Thyroiditis, Chronic Lymphocytic

Key Features

• Firm, freely movable, nontender, diffusely enlarged thyroid gland

• Thyroid function is usually normal but may be elevated or decreased depending on the stage of the disease

• Most common cause of goiter and acquired hypothyroidism in childhood

• More common in girls, and the incidence peaks during puberty

Clinical Findings

• Onset is usually insidious

• Occasionally patients note a sensation of tracheal compression or fullness, hoarseness, and dysphagia

• No local signs of inflammation or systemic infection are present

• A detailed family history may reveal the presence of multiple autoimmune diseases in family members

Diagnosis

• Laboratory findings vary

• Serum concentrations of TSH, T₄, and FT₄ are usually normal

• Some patients are hypothyroid with an elevated TSH and low thyroid hormone levels

• A few patients are hyperthyroid with a suppressed TSH and elevated thyroid hormone levels

• Thyroid antibodies (antithyroglobulin, antithyroid peroxidase) are frequently elevated

• Thyroid uptake scan adds little to the diagnosis

• Surgical or needle biopsy is diagnostic but seldom necessary

Treatment

• Whether treatment is needed when thyroid function is normal is controversial

• Full replacement doses of thyroid hormone may decrease the size of the thyroid, but may also result in hyperthyroidism

• Hypothyroidism commonly develops over time; consequently, patients require lifelong surveillance

• Children with documented hypothyroidism should receive thyroid hormone replacement