This disease is more common in middle-aged women aged 30-50, and the ratio of male to female is (1: 57) ~ 1: 6, accounting for 1/5 of thyroid diseases. The onset of this disease is usually hidden, developing slowly, often without special feelings, and patients are often difficult to detect. The main manifestation is goiter, especially in the early stage of the disease. The thyroid gland is diffusely enlarged, symmetrical on both sides, slightly larger on many sides, smooth or nodular on the surface and hard in texture. Rubber hardness, mostly painless but slightly painful. Occasionally there are symptoms of oppression, such as dyspnea, dysphagia, neck compression, hoarseness and so on. About 50% of patients have normal thyroid function. A few patients may have hyperthyroidism symptoms at the initial stage of the disease or at a certain stage of the course of the disease, such as palpitation, fear of heat, hyperhidrosis, hyperhidrosis and emaciation. With the further development of the disease, it may eventually develop into hypothyroidism, with symptoms such as chills, edema, loss of appetite, constipation and rough skin. Due to the long course of disease and atypical clinical symptoms, it can be roughly divided into 8 clinical types:

(1) Hashimoto's hyperthyroidism: The patient is accompanied by hyperthyroidism, and some cases may also have infiltrative exophthalmos and pregelation edema. Can have typical hyperthyroidism performance. The circulating antibody titer is high. Hyperthyroidism in such patients can last for several years and often requires antithyroidism.

Drug treatment, but the dose should not be too large, we should pay attention to the occurrence of drug-induced hypothyroidism. It is not suitable for surgical resection or radionuclide therapy, and it is prone to permanent hypothyroidism.

(2) Pseudohyperthyroidism: A few patients may have clinical manifestations of hyperthyroidism, such as palpitation, hyperhidrosis, nervousness, etc., but thyroid function examination showed no signs of hyperthyroidism, and TGAb and TMAb were positive. Such patients do not need antithyroid drugs, and their symptoms can disappear by themselves.

(3) Exophthalmos: The disease may have infiltrative exophthalmos, and the thyroid function may be normal, hyperactive or decreased. Lymphocyte infiltration and edema were found in the posterior orbital muscle. Serum TGAb and TMAb were positive.

(4) Subacute thyroiditis: A few patients have acute onset, fever, rapid goiter, local pain and tenderness, and accelerated erythrocyte sedimentation rate, but the iodine uptake rate is normal or increased, and the high titer of thyroid antibody is limited.

(5) Adolescent type: Hashimoto's thyroiditis accounts for about 40% of adolescent goiter. Its thyroid gland is small, its thyroid function is normal, its thyroid antibody titer is low, and its clinical diagnosis is difficult. Some patients with goiter increase rapidly, said

Some patients with adolescent proliferative disorder may be complicated with hypothyroidism.

(6) Fibrosis: Patients with a long course of disease may have extensive thyroid fibrosis. It is characterized by thyroid atrophy and hypothyroidism, with uneven fibrosis in some patients and dense fibrosis in some or one lobe. Local quality control company

Hard, the rest is typical lymphocyte infiltration. Easily misdiagnosed as a tumor.

(7) Thyroid adenoma or carcinoma: solitary nodules often appear, with high drops of TGAb and TMAb. Nodules are pathological changes of adenoma or cancer, and the rest are histological changes of Hashimoto's thyroiditis.

(8) Accompanied by other autoimmune diseases. It can be manifested as autoimmune multiple endocrine diseases. Clinically, hypothyroidism can be accompanied by Addison's disease, diabetes, hypothyroidism and primary amenorrhea. It can also be accompanied by other autoimmune diseases.

Such as pernicious anemia, myasthenia gravis, autoimmune hepatitis, systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis and chronic atrophic gastritis.

Hashimoto's thyroiditis generally cannot be relieved by itself. The clinical symptoms and biopsy of some patients remained unchanged for a long time; Some patients develop nodular goiter; About 30% ~ 40% patients develop permanent hypothyroidism after the stable period or unconsciously; Patients with Hashimoto's thyroiditis generally do not need special treatment if their thyroid function is normal. Patients with hypothyroidism and goiter with short course of disease should be treated with thyroid hormone preparation. Dry thyroid tablets or levothyroxine are generally used. Dose depends on the response of the disease, so it should start with a small dose and gradually increase later. The course of treatment depends on the condition, and sometimes you need to take medicine for life. The application of drugs must be carried out under the guidance of doctors, otherwise thyroid poisoning will easily occur.