Total thyroidectomy for pressure symptoms in patients with Hashimoto's thyroiditis

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Hashimoto's (chronic lymphocytic) thyroiditis (HT) is a common autoimmune disease and the most common cause of hypothyroidism. It is estimated that 20% of patients with HT will develop hypothyroidism.1 HT is associated with elevated anti‐thyroglobulin and anti‐thyroperoxidase antibodies5 and is characterized histologically by lymphocytic infiltration of the thyroid, atrophy of follicles, fibrosis and Hurthle cell change within the follicular cells. Anti‐thyroperoxidase antibodies are the most specific markers to confirm a diagnosis of HT8 and can be detected at least 7 years prior to diagnosis.9 There is some evidence to suggest that an increase in dietary iodine is linked to HT, but the cause of this possible relationship is unclear.10
It is estimated that background histological evidence of thyroiditis is present in 45% of female and 20% of male autopsy studies in the UK and USA.3 Therefore, background HT is a common additional diagnosis to the primary histopathology.3
HT is usually treated medically with thyroxine,12 and surgery is rarely required – although on occasions it may be required for suspicion of malignancy, pressure symptoms or cosmesis.1
In general, pressure symptoms are a common indication for thyroidectomy, especially in multinodular goitres, and also in other conditions such as large solitary thyroid nodules, solitary thyroid cysts and some thyroid cancers.1
It has been reported that between 5% and 12% of patients with HT will have pressure symptoms.1 However, pressure symptoms in patients with HT as the primary pathology will be an indication for surgery in a minority of those with this disease.
We have observed a group of patients with HT with significant pressure symptoms despite appearing to have relatively small thyroid glands, who benefit from thyroidectomy in relieving their pressure symptoms.
Therefore, the aims of this study were to determine the incidence of pressure symptoms in patients with HT who underwent thyroidectomy and to determine if there is an association between pressure symptoms and thyroid gland size in HT, to better define the indications for surgery in HT.

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