Endocrine Abstracts

Background

The protean and non-specific nature of diagnostic criteria of Hashimoto’s thyroiditis leads either to overdiagnosis or underdiagnosis. The aim of this study is to propose a comprehensive diagnostic scoring system based on objective clinic-investigative criteria.

Methods

A case-control study of patients who underwent surgical thyroidectomy, were compared a with a set of clinical, biochemical, pathological parameters in patients with Hashimoto’s thyroiditis (n = 75) and controls (n = 75), in order to design a comprehensive multi-parametric scoring system. We analysed twelve criteria - Age, Sex, goiter grade, associated pathology, duration of disease, euthyroid/ hypothyroid status; family history, presence of auto-immune features, anti-thyroid peroxidase titer, anti thyroglobulin antibody titer, thyroid cytopathological diagnosis of HT, extent of thyroidectomy. All these features were analysed and scored in comparision with histopathology as gold standard. A different validation cohort of 56 patients were reviewed and classified according to the score. Linear correlation and descriptive statistics were performed with SPSS 20.0 version.

Results

The study parameters were dichotomized in to major criteria (euthyroid/ hypothyroid status; family history, presence of auto-immune features, anti-thyroid peroxidase titer, anti thyroglobulin antibody titer, thyroid cytopathological diagnosis of HT) and minor (Age, Sex, goiter grade, associated pathology, duration of disease, extent of thyroidectomy) criteria. Diagnostic accuracy of various combinations of major criteria was – with 6 = 100%; 5 = 100%; 4 = 100%; 3 = 100%, 95%, 85%; 2 = 90%; 1 = 82%. Finally, score of atleast ≥ 3/6 major criteria, with mandatory elevated anti Tg and anti TPO Ab titer was diagnostic of HT. This diagnostic accuracy was statistically significant compared to controls.

Conclusions

This multi-parametric scoring system appears to be a comprehensive, accurate and simplistic in the diagnosis of Hashimoto’s thyroiditis and resultant optimal management.

Keywords: Hashimoto’s thyroiditis; goiter; histopathology; thyroidectomy; thyroglobulin.