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Autoimmune Thyroid Disease: Overview, Diagnosis, and Treatment

About Thyroid Disease

Autoimmune thyroid diseases (AITDs) are one of the most prevalent autoimmune diseases.1

Undiagnosed AITDs can put patients at risk for certain serious conditions, such as cardiovascular diseases, osteoporosis, and infertility. Despite the consequences of AITDs, and the relatively high prevalence, approximately 5 percent of the population2 (up to 60 percent of people with AITDs) are unaware of their condition.3 The use of laboratory diagnostics can support you in differentiating between the ambiguous symptoms of AITDs.4

AITDs affect women at a higher incidence than it does in men, with population prevalence up to 4.6 percent in women and only 2.83 percent in men,5 and are among the most common autoimmune diseases, though their vague symptoms mean they often go undiagnosed.

AITDs include a number of conditions in which thyroid dysfunction is caused by abnormal cellular or immune responses. Hashimoto’s thyroiditis and Graves’ disease are the two most clinically significant forms of AITDs.1

There are differences in the onset and type of symptoms in these two AITDs:

  • Hashimoto’s thyroiditis is typically an insidious syndrome and presents as hypothyroidism. Patients may have the disease for months or years without noticing a single symptom.4,6
  • Graves’ disease has a more sudden onset and presents as hyperthyroidism. Heart palpitations and nervousness are frequent first symptoms.4

 

5% of the population 

Despite the consequences of AITDs, and the relatively high prevalence, approximately 5 percent of the population2 are unaware of their condition.3   

These AITDs often cause the following symptoms:7,8

Hashimoto’s thyroiditis common symptoms include:

  • Decreased concentration ability
  • Depression
  • Excessive sleepiness
  • Leg swelling
  • Bradycardia
  • Cold intolerance
  • Modest weight gain
  • Goiter
  • Constipation

Graves’ disease common symptoms include: 

  • Anxiety
  • Irritability
  • Sleeping difficulty
  • Fatigue
  • Rapid or irregular heartbeat
  • Heat sensitivity
  • Weight loss, despite normal food intake
  • Goiter
  • Diarrhea

Serological testing can help diagnose an  AITD and to distinguish it from other forms of thyroid dysfunction. 

Hyperthyroidism: Refining differential diagnosis through testing

Serological testing can help diagnose an  AITD and to distinguish it from other forms of thyroid dysfunction. International guidelines classification criteria recommend laboratory testing for autoantibodies against:4

  • Thyroid peroxidase (TPO)
  • Thyroglobulin (TG)
  • Thyroid stimulating hormone receptor (TSH-R)

The measurement of anti-TPO antibodies is the most common test for AITDs; these antibodies can be detected in Graves’ disease or Hashimoto’s thyroiditis.

 

Patients suffering from AITDs might only have one positive autoantibody test result. For example, 6 percent of patients with Hashimoto’s thyroiditis have isolated anti-TG positivity,9 therefore measurement of all three autoantibodies is recommended. Anti-TSH-R has the highest prevalence in untreated Graves’ disease.10 Besides AITDs, anti-TG antibodies are a critical biomarker in patients with thyroid cancer—these antibodies may interfere with the measurement of TG protein levels.11

 

Not sure which allergy or autoimmune disease could be behind your patient’s symptoms? Use this interactive tool to take the next step in making your differential diagnosis. 

Testing Confidence

Testing Increases Diagnostic Confidence

Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv 

i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238

Learn about autoimmune disease.

Learn more about testing.

Management and care of patients with thyroid disease

Prompt treatment of thyroid disease is important for patient quality of life. Untreated hyperthyroid diseases, such as Graves’ disease, not only reduces quality of life, but also poses the serious risks of psychiatric illness, cardiac disease, arrhythmia, and sudden cardiac death.12 Patients with hypothyroidism, such as in Hashimoto’s disease, have worse quality of life. They experience predominantly fatigue but also weight gain, dry skin, cold intolerance, muscle weakness, constipation, eye puffiness, hoarse voice, and poor memory.13 The three treatment modalities for hyperthyroidism include:14

1. Medical therapy
2. Radioactive iodine therapy
3. Surgery

Supportive therapy is sometimes additionally required to control symptoms.14 Treatment of patients with hypothyroidism consists of replacement with thyroid hormones.14

Clinical guidelines have been designed to assist healthcare providers in the treatment of thyroid conditions and to improve patient care.

References
  1. Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: the tallest tree in the forest of polyautoimmunity. F1000Res. 2017;6:1776
  2. Tomer Y, Huber A. The Etiology of Autoimmune Thyroid Disease: A Story of Genes and Environment. J Autoimmun. 2009;32(3-4):231–239. 
  3. American Thyroid Association. Prevalence and Impact of Thyroid Disease. https://www.thyroid.org/media-main/about-hypothyroidism/. Accessed December 2017.
  4. Slatosky J, Shipton B, Wahba H. Thyroiditis: Differential Diagnosis and Management. Am Fam Physician. 2000;15;61(4):1047-1052.
  5. Madariaga AG, Palacios SS, Guillén-Grima F. The Incidence and Prevalence of Thyroid Dysfunction in Europe: A Meta-Analysis. J Clin Endocrinol Metab. 2014;99(3):923-931. 
  6. Iddah MA, Macharia BN. Autoimmune thyroid disorders. ISRN Endocrinol. 2013;2013:509764.
  7. Mayo Clinic. Hypothyroidism (underactive thyroid). https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284.  Accessed December 2017. 
  8. Mayo Clinic. Hyperthyroidism (overactive thyroid). https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659. Accessed December 2017.
  9. Tozzoli R, Villalta D, Kodermaz G, et al. Autoantibody profiling of patients with autoimmune thyroid disease using a new multiplexed immunoassay method. Clin Chem Lab Med. 2006;44:837-842. 
  10. Zöphel K, Roggenbuck D, Schott M. Clinical review about TRAb assay’s history. Autoimmun Rev. 2010; 9:695-700.   
  11. Ringel MD, Nabhan F.  Approach to Follow-Up of the Patient With Differentiated Thyroid Cancer and Positive Anti-Thyroglobulin Antibodies. J Clin Endocrinol Metab. 2013; 98: 3104-3110.
  12. Girgis CM, et al. Current concepts in Graves’ disease. Ther Adv Endocrinol Metab. 2011. 2(3) 135-144.
  13. Chakera AJ, Pearce SHS, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther. 2012; 6: 1–11.
  14. King R, Ajjan RA. Treatment Modalities in Thyroid Dysfunction. 2012. 10.5772/38536