Comparison of the sonography index of thyroid gland with serum level of Anti-thyroid peroxidase, Anti-thyroglobulin and thyroid function test in patients with Hashimoto thyroiditis

2021 ◽  
Author(s):  
Fatemeh Eftekharian ◽  
Gholamhossein Ranjbar Omrani ◽  
Mohammad Hossein Dabbaghmanesh ◽  
Reza Sahraei ◽  
Marzieh Bakhshayeshkaram ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Hashimoto’S Thyroiditis ◽  
Thyroid Volume ◽  
Thyroid Function Test ◽  
Serum Levels ◽  
Significant Negative Correlation ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Antibody Titers

Abstract Background The purpose of this study was to determine the association of sonographic parameters with the serum levels of anti-thyroid peroxidase (TPO), anti-thyroglobulin (Tg), and thyroid hormones in patients with Hashimoto's thyroiditis. Methods 149 patients (118 females, 31 males; aged 18–60 years; mean age: 38.60 ± 8.03 years) who were diagnosed with Hashimoto's thyroiditis were enrolled in the study. Blood sample was taken to measure the serum levels of free T3 and T4, thyroid stimulating hormone (TSH), anti-TPO antibody titers, and anti-Tg antibody titers. The thyroid sonography of each patient was classified into one of the five grades by real-time ultrasonography (US) based on echogenicity, thyroid size, and thyroid pattern. We evaluated whether a correlation existed between thyroid characteristics on US and serum levels of thyroid hormones, anti-TPO and anti-Tg. Results Nodular structures were detected in 54 (36.2%) patients (38 micronodular and 16 macros nodular). Echogenicity was recorded as isoechoic in 15 (10.07%) and hypoechoic in 119 (79.87%) subjects. Euthyroid ‎subjects had significantly thicker isthmus than overt and subclinical hypothyroid patients (p = 0.018). Mean serum TSH, anti-Tg and anti-TPO titers was significantly higher in patients with micronodules than those with micronodules and subjects without nodules (P < 0.05). Isthmus thickness had a significant negative correlation with FT4 and FT3 (P = 0.046; r = 0.11& P = 0.017; r = 0.15, respectively). Thyroid autoantibodies had positive significant correlations with different parameters of the thyroid volume (P < 0.05). Conclusions Thyroid’s US findings in addition to serum levels of anti-Tg and anti-TPO titers would be useful in diagnosis and evaluation of the severity and extent of Hashimoto's thyroiditis, but further evaluations are needed. Trial registration: Trial registry identifier IR.SUMS.REC.1395.S161 (2015/11/30).

Recovery of thyroid function with a decreased titre of antimicrosomal antibody in a hypothyroid man with Hashimoto's thyroiditis

1983 ◽  
Vol 102 (4) ◽  
pp. 531-534 ◽  
Author(s):  
Makiko Yamamoto ◽  
Kazuro Kaise ◽  
Hirofumi Kitaoka ◽  
Katsumi Yoshida ◽  
Nobuko Kaise ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Serum Levels ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
Surgical Biopsy ◽  
Low Levels ◽  
Serum Thyroid Hormones ◽  
Antimicrosomal Antibody ◽  
Serum Tsh

Abstract. A 36 year old man with a diffuse goitre, signs of mild hypothyroidism, strikingly low levels of T4 (0.9 μg/dl) and T3 (24 ng/dl), elevated TSH (140 μU/ml) and elevated microsomal haemagglutination antibody (MCHA, 1:409 600), subsequently became non-goitrous and euthyroid with a decreased titre of antimicrosomal antibody without any medication. At the time of surgical biopsy, serum levels of T4 and T3 had risen to the normal range (4.6 μg/dl and 73 ng/dl, respectively), serum TSH had decreased to 30 μU/ml and the titre of MCHA to 1:25 600. Thyroid specimens showed Hashimoto's thyroiditis. The activity of thyroid peroxidase (TPO) was normal. The latest examination, 1 year and 3 months after initial evaluation, showed that the patient remained euthyroid with no goitre, that serum thyroid hormones were within the normal range (T4 7.7 μg/dl and T3 97 ng/dl), and that TSH was not detectable. The titre of MCHA decreased strikingly to 1:400.

scholarly journals Relationship Between Thyroid Hormonal Status in Patients with a Hypothyroid Form of Hashimoto’s Thyroiditis and Iodine Concentrations in Drinking Water

2021 ◽  
Author(s):  
Olha Kasiyan ◽  
Halyna Tkachenko ◽  
Natalia Kurhaluk ◽  
Svitlana Yurchenko ◽  
Alek Manenko
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Iodine Concentration ◽  
Iodine Intake ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Supply Network ◽  
Thyroid Status ◽  
Thyroglobulin Antibodies ◽  
Regressive Analysis

AbstractThe current study aimed to identify correlative and regressive dependencies between the water iodine concentration and the levels of TSH (thyroid-stimulating hormone), thyroglobulin antibodies (TgAbs), and thyroid peroxidase (TPOAb) in the serum of 168 in patients (34 men and 134 women) with a hypothyroid form of Hashimoto’s thyroiditis who use water from the supply network and individual wells. Based on the water iodine concentration, low and moderate degrees of iodine endemia in the location of the patients were determined. In the groups of men and women using water from different water supply sources, there were direct correlations between the water iodine concentrations and the TgAbs and TPOAb titers as well as an inverse dependence between iodine and TSH levels. Multivariate regressive analysis indicated that TgAb and TSH in the group of women using water from a supply network and TPOAb titers in the group of women using well water were independent factors associated with water iodine concentrations. Statistically significant correlations and regressive dependencies between the water iodine concentrations and the biomarkers of the thyroid status of the patients indicate the risk of Hashimoto’s thyroiditis progression, especially among women with additional iodine intake.

Salivary gland function in women with Hashimoto’s thyroiditis without xerostomia and the correlation with auto-thyroid antibodies

2020 ◽  
Author(s):  
Xiao-an Pang ◽  
Zhi-xiao Wei ◽  
Jun-hong Li ◽  
Xiao-qi Pang
Keyword(s):  
Salivary Gland ◽  
Hashimoto’S Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Control Group ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibody ◽  
Submandibular Glands ◽  
Quantitative Parameters ◽  
Salivary Function

Abstract Background Hashimoto’s thyroiditis (HT) may cause salivary dysfunction in patients resulting in xerostomia, but little is known about changes in salivary function in patients with no obvious dry mouth symptoms. In this study we assessed salivary function in women with HT, who had not experienced xerostomia and, for the first time, evaluated the effects of thyroid auto-antibodies on this function. Methods Sixty consecutive subjects were included, comprising 32 women (mean age, 36 ± 12 years) diagnosed with HT accompanied by differentiated thyroid cancer (DTC) in the study group (HT group), along with a control group (DTC group) of 28 women (mean age, 40 ± 12 years) diagnosed with DTC only. Salivary gland scintigraphy was used to assess salivary function with the semi-quantitative parameters of maximum absorption ratio and maximum secretion ratio, the decrease of which indicate impaired salivary function. Moreover, the HT and DTC groups were divided into four subgroups (Anti– HT, Anti+ HT, Anti– DTC, and Anti+ DTC), based on the presence of anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). Finally, salivary gland semi-quantitative parameters were correlated with levels of thyroid-stimulating hormone (TSH), TGAb, and TPOAb in the HT and DTC groups. Results None of the semi-quantitative parameters examined in parotid or submandibular glands differed significantly between the HT and DTC groups. However, the maximum secretion ratio for the parotid and submandibular glands were significantly different in the subgroup comparison (p < 0.05). Furthermore, the TgAb, TPOAb, and TSH values correlated significantly with salivary excretive function (p ≤ 0.05). Conclusion Women with HT without xerostomia may not have salivary functional impairment during hypothyroidism. Serum thyroid autoantibody and TSH levels may mainly influence salivary excretive function but not uptake function.

The Effect of Hypolipidemic Agents on Thyroid Autoimmunity in Women with Hashimoto’s Thyroiditis Treated with Levothyroxine and Selenomethionine

2017 ◽  
Vol 126 (05) ◽  
pp. 321-326 ◽  
Author(s):  
Robert Krysiak ◽  
Witold Szkróbka ◽  
Bogusław Okopień
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Lipids ◽  
Thyroid Autoimmunity ◽  
Hdl Cholesterol ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Hypolipidemic Agents ◽  
Antibody Titers ◽  
Group B

Abstract Background Levothyroxine and selenomethionine were found to reduce thyroid antibody titers in patients with Hashimoto’s thyroiditis. The same effect was produced by intensive statin therapy. The aim of the present study was to assess whether hypolipidemic agents modulate the impact of thyroid hormone supplementation and selenomethionine on thyroid autoimmunity. Methods The study included 62 women with Hashimoto's thyroiditis treated for at least 6 months with levothyroxine and selenomethionine. On the basis of plasma lipids, women were divided into three groups: women with isolated hypercholesterolemia (group A; n=20), women with isolated hypertriglyceridemia (group B; n=17), and women with normal plasma lipids (group C; n=25). Group A were then treated with atorvastatin (20 mg daily), while group B received micronized fenofibrate (200 mg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as serum levels of thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and 6 months later. Results Fenofibrate decreased triglycerides and increased HDL cholesterol, while simvastatin decreased total and LDL cholesterol. Fenofibrate reduced titers of thyroid peroxidase and, to a lesser extent, thyroglobulin antibodies. Atorvastatin tended to increase thyroid peroxidase antibodies. No changes in thyrotropin, free thyroxine and free triiodothyronine were observed in any treatment group. Fenofibrate-induced changes in thyroid antibody titers correlated with baseline antibody titers, as well as with treatment-induced changes in HDL cholesterol and insulin sensitivity. Conclusions The obtained results indicate that only fibrates may potentiate the effect of selenomethionine and levothyroxine on thyroid autoimmunity in women.

scholarly journals Serum Selenium Status and Its Interrelationship with Serum Biomarkers of Thyroid Function and Antioxidant Defense in Hashimoto’s Thyroiditis

Antioxidants ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 1070
Author(s):  
Rahim Rostami ◽  
Sarmad Nourooz-Zadeh ◽  
Afshin Mohammadi ◽  
Hamid Reza Khalkhali ◽  
Gordon Ferns ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Hashimoto’S Thyroiditis ◽  
Antioxidant Defense ◽  
Thyroid Volume ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Urinary Iodine Concentration ◽  
Serum Selenium ◽  
Se Deficiency ◽  
Se Status

Selenium (Se) deficiency has been implicated in the pathogenesis of Hashimoto’s thyroiditis (HT), although the available evidence is limited. The present study aimed to explore the interrelationships between serum Se status with measures of thyroid function and antioxidant defense in new cases of HT patients with hypoechogenic thyroid. HT patients (n = 49) and matched controls (n = 50) were recruited. Selenium, thyroid hormone panel, thyroid volume (TVol), glutathione (GSH), glutathione peroxidase3 (GPx3) activity, urinary iodine concentration (UIC), and urinary creatinine (Cr) were assessed. HT patients exhibited lower Se levels compared to controls (p < 0.001) with the rates of Se-deficient (<0.85 µmol/L) participants being 58.8% and 34%, respectively. Se-deficient patients exhibited higher thyroid stimulating hormone (TSH), Thyroid volume (TVol), thyroglobulin, antibody-titers, GPx3 activity and UIC/Cr compared to Se-sufficient patients (all p < 0.001). In the Se-deficient patients, inverse correlations were seen between Se-levels with TSH, TVol, and Thyroid peroxidase antibody (TPO-Ab) (all p < 0.001). This study is the first to uncover that coexisting Se-deficiency and elevated iodine in HT may enhance autoimmune reactions and accelerate the deterioration of thyroid function through oxidative stress. Our study also highlights the importance of optimal Se status in this disease, thus providing a rationale for the execution of intervention trials for the evaluation of the clinical benefits of antioxidant-status improvement in HT.

scholarly journals Role of interlekin-35 as a biomarker in patients with newly diagnosed Hashimoto’s thyroiditis

2016 ◽  
Vol 50 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Hakki Yilmaz ◽  
M. Cakmak ◽  
B. Ceydilek ◽  
C. Demir ◽  
A. Aktas
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Critical Role ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Interleukin 12 ◽  
Enzyme Linked Immunosorbent Assay ◽  
Thyroid Peroxidase ◽  
Newly Diagnosed ◽  
Group 2 ◽  
Group 1

AbstractObjective. Interleukin-35 (IL-35), an interleukin-12 (IL-12) cytokine family member, is shown to be a potent immunosuppressive and anti-inflammatory cytokine. Inducible regulatory T cells (Tregs) produce IL-35 that mediates the immune inhibitory function of Tregs. Growing evidence revealed that upregulation of IL-35 expression may play a critical role in the prevention of autoimmune diseases in various experimental autoimmunity models and vice versa. Hashimoto’s thyroiditis (HT) is considered to be a Treg cell-related autoimmune disease with loss of self-tolerance. Methods. One hundred-twenty eight subjects, newly diagnosed hypothyroid HT patients [56 overt (Group 1), 72 subclinical hypothyroid (Group 2)] and 38 healthy controls (Group 3) were enrolled in the study. The levels of serum IL-35 were determined by enzyme-linked immunosorbent assay (ELISA). Results. Serum IL-35 levels were lower in the HT group when compared with subclinical HT group [304.5 (834.6) pg/ml vs. 636.1 (1542.0) pg/ml, p=0.004] and control cases [304.5 (834.6) pg/ml vs. 1064.7 (2526.8) pg/ml, p<0.001]. Serum IL-35 levels were inversely associated with thyroid stimulating hormone (TSH; rs=-0.396, p<0.001) and anti-thyroid peroxidase antibodies (TPOAb; rs=-0.571, p<0.001) in whole group. Serum IL-35 were negatively associated with TSH (rs=-0.264, p=0.003) and TPOAb (rs=-0.735, p<0.001) in patients with Hashimoto’s thyroiditis (Group 1 + Group 2). Conclusion. The results suggest that IL-35 may play a role in the pathogenesis of HT.

scholarly journals Increase of interferon-γ inducible α chemokine CXCL10 but not β chemokine CCL2 serum levels in chronic autoimmune thyroiditis

2005 ◽  
Vol 152 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Alessandro Antonelli ◽  
Mario Rotondi ◽  
Poupak Fallahi ◽  
Paola Romagnani ◽  
Silvia Martina Ferrari ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Multinodular Goiter ◽  
Thyroid Volume ◽  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Newly Diagnosed ◽  
Linear Regression Models ◽  
Chronic Autoimmune Thyroiditis ◽  
Hypothyroid Patients

Objective: To measure serum levels of CXCL10 and CCL2 prototype chemokines of the two major subclass (CXC and CC) in patients with newly diagnosed chronic autoimmune thyroiditis (AT), and relate the findings to the clinical phenotype. Design and methods: Serum CXCL10 and CCL2 were assayed in 70 consecutive patients with newly diagnosed chronic AT, in sex- and age-matched healthy volunteers (n = 37) and in 20 patients with non-toxic multinodular goiter, extracted from a random sample of the general population from the same geographic area. Results: CXCL10 serum levels were significantly higher in patients with thyroiditis than in controls or multinodular goiter patients, while comparable CCL2 levels were found between groups. CXCL10 levels were significantly increased in hypothyroid patients and in those with an hypoechoic pattern (P = 0.0004 and P = 0.0001, respectively) while serum CCL2 levels were significantly increased in patients older than 50 years and in those with hypothyroidism (P = 0.0001 and P = 0.03, respectively). No correlation between CXCL10 and CCL2 serum levels could be demonstrated. CXCL10 and CCL2 were studied separately in relation to clinical features of AT patients. Two separate multiple linear regression models for CXCL10 and CCL2 were performed, including age, thyroid volume, thyroid stimulating hormone (TSH), FT4, anti-thyroid peroxidase (AbTPO), hypoechoic pattern, and the presence of hypervascularity, demonstrating that ln of serum CXCL10 levels was associated with TSH independently of other possible confounders levels [regression coefficient (R.C.) 0.143 confidence interval (C.I.) (0.042–0.245); P = 0.0059], while serum CCL2 were significantly associated only with age [R.C. 5.412 C.I. (3.838–6.986); P < 0.0001]. Conclusion: Our results, obtained in a large cohort of newly diagnosed AT patients demonstrate increased CXCL10 especially in hypothyroid patients with a more aggressive disorder, and normal CCL2 serum levels in AT.

scholarly journals Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Shirish S. Chandanwale ◽  
Rahul Nair ◽  
Anushree Gambhir ◽  
Supreet Kaur ◽  
Aditi Pandey ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Hashimoto’S Thyroiditis ◽  
Thyroid Function Test ◽  
Lymphocytic Infiltration ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Thyroid Follicular Cell ◽  
Cell Clusters ◽  
Thyroid Peroxidase Antibodies ◽  
Function Test

Introduction. Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim. Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods. The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results. The majority were Hashimoto’s thyroiditis (n=100) and females (n=103). Other forms of thyroiditis were Hashimoto’s thyroiditis with colloid goiter (n=5), De Quervain’s thyroiditis (n=3), and one case each of postpartum thyroiditis and Hashimoto’s thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 (n=70) and the majority (n=73) had diffuse enlargement of thyroid. The majority of patients were hypothyroid (n=52). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto’s thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion. The diagnostic cytological features in Hashimoto’s thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the “Gold Standard” for diagnosing Hashimoto’s thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

scholarly journals Serum Resolvin E1 Levels and Its Relationship with Thyroid Autoimmunity in Hashimoto's Thyroiditis

2020 ◽  
Author(s):  
Jing Song ◽  
Rongxin Sun ◽  
Yuanyuan Zhang ◽  
Jing Ke ◽  
Dong Zhao
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Protective Factor ◽  
Thyroid Autoimmunity ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Omega 3 ◽  
Clinical Indicators ◽  
Thyroglobulin Antibody ◽  
Ordinal Logistic Regression Analysis

Abstract Objective: Omega-3 polyunsaturated fatty acids (PUFAs) can produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. Resolvins have been associated with autoimmune disorders. This study aimed to measure the level of resolvin E1 (RVE1) in the serum of Hashimoto's thyroiditis (HT) patients and healthy controls (HCs) and to further analyze its correlation with thyroid autoantibodies and other clinical indicators.Design, patients and measurements: Fifty-seven participants were recruited—30 untreated HT patients and 27 sex‐ and age‐matched HCs. Levels of serum RVE1 were measured by ELISA according to the manufacturer’s protocol. Serum total T3 (TT3), TT4, free T3 (FT3), FT4, thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid-stimulating hormone (TSH) levels were measured using an electrochemiluminescence immunoassay. Routine biochemical and hemogram tests were performed on each sample.Results: Serum RVE1 levels in HT patients (24.09, 15.76-34.38 pg/mL) were significantly lower than those in HCs (28.51, 20.76-51.23 pg/mL) (P=0.027). As the TgAb level increased, the RVE1 content showed a decreasing trend (P for trend=0.001). Multivariable ordinal logistic regression analysis showed that RVE1 was negatively correlated with increasing TgAb in both the unadjusted (OR=0.9446, 95% CI=0.9111-0.9782, P=0.002) and adjusted models (OR=0.9380, 95% CI=0.8967-0.9811, P=0.005).Conclusions: Decreased RVE1 levels indicate impaired resolution of inflammation in HT patients. RVE1 may be a protective factor for elevated TgAb levels.

scholarly journals Clinical and biochemical manifestations of undiagnosed Hashimoto’s thyroiditis

2021 ◽  
pp. 200
Author(s):  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Fluid Restriction ◽  
Functional Abilities ◽  
Cognitive Assessments ◽  
Free T4 ◽  
Cold Intolerance ◽  
Biochemical Features

We report the case of a 69 year old female who presented with mild cognitive impairment and difficulty mobilising in the setting of profound hypothyroidism secondary to Hashimoto’s thyroiditis with associated elevated creatine kinase (CK), hyponatraemia, anaemia, renal impairment, hypercholesterolaemia and hypertryglyceridaemia. On initial investigations the patient had a thyroid stimulating hormone (TSH) of 49 mU/L, free T4 <5.4 pmol/L, thyroid peroxidase (TPO) antibody positive, CK 1628 units/L, sodium 120 mmol/L, haemoglobin 87 g/L, creatinine 109 mcmol/L, total cholesterol 8.1 mmol/L and tryglycerides 4.7 mmol/L. On examination the patient had no features of myxoedema coma but was found to have delayed relaxation of tendon reflexes, puffy facies with loss of outer one third of eyebrows, coarse hair, brittle nails and slowing of speech and movement with obvious cold intolerance. There was no muscle weakness on examination to suggest myositis although the patient complained of generalised aches and lethargy. The patient was initially treated with 100mcg oral thyroxine daily however this was increased and oral liothyronine introduced following an inadequate improvement. Eleven days post admission the TSH was 6.26 mU/L and the free T4 was 12.4pmol/L following a total of 1500mcg oral thyroxine replacement and 60mcg oral liothyronine replacement. The hyponatraemia improved with a strict fluid restriction of 500 millilitres daily to sodium 133 mmol/L and the renal function improved to a creatinine of 70 mcmol/L on discharge. Atorvastatin was withheld due to the elevated CK which improved to 370 units/L and the anaemia remained stable throughout the admission. Although the patient refused formal cognitive assessments her functional abilities improved with treatment. This case highlights the clinical and biochemical features of severe hypothyroidism in the setting of undiagnosed Hashimoto’s thyroiditis.

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