6 Goitrous autoimmune thyroiditis (Hashimoto's disease)

Abstract

It can be stated that all forms of lymphadenoid thyroiditis are probably autoimmune in origin and that goitrous and atrophic variants form a continuous spectrum (Buchanan and Harden, 1965). Hashimoto's (1912) classic description of four cases covered only selected aspects of the clinical picture since the study was based on greatly enlarged thyroid glands examined postoperatively. Despite these limitations the name 'Hashimoto's disease' retains certain advantages as well as 50 years of common usage. Before his time, these goitres were classified as either 'struma parenchymatosa' or 'struma fibrosa' and he introduced the term 'struma lymphomatosa'. The term 'autoimmune thyroiditis' (AIT) covers too many disparate clinical states, i.e. the generalized and focal lesions, the goitrous and atrophic variants, and even the animal diseases both genetic and experimentally induced. The traditional eponym can be retained for clinical purposes provided it is applied to patients presenting with a goitre and with thyroid antibodies in the serum or histological proof, either from needle biopsies or surgical specimens. There are very distinct clinical and histological forms of the disease which it is important to distinguish as they may behave in a different manner and respond to treatment according to the predominant parameters of the abnormal immune responses.