Hashimoto’s Disease – Hypothyroidism

00:01 Let’s talk about Hashimoto’s in great detail.

00:03 Most common of the hypothyroidism in the world, early in the course presents how? Once again, Hashitoxicosis, we have had the discussion plenty.

00:12 Characterized by gradual thyroid failure, initially there might be release of T3, T4, eventually leading into permanent, permanent, permanent primary hypothyroidism, most prevalent in elderly females, autoimmune, 20:1 ratio of women to men and you want to memorize by all means HLA-DR5 and B5.

00:35 Pathogenesis, what happens? You have anti thyroglobulin antibodies, you might have antibodies that are attacking thyroid peroxidase TSH receptors.

00:48 Do you see anywhere along the line of thyroid hormone synthesis, you might have autoantibodies that are then-that are then attacking it resulting in primary hypothyroidism.

01:01 If I were you, I would pay attention to the first two bullet points.

01:05 Autoimmune disease, it is going to be diffused enlarged on the thyroid.

01:09 Notice, I did not say diffused radioactive iodine uptake, huh! Firm, non-tender goiter, hypothyroidism preceded by transient thyrotoxicosis, one more time, due to the release of your thyroid hormones from your colloid.

01:23 Eventually, gland becomes shrunken and dead, it is with lymphocytic infiltration.

01:30 In fact, if you were to take a look at the picture here, histologically, you will notice a swarm of “bees” referring to lymphocytes coming in there and completely annihilating or just about completely annihilating this thyroid gland.

01:48 It is very difficult for us to clearly identify a normal thyroid follicular cell.

01:53 You don’t find the normal colloid that you would expect to see and at this point, I fully expect you to know what a normal thyroid follicular cell looks like with that central region of colloid.

02:06 And with all this lymphocytic infiltration, no wonder your thyroid gland is going to be destroyed complete.

02:12 Cytology upon FNA, what is variable, but nonetheless, things that you want to keep in mind include lymphocytic infiltration at which point flow cytometry is warranted.

02:24 Hurthle cells; H - Hashimoto, H - Hurthle cells, you must know the other name, the alias is oncocytes, which you must know the description.

02:40 Gone are the days of buzzwords, you might have an attending who might ask you the des- the description of a Hurthle cell and you don’t want to just stare back at him or her and come across as being clueless, right? Hurthle cells are large polyclonal cells with abundant what is known as oxyphil cytoplasm, it provides false positive cytologic diagnosis of Hurthle cell tumor.