A Long Term Clinical, I mmu no logical, and Histological Follow-Up Study of Patients with Goitrous Chronic Lymphocytic Thyroiditis

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Abstract
Goiter size, thyroid function, antimicrosomal and antithyroglobulin antibodies, and thyroid histology werecompared in 43 patients with goitrous chronic lymphocytic thyroiditis(Hashiomoto’s disease) confirmed by biopsy before andafter an interval of 10–20 yr. Although all were given thyroidhormone therapy, 13 patients took it infrequently, and areconsidered untreated. Among these 13 patients, 5 (38%) becamehypothyroid, and 1 became thyrotoxic. Goiter size decreased in17 (57%) of 30 patients during therapy and in 3 (23%) of 13untreated patients, and the incidence of reduction was greaterin treated than in untreated patients (P < 0.05). However, in 13(43%) of the patients, goiter size did not decrease even duringtreatment. Titers of antithyroid antibodies decreased in only 8(21%) of 38 patients. There was no significant correlation betweenchanges in antibodies and the size of goiter, and treatmentwith thyroid hormone did not decrease the titers of antibodies.In patients whose goiters were initially diffusely enlarged and regressed significantly in size during the follow-up period, theinitial biopsies showed histological changes in diffuse lymphocyticinfiltration and diffuse epithelial changes. Comparativestudies of histological differences between patients who weretreated with thyroid hormone and those who were not were madein the patients who had no change in goiter size during theobservation period, which was greater than 10 yr. The histologicalchanges were similar in both groups at the beginning of thestudy, and no significant histological changes during the periodof greater than 10 yr were found in either group. In one patientwho developed thyrotoxicosis after 20 yr and was rebiopsied, thehistological picture was that of thyroid hyperplasia and lymphocyticthyroiditis.These data indicate that goitrous chronic lymphocytic thyroiditischanges little as a function of time in many patientsregardless of whether thyroid hormone is administered. (J ClinEndocrinol Metab61: 1172, 1985)