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Causes of Hashimoto's Thyroiditis

Contents
  1. Hashimoto's Thyroiditis: Introduction
  2. List of Causes
  3. Hidden causes
  4. Excerpts from book chapters
  5. Complication causes
  6. Related cause information

List of causes of Hashimoto's Thyroiditis

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Hashimoto's Thyroiditis) that could possibly cause Hashimoto's Thyroiditis includes:

  • Family history of thyroid disorders is common, with HLA-DR5 gene most strongly implicated
  • The incidence is increased in patients with chromosomal disorders, including Turner's syndrome, Down's syndrome and Klinefelter's syndrome

More causes: see full list of causes for Hashimoto's thyroiditis

Hashimoto's Thyroiditis Causes: Book Excerpts

Hashimoto's Thyroiditis as a complication of other conditions:

Other conditions that might have Hashimoto's Thyroiditis as a complication may, potentially, be an underlying cause of Hashimoto's Thyroiditis. Our database lists the following as having Hashimoto's Thyroiditis as a complication of that condition:

Related information on causes of Hashimoto's Thyroiditis:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Hashimoto's Thyroiditis may be found in:

Causes of Hashimoto's Thyroiditis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Hashimoto's Thyroiditis.

Proptosis/Exophthalmos: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • TAO
    –Major cause of unilateral and bilateral proptosis
    –Usually bilateral, although often asymmetric
    –Course is variable
    –Associated with Graves’ disease; more commonly occurs in women, smokers, and in patients treated with radioactive iodine
  • Orbital cellulitis
    –Most cases occur due to contiguous spread from sinusitis
  • Mucormycosis
    –Occurs primarily in diabetic and immunocompromised patients
    • Orbital tumors
      –Children: Dermoid, capillary hemangioma, rhabdomyosarcoma, lymphangioma, optic nerve glioma, leukemia (chloroma or granulocytic sarcoma), metastatic neuroblastoma, plexiform neurofibroma, teratoma
      –Adults: Metastatic breast, lung, or prostate cancer; cavernous hemangioma; mucocele; lymphoid tumors; optic nerve sheath meningioma; neurofibroma; neurilemoma (schwannoma); fibrous histiocytoma; hemangiopericytoma
    • Trauma (e.g., intraorbital foreign body, retrobulbar hemorrhage)
    • Orbital vasculitis (e.g., Wegener's granulomatosis, polyarteritis nodosa)
    • Arteriovenous malformation (e.g., carotid-cavernous fistula, retina or brain)
    • Cavernous sinus thrombosis
      –Orbital cellulitis signs plus cranial neuropathies (third, fourth, fifth, and/or sixth)
      –Mental status changes
      –Usually bilateral and rapidly progressive
    • Neurofibromatosis
    • Pseudoproptosis
      –Enlarged globe (myopia, buphthalmos)
      –Enophthalmos of the fellow eye

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Proptosis/Exophthalmos: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Orbital cellulitis is associated with ethmoid sinusitis, presents with rapid onset of fever, EOM restriction, periorbital edema
  • Malignancy
    –Rhabdomyosarcoma: Most common primary pediatric orbital malignancy, average age 5–7, proptosis is presenting sign, may develop acutely
    –Neuroblastoma: One of most common childhood cancers, most frequent source of orbital metastasis, associated with opsoclonus (rapid multidirectional eye movements), periorbital ecchymoses, 40% bilateral
    –Acute leukemia: Most common childhood malignancy, may cause proptosis, ecchymosis, and lid edema
  • Benign tumors
    –Capillary hemangioma: Most common benign pediatric orbital tumor, females > males, presents in infancy, slowly progressive, increases in size with crying, associated with skin hemangioma, thrombocytopenic purpura
    –Lymphangioma: Second most common benign pediatric orbital tumor consists of lymph-filled channels, may hemorrhage after minor trauma or URI (chocolate cyst)
  • Neurofibromatosis type 1 (NF1)
    –Optic gliomas: Slowly progressive, associated with decreased vision, optic disc atrophy, and swelling
    –Orbital and periorbital plexiform neurofibromas; associated with sphenoid bone defects, may be pulsatile
  • Hyperthyroidism
    –Graves disease is the cause of hyperthyroidism most commonly associated with proptosis/exophthalmos
    –Proptosis may be unilateral or bilateral, and lid retraction is common
    • Trauma
      –Fracture of orbital bones and hemorrhage into the orbital space may cause proptosis, pain, and EOM impairment
    • Orbital dermoid cyst
      –Rupture of cyst causes an inflammatory reaction
  • Craniosynostosis (e.g., Apert, Crouzon)

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Exophthalmos: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Cavernous sinus thrombosis

Usually, cavernous sinus thrombosis causes the sudden onset of pulsating, unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, and impaired extraocular movement and visual acuity. Other features include a high fever with chills, papilledema, a headache, nausea, vomiting, somnolence and, rarely, seizures.

Dacryoadenitis

Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movements (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia

Foreign body in the eye

When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.

Hemangioma

Most common in young adults, this orbital tumor produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.

Lacrimal gland tumor

Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.

Leiomyosarcoma

Most common in people ages 45 and older, leiomyosarcoma is characterized by slowlydeveloping, unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.

Orbital cellulitis

Commonly the result of sinusitis, this ocular emergency causes the sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce a fever, eye pain, a headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.

Orbital choristoma

A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.

Orbital emphysema

Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.

Parasite infestation

Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.

Scleritis (posterior)

The gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.

Thyrotoxicosis

Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It's usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Thyroid enlargement: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Hypothyroidism

Hypothyroidism is most prevalent in women and usually results from a dysfunction of the thyroid gland, which may be due to surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency

A goiter may result from a lack of iodine in the diet. If the goiter arises from a deficiency of iodine in the food or water of a particular area, it’s called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis

Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis

Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens

Goitrogens are drugs — such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid — and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Exophthalmos: Causes
(Professional Guide to Diseases (Eighth Edition))

Exophthalmos commonly results from hyperthyroidism, particularly ophthalmic Graves’disease in which the eyeballs are displaced forward and the lids retract. Unilateral exophthalmos may also result from trauma (such as fracture of the ethmoid bone, which allows air from the sinus to enter the orbital tissue, displacing soft tissue and the eyeball). Exophthalmos may also stem from hemorrhage, varicosities, thrombosis, and edema, all of which similarly displace one or both eyeballs.

Other systemic and ocular causes include:

❑ infection — orbital cellulitis, panophthalmitis, and infection of the lacrimal gland or orbital tissues

❑ parasitic cysts — in surrounding tissue

❑ pseudoexophthalmos paralysis of extraocular muscles — relaxation of eyeball retractors, congenital macrophthalmia, and high myopia

❑ tumors and neoplastic diseases — in children, rhabdomyosarcomas, leukemia, gliomas of the optic nerve, dermoid cysts, teratomas, metastatic neuroblastomas, and lymphoma; in adults, lacrimal gland tumors, mucoceles, cavernous hemangioma, meningiomas, metastatic carcinomas, and lymphoma.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Non-Hodgkin's lymphoma: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of non-Hodgkin's lymphoma is unknown, although some theories suggest a viral source. Since the early 1970s, the incidence of these lymphomas has increased more than 80%, with about 53,000 new cases appearing annually in the United States. The reason for the increase is unknown, although it has been partly attributed to acquired immunodeficiency syndrome. Non-Hodgkin's lymphomas are two to three times more common in males than in females and occur in all age-groups. Compared to Hodgkin's disease, they occur about one to three times more often and cause twice as many deaths in children younger than age 15. Incidence rises with age (median age is 50). These lymphomas seem linked to certain races and ethnic groups, with increased incidence in whites and people of Jewish ancestry.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Thyroiditis: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Autoimmune thyroiditis is due to antibodies to thyroid antigens in the blood. It may cause inflammation and lymphocytic infiltration (Hashimoto’s thyroiditis). Glandular atrophy (myxedema) and Graves’ disease are linked to autoimmune thyroiditis.

Subacute granulomatous thyroiditis usually follows mumps, influenza, coxsackievirus, or adenovirus infection. Riedel’s thyroiditis is a rare condition of unknown etiology.

Miscellaneous thyroiditis results from bacterial invasion of the gland in acute suppurative thyroiditis; tuberculosis, syphilis, actinomycosis, or other infectious agents in the chronic infective form; and sarcoidosis and amyloidosis in chronic noninfective thyroiditis. Postpartum thyroiditis (silent thyroiditis) is another autoimmune disorder associated with transient thyroiditis in females within 1 year after delivery.

Thyroiditis is most prevalent among people ages 30 to 50 and is more common in females than in males. Incidence is highest in the Appalachian region of the United States.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Thyroid cancer: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Predisposing factors to thyroid cancer include radiation exposure (especially childhood radiation therapy), prolonged thyroid-stimulating hormone (TSH) stimulation (through radiation or heredity), familial predisposition, or chronic goiter.

Thyroid cancer occurs in all age-groups, especially in people who have had radiation treatment of the neck area. It affects 1 in 1,000 people.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Simple goiter: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Simple goiter occurs when the thyroid gland can’t secrete enough thyroid hormone to meet metabolic requirements. As a result, the thyroid gland enlarges to compensate for inadequate hormone synthesis, a compensation that usually overcomes mild to moderate hormonal impairment. Because thyroid-stimulating hormone (TSH) levels are generally within normal limits in patients with simple goiter, goitrogenicity probably results from impaired intrathyroidal hormone synthesis and depletion of glandular iodine, which increases the thyroid gland’s sensitivity to TSH. However, increased levels of TSH may be transient and therefore missed.

Endemic goiter usually results from inadequate dietary intake of iodine, which leads to inadequate secretion of thyroid hormone. Since the introduction of iodized salt in the United States, cases of endemic goiter have virtually disappeared.

Sporadic goiter commonly results from the ingestion of large amounts of goitrogenic foods or the use of goitrogenic drugs. Goitrogenic foods, such as rutabagas, cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes, contain agents that decrease thyroxine (T4) production. Goitrogenic drugs include propylthiouracil, iodides, phenylbutazone, para-aminosalicylic acid, cobalt, and lithium. In a pregnant woman, these substances may cross the placenta and affect the fetus.

Inherited defects may be responsible for insufficient T4 synthesis or impaired iodine metabolism. Because families tend to congregate in a single geographic area, this familial factor may contribute to the incidence of both endemic and sporadic goiters.

Females are more commonly affected than males. Incidence increases after age 40.  

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Thyroid enlargement: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Hypothyroidism

This disorder, which is most prevalent in women, usually results from a dysfunction of the thyroid gland caused by surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency

A goiter may result from a lack of iodine in the diet. A goiter that arises from a deficiency of iodine in the food or water of a particular area is called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis

Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis

Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; diaphoresis; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens

Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs containing goitrogens include lithium, sulfonamides, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Exophthalmos [Proptosis]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Cavernous sinus thrombosis

This disorder usually causes sudden onset of pulsating unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, limited extraocular movement, and impaired visual acuity. Other features include high fever with chills, papilledema, headache, nausea, vomiting, somnolence and, rarely, seizures.

Dacryoadenitis

Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movement (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia.

Foreign body in the eye

When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.

Hemangioma

Most common in young adults, this orbital tumor produces progressive exophthalmos, which may be mild or severe and unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movement, and blurred vision.

Hodgkin’s disease

In this disorder, unilateral exophthalmos may develop gradually along with eyelid edema, diplopia, and a palpable eyelid mass. More characteristic findings include painless swelling of one or more lymph nodes, intermittent fever, weight loss, fatigue, malaise, night sweats, hepatosplenomegaly, and pruritus.

Lacrimal gland tumor

Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.

Leiomyosarcoma

Most common in people ages 45 and older, this tumor is characterized by slowly developing unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.

Leukemia

When leukemia causes intraorbital hemorrhage, mild to moderate bilateral exophthalmos and lacrimal gland enlargement also result. Associated signs and symptoms include bleeding tendency, fever, arthralgia, pallor, weakness, hepatosplenomegaly and, possibly, lymphadenopathy.

Lymphangioma

Hemorrhage of this congenital tumor causes unilateral or bilateral exophthalmos, among other signs.

Neuroblastoma

This highly malignant tumor, the most common extracranial solid tumor of childhood, may produce exophthalmos.

Ocular tuberculosis

Occasionally, this rare disease causes progressive exophthalmos accompanied by ptosis, painless eyelid edema and erythema, and enlarged lacrimal glands. Examination may reveal yellow or white fat deposits on the cornea and small white nodules in the iris.

Optic nerve meningioma

This tumor usually produces unilateral exophthalmos and a swollen temple. Impaired visual acuity, visual field deficits, and headache may occur.

Orbital cellulitis

Commonly the result of sinusitis, this ocular emergency causes sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce eye pain, conjunctival injection, tearing, eyelid edema and erythema, a purulent discharge, and limited extraocular movement as well as fever, headache, and malaise.

Orbital choristoma

A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.

Orbital emphysema

Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.

Orbital pseudotumor

Progressive unilateral exophthalmos characterizes this uncommon disorder. Limited extraocular movement, eyelid edema, eye pain, and diplopia may also occur.

Parasite infestation

Usually, this disorder causes painless progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.

Scleritis (posterior)

Gradual onset of mild to severe unilateral exophthalmos is common in scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.

Thyrotoxicosis

Although a classic sign of this disorder, exophthalmos is absent in many patients. It’s usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Neck Mass/Thyroid Enlargement: Differential Overview
(Field Guide to Bedside Diagnosis)

Neck Mass

❑ Inflammatory lymphadenopathy

❑ Parotid swelling/tumor

❑ Laryngeal cancer

❑ Intramuscular hematoma

❑ Lymphoma

❑ Nasopharyngeal carcinoma

❑ Branchial cleft cyst

❑ Thyroglossal duct cyst

❑ Supraclavicular adenopathy

❑ Aortic aneurysm

❑ Carotid aneurysm

❑ Ludwig angina

❑ Pharyngeal pouch

❑ Carotid body tumor

Thyroid Enlargement

❑ Simple goiter

❑ Hashimoto thyroiditis

❑ Grave disease

❑ Drugs

❑ Subacute thyroiditis

❑ Thyroid cancer

❑ Infiltrative disease

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Thyroid Nodule: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Hashimoto thyroiditis

❑ Multinodular goiter

❑ Follicular adenoma

❑ Thyroid cyst

❑ Thyroid carcinoma

❑ Subacute thyroiditis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Exophthalmos: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Grave disease

❑ Familial

❑ Orbital asymmetry

❑ Orbital cellulitis

❑ Cavernous sinus thrombosis

❑ Orbital hemorrhage/emphysema

❑ Intracavernous carotid artery aneurysm

❑ Arteriovenous fistula

❑ Carotid-cavernous sinus fistula

❑ Orbital tumor

❑ Pituitary apoplexy

❑ Meningioma

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Thyroiditis: Causes
(Handbook of Diseases)

Autoimmune thyroiditis is due to antibodies to thyroid antigens. It may cause inflammation and lymphocytic infiltration (Hashimoto’s thyroiditis). Glandular atrophy and Graves’ disease are linked to autoimmune thyroiditis.

Postpartum thyroiditis (silent thyroiditis) is another form of autoimmune thyroiditis that occurs in women within 1 year after delivery.

Subacute granulomatous thyroiditis usually follows mumps, influenza, coxsackievirus, or adenovirus infection. Riedel’s thyroiditis is a rare condition of unknown etiology.

Miscellaneous thyroiditis results from bacterial invasion of the gland in acute suppurative thyroiditis; tuberculosis, syphilis, actinomycosis, or other infectious agents in the chronic infective form; and sarcoidosis and amyloidosis in chronic noninfective thyroiditis.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Thyroid cancer: Causes
(Handbook of Diseases)

Predisposing factors include radiation exposure, prolonged thyrotropin stimulation (through radiation or heredity), familial predisposition, or chronic goiter.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Chronic fatigue and immune dysfunction syndrome: Causes
(Handbook of Diseases)

Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.

CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Goiter: Causes
(Handbook of Diseases)

Simple goiter occurs when the thyroid gland can’t produce and secrete enough thyroid hormone to meet metabolic requirements. As a result, the thyroid gland enlarges to compensate for inadequate hormone synthesis. Such compensation usually overcomes mild to moderate hormonal impairment.

Because thyroid-stimulating hormone (TSH) levels are generally within normal limits in patients with simple goiter, the disease probably results from impaired intrathyroidal hormone synthesis or depletion of glandular iodine, which increases the thyroid gland’s sensitivity to TSH. Thyroid growth-stimulating immunoglobulins can also cause gland enlargement. However, increased levels of TSH may be transient and therefore missed.

Endemic goiter

Endemic goiter usually results from inadequate dietary intake of iodine, which leads to inadequate production and secretion of thyroid hormone. The use of iodized salt prevents this deficiency.

Sporadic goiter

Sporadic goiter commonly results from the ingestion of large amounts of goitrogenic foods or the use of goitrogenic drugs.

Goitrogenic foods contain agents that decrease thyroxine (T4) production. Such foods include rutabagas, cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes.

Goitrogenic drugs include propylthiouracil, methimazole, iodides, and lithium. In a pregnant woman, such substances may cross the placenta and affect the fetus.

Both types

Inherited defects may be responsible for insufficient T4 synthesis or impaired iodine metabolism. Because families tend to congregate in a single geographic area, this familial factor may contribute to the incidence of both endemic and sporadic goiter.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Exophthalmos: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Foreign body in the eye

When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing. Loss of vision or blurred vision may occur in the affected eye.

Hemangioma

Most common in young adults, hemangioma is an orbital tumor that produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.

Lacrimal gland tumor

In patients with a lacrimal gland tumor, exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis, eye deviation, and pain.

Optic nerve meningioma

An optic nerve meningioma usually produces unilateral exophthalmos and a swollen temple. Impaired visual acuity, visual field deficits, and headache may occur.

Orbital cellulitis

Commonly the result of sinusitis, orbital cellulitis is an ocular emergency that causes sudden onset of unilateral exophthalmos, which may be mild or severe. It may also produce fever, eye pain, headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.

Orbital choristoma

A common sign of orbital choristoma (a benign tumor), progressive exophthalmos may be associated with diplopia and blurred vision. A mass may be visible in the orbital area.

Orbital emphysema

With orbital emphysema, air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation. The patient may report orbital pressure.

Parasite infestation

Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.

Scleritis (posterior)

Gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.

Thyrotoxicosis

Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It’s usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Thyroid enlargement: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Hypothyroidism

Besides an enlarged thyroid, signs and symptoms of hypothyroidism include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

CULTURAL CUE:Goiters are common in areas of the world that are deficient in iodine, such as Asia, Latin America, Africa, and parts of Europe.


Thyroiditis

Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement. In subacute granulomatous thyroiditis, moderate thyroid enlargement may follow an upper respiratory infection or a sore throat. The thyroid may be painful and tender. Dysphagia may also occur.

Thyrotoxicosis

One of the classic features of thyrotoxicosis is an enlarged thyroid gland. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Other causes

Goitrogens

Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs include lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Thyroid enlargement: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Hypothyroidism.Hypothyroidism causes an enlarged thyroid. Additional signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency.A deficiency of iodine in the food or water of a particular area may cause an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis.Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis.Signs and symptoms of thyrotoxicosis include an enlarged thyroid, nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors.An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens.Goitrogens are drugs—such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid—and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Exophthalmos [Proptosis]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Cavernous sinus thrombosis.Usually, cavernous sinus thrombosis causes the sudden onset of pulsating, unilateral exophthalmos. Accompanying it may be eyelid edema, decreased or absent pupillary reflexes, and impaired extraocular movement and visual acuity. Other features include a high fever with chills, papilledema, a headache, nausea, vomiting, somnolence and, rarely, seizures.

Dacryoadenitis.Unilateral, slowly progressive exophthalmos is the most common sign of dacryoadenitis. Assessment may also reveal limited extraocular movements (especially on elevation and abduction), ptosis, eyelid edema and erythema, conjunctival injection, eye pain, and diplopia.

Foreign body in the eye.When a foreign body enters the eye, exophthalmos may accompany other signs and symptoms of ocular trauma, such as eye pain, redness, and tearing.

Hemangioma.This orbital tumor produces progressive exophthalmos, which may be mild or severe, unilateral or bilateral. Other signs and symptoms include ptosis, limited extraocular movements, and blurred vision.

Lacrimal gland tumor.Exophthalmos usually develops slowly in one eye, causing its downward displacement toward the nose. The patient may also have ptosis and eye deviation and pain.

Leiomyosarcoma.Leiomyosarcoma is characterized by slowlydeveloping, unilateral exophthalmos. Other effects include diplopia, impaired vision, and intermittent eye pain.

Orbital cellulitis.Commonly the result of sinusitis, this ocular emergency causes the sudden onset of unilateral exophthalmos, which may be mild or severe. Orbital cellulitis may also produce a fever, eye pain, a headache, malaise, conjunctival injection, tearing, eyelid edema and erythema, purulent discharge, and impaired extraocular movements.

Orbital choristoma.A common sign of this benign tumor, progressive exophthalmos may be associated with diplopia and blurred vision.

Orbital emphysema.Air leaking from the sinus into the orbit usually causes unilateral exophthalmos. Palpation of the globe elicits crepitation.

Parasite infestation.Usually, parasite infestation causes painless, progressive exophthalmos in one eye that may spread to the other eye. Associated findings include limited extraocular movement, diplopia, eye pain, and impaired visual acuity.

Scleritis (posterior).The gradual onset of mild to severe unilateral exophthalmos is common with scleritis. Other signs and symptoms include severe eye pain, diplopia, papilledema, limited extraocular movement, and impaired visual acuity.

Thyrotoxicosis.Although a classic sign of thyrotoxicosis, exophthalmos is absent in many patients. It's usually bilateral, progressive, and severe. Associated ocular features include ptosis, increased tearing, lid lag and edema, photophobia, conjunctival injection, diplopia, and decreased visual acuity. Other findings include an enlarged thyroid, nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremors, palpitations, and tachycardia.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Goiter: Goiter - etiology
(The 5-Minute Pediatric Consult)

  • The multinodular goiter 1 (MNG1) locus has been identified on chromosome 14q and on chromosome Xp22.
  • Other genes implicated in simple goiter formation include thyroglobulin, thyroid-stimulating hormone (TSH) receptor, and Na+/I- symporter.
  • Thyroid peroxidase mutations lead to iodide organification defects and goitrous congenital hypothyroidism.
  • Twin and family studies show a modest to major contribution of environmental factors, especially iodine deficiency and cigarette smoking.
  • Autoimmune goiters, such as chronic lymphocytic thyroiditis, occur in children with a genetic predisposition.
  • Thyroid cancers are usually sporadic. Medullary carcinoma can be familial (autosomal dominant), as part of multiple endocrine neoplasia (MEN)-2A and -2B, or as isolated malignancy.
  • Pendred syndrome (autosomal recessive) causes congenital sensorineural deafness and iodine organification defect that leads to goiter.

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Source: The 5-Minute Pediatric Consult, 2008


 » Next page: Symptoms of Hashimoto's Thyroiditis

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