Hashimoto's thyroiditis

Headline
Etiology Chronic lymphocytic thyroiditis = ~CD4+ T cell activation ⇒ B cell stimulation ⇒ destruction of follicular cells
Epidemiology F>>M 20:1, age of onset 60-70
Clinical presentation see hypothyroidism
Pathogenesis
Diagnostic investigations Auto-antibodies: TPO, thyroglobulin
Histo: ± oncocytic change
Management Replace with levothyroxine
➥ ↑ clearance of Vit K-dependent clotting factors = ↑ warfarin requirements
➥ Titrate to TSH
➥➥ Recurrent thyroiditis: consider ablation (rare)