Endocrine Abstracts

JOINT2686

Background: The varied and non-specific nature of diagnostic criteria of Hashimoto’s thyroiditis often leads to sub optimal diagnosis and resultant sub optimal management. The aim of this study is to propose a comprehensive diagnostic scoring algorithm based on reproducible multi-component objective clinico-investigative criteria.

Methods: A case-control study of patients who underwent surgical thyroidectomy, were compared with a set of clinical, biochemical, pathological parameters in patients with Hashimoto’s thyroiditis (n = 60) and controls (n = 60), 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 36 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 were – 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 algorithm appears to be a practical, accurate and straightforward in the accurate diagnosis and subsequent optimal management of Hashimoto’s thyroiditis.

Keywords Hashimoto’s thyroiditis; goiter; histopathology; thyroidectomy; thyroglobulin)