Screening of Family Members of Patients with Hashimoto's Thyroiditis

Hashimoto’s Thyroiditis is a familial autoimmune disease. It can occur as early as 6-7 years old, and late as 90. It can go undiagnosed for 20 years before the patient becomes sick enough to see a physician for hypothyroidism. During that period the thyroid is growing bigger and developing nodules. When the TSH goes above 2.0 there also is an increased risk of stimulating an occult thyroid cancer to grow. Thyroiditis is the number one cause of hypothyroidism. However, because of a problem with the TSH assay, many with the disease are told they are normal. The TSH test in most labs has a normal range up to 5-6. When the TSH is above 10 the patient is clinically hypothyroid. When patients with early thyroiditis are removed from the normal range TSH falls to 2.0.  The physician looks only at the abnormal tests on the panel, and until the TSH is above 5, the patient is told they are normal. There is an increased risk of thyroid cancer if the TSH is above 2.0 during the period of years it takes to go from 2 to 5-6.

An example is a  family with several members with hypothyroid Hashimoto’s thyroiditis, but the 17 Y/O daughter when screened had Hashimoto’s thyroiditis, and on ultrasound had a suspicious nodule.

The USGFNA confirmed papillary thyroid cancer. The nodule was small, and it was contained in the thyroid gland at surgery. She was low low risk and did not need radiation therapy. Her nodule may not have been found until she was 30-40, and needed radiation then. Screening is simple and easy. 15 minutes to feel the neck, draw TSH, and thyroid antibodies, and if the gland feels firm or nodular endocrine neck ultrasound.

Thanks,

Richard Guttler MD