ-specific autoimmune disease characterized by thyroid autoantibodies, functional hypothyroidism, and absence of goiter. Atrophic thyroiditis is a rare entity, which occurs between the ages of 40–60 years especially in elderly women. Immunogenetical analysis suggests that atrophic thyroiditis may be a distinct entity from Hashimoto’s disease. Genetic and environmental factors appear to interact leading to appearance of autoantigens with autoantibody formation. The frequency of HLA-DR8 and HLA-DQB1∗0302 is significantly increased in AT patients positive for TSH-binding inhibitor immunoglobulin compare with controls and goitrous autoimmune thyroiditis. Atrophic thyroiditis is a Th2 disease with blocking anti-TSH receptor antibodies. It has been suggested that Hashimoto's thyroiditis, primary myxedema or AT, and Graves’ disease are different expressions of a basically similar autoimmune process, and that the clinical appearance reflects the spectrum of the immune response in the particular patient. This response may include cytotoxic antibodies, stimulatory antibodies, blocking antibodies, or cell-mediated immunity. The clinical presentation varies from asymptomatic AT, overt hypothyroidism, and myxedema. The pathological features are atrophic thyroid gland with lymphocytic infiltration and fibrous tissue replacing normal thyroid parenchyma. There are no current diagnostic criteria for AT. We propose the following bases for AT diagnosis: clinic or subclinic hypothyroidism, positive thyroid stimulation blocking antibodies and thyroid ultrasound with diffuse low thyroid echogenicity associated with a reduced thyroid volume.

In asymptomatic AT, preventive thyroid replacement therapy is indicated in patients with elevated basal TSH levels. Overt hypothyroidism always requires hormonal substitution.

Keywords

Atrophic thyroiditis antithyroid antibodies 

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References

  1. 1.
    Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med 1996 11; 335:99–107.CrossRefGoogle Scholar
  2. 2.
    Zantut-Wittmann DE, Persoli L, Tambascia MA, Fischer E, Franco Maldonado D, Costa AM, Joao Pavin E. HLA-DRB1*04 and HLA-DQB1*03 association with the atrophic but not with the goitrous form of chronic autoimmune thyroiditis in a Brazilian population. Horm Metab Res 2004; 36:492–500.CrossRefPubMedGoogle Scholar
  3. 3.
    Chabchoub G, Mnif M, Maalej A, Charfi N, Ayadi H, Abid M. Epidemiologic study of autoimmune thyroid disease in south Tunisia. Ann Endocrinol (Paris) 2006; 67:591–5.Google Scholar
  4. 4.
    Lahner H, Quadbeck B, Janssen OE, Mann K. Diagnosis and treatment of autoimmune thyroiditis. MMW Fortschr Med 2004; 146: 28–30.PubMedGoogle Scholar
  5. 5.
    Fountoulakis S, Tsatsoulis A. On The pathogenesis of autoimmune thyroid disease: A unifying hypothesis. Clin Endocrinol 2004; 60:397–409.CrossRefGoogle Scholar
  6. 6.
    Farid NR, Sampson L, Moens H, Barnard JM. The association of goitrous autoimmune thyroiditis with HLA-DR5. Tissue Antigens 1981; 17:265–8.PubMedGoogle Scholar
  7. 7.
    Bogner U, Badenhoop K, Peters H, Schmieg D, Mayr WR, Usadel KH, Schleusener H. HLA-DR/DQ gene variation in nongoitrous autoimmune thyroiditis at the serological and molecular level. Autoimmunity 1992; 14:155–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Cho BY, Chung JH, Shong YK, Chang YB, Han H, Lee JB, Lee HK, Koh CS. A strong association between thyrotropin receptor-blocking antibody-positive atrophic autoimmune thyroiditis and HLA-DR8 and HLA-DQB1∗0302 in Koreans. J Clin Endocrinol Metab 1993; 77:611–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Chung JH, Cho BY, Lee HK, Kim TG, Han H, Koh CS. The tumor necrosis factor beta ∗ 1 allele is linked significantly to HLA-DR8 in Koreans with atrophic autoimmune thyroiditis who are positive for thyrotropin receptor blocking antibody. J Korean Med Sci 1994; 9:155–61.PubMedGoogle Scholar
  10. 10.
    Takasu N, Yamada T, Katakura M, Yamauchi K, Shimizu Y, Ishizuki Y. Evidence for thyrotropin (TSH)-blocking activity in goitrous Hashimoto's thyroiditis with assays measuring inhibition of TSH receptor binding and TSH-stimulated thyroid adenosine 3',5'-monophosphate responses/cell growth by immunoglobulins. J Clin Endocrinol Metab 1987; 64:239–45.CrossRefPubMedGoogle Scholar
  11. 11.
    Chiovato L, Vitti P, Santini F, Lopez G, Mammoli C, Bassi P, Giusti L, Tonacchera M, Fenzi G, Pinchera A. Incidence of antibodies blocking thyrotropin effect in vitro in patients with euthyroid or hypothyroid autoimmune thyroiditis. J Clin Endocrinol Metab 1990; 71:40–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Amino N. Autoimmunity and hypothyroidism. Baillieres Clin Endocrinol Metab. 1988; 2:591–617.CrossRefPubMedGoogle Scholar
  13. 13.
    Bogner U, Hegedüs L, Hansen JM, Finke R, Schleusener H. Thyroid cytotoxic antibodies in atrophic and goitrous autoimmune thyroiditis. Eur J Endocrinol 1995; 132:69–74.CrossRefPubMedGoogle Scholar
  14. 14.
    Sugenoya A, Itoh N, Kasuga Y, Kobayashi S, Ohhashi T, Nagai N, Iida F. Histopathological features of atrophic thyroiditis with blocking type-TSH binding inhibitor immunoglobulins. Endocr J 1995; 42:277–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Stassi G, De Maria R. Autoimmune thyroid disease: new models of cell death in autoimmunity. Nat Rev Immunol 2002; 2:195–204.CrossRefPubMedGoogle Scholar
  16. 16.
    Akamizu T, Amino N, J De Groot LJ. Hashimoto's Thyroiditis. 2007.http://www.thyroidmanager.org
  17. 17.
    Bonnyns M, Vanhaelst L, Bastenie PA. Asymptomatic atrophic thyroiditis. Horm Res 1982; 16:338–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Vitti P, Lampis M, Piga M, Loviselli A, Brogioni S, Rago T, et al. Diagnostic usefulness of thyroid ultrasonography in atrophic thyroiditis. Clin Ultrasound 1994; 22: 375–9.CrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Luis J. Jara
    • 1
  • Olga Vera-Lastra
    • 2
  • Gabriela Medina
    • 3
  1. 1.Hospital de Especialidades, Centro Médico, La Raza, Instituto Mexicano del Seguro SocialMexico CityMexico
  2. 2.Internal Medicine DepartmentHospital de Especialidades, Centro Médico, La Raza, Instituto Mexicano del Seguro SocialMexico CityMexico
  3. 3.Clinical Research UnitHospital de Especialidades, Centro Médico, La Raza, Instituto Mexicano del Seguro SocialMexico CityMexico

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