Hashimoto thyroiditis is an autoimmune disorder characterized by gradual destruction of thyroid follicular

cells,leading to progressive hypothyroidism. It is the most common cause of thyroid dysfunction in iodine-

sufficient regions and shows marked female predominance. Surgical evaluation is required when malignancy

Hashimotothyroiditis presents in young individuals with long-standing goiters that can mimic neoplastic

appropriate evaluation are essential for accurate diagnosis and effective management.

Hashimoto thyroiditis is a chronic autoimmune disorder in which ongoing immune-mediated injury

progressively destroys thyroid follicular cells. This process is driven by a cell-mediated immune response and

increased production of thyroid autoantibodies [1]. In iodine-sufficient regions, it represents the most frequent

cause ofhypothyroidism. The condition is distinctly more common in females [2].

We report a case of Hashimoto thyroiditis in a 35-year-old woman with eight-year history of midline neck

FNAC performed at an outside center yielded a diagnosis of atypia of undetermined significance (AUS),

Bethesda category III.

A total thyroidectomy specimen was received for histopathological examination. Grossly, the thyroid gland

appeared grey-brown, encapsulated, and slightly irregular on its external surface. The right lobe measured 7.5

× 4 × 2.6 cm and showed a grey-brown, nodular, waxy cut surface. The left lobe measured 3 × 1.5 × 0.5 cm,

and theisthmus measured 1.2 × 1 × 0.4 cm

Hashimoto thyroiditis commonly affects women, with reported female-to-male ratio ranging from 7:1 to 10:1

[3]. Our case was also a 35-year-old female. The incidence of Hashimoto thyroiditis increases with age,

typically between 45 and 55 years, although younger individuals, as in this case, may also be affected [3].

Genetic influences play an important role, with several susceptibility loci involving the HLA complex,

immune-regulatory genes, and thyroid-specific genes such as the TSH receptor and thyroglobulin [4-5]. The

disease is more frequently observed in individuals with Turner syndrome and Down syndrome [6-7]. However,

our patient had no associated syndromic history.

may occasionally yield false-negative or indeterminate results, as in our case.

Histopathology remains the definitive diagnostic method, characteristically showing lymphocytic infiltration,

follicular destruction, plasma cells, macrophages, and occasionally multinucleated giant cells and atrophic

follicles lined by Askanazy cells [11]. Although many patients remain euthyroid initially, they have an

increased risk of developing overt hypothyroidism, with an estimated progression rate of about 5% per year

[12].Hashimoto thyroiditis are at risk for a rare thyroid malignancy: primary thyroid lymphoma [3]. Thyroid

peroxidise antibody and Thyroglobulin antibody are most Common antibodies found in Hashimoto thyroiditis,

however these tests were not done in our case as the patient was not able to afford them [13]. The relation

between HT and thyroid epithelial cancers is controversial, with some molecular and morphological studies

suggesting a predisposition to papillary carcinoma [14].

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2. Karunarathmal, PN Rodrigo, S Ranssinghe', Senanayalal, Jayawardana “Hashimoto Thyroiitis: A

Comprehensive Review Of Pathogenesis, Diagnosis, And Managenent Strategies In Autoimmune

Thyroid Disease”Uva Clinical Anaesthesia And Intensive Care Issn 2827-7198 . June 22 ,2025.

3. Jasleen Kaur; IshwarlalJialal “ Hashimoto Thyroiditis“ Last Update: February 9, 2025

4. Zaletel K, Gaberšček S. Hashimoto's Thyroiditis: From Genes to the Disease. Curr Genomics. 2011

Dec;12(8):576-88.

5. Qiu K, Li K, Zeng T, Liao Y, Min J, Zhang N et al. Integrative Analyses of Genes Associated with

8. Li G, He L, Huang J, et al. miR-142-3p encapsulated in T lymphocyte-derived tissue small extracellular

vesicles induces Treg function defect and thyrocyte destruction in Hashimoto's thyroiditis. BMC Med.

2023;21(1):206. 10.1186/s12916-023-02944-4.

9. Luo J, Zhou L, Sun A, Min Y, Lin Y, Han L. Clinical comparative efficacy and therapeutic strategies for

the Hashimoto's thyroiditis:A systematic review and network meta-analysis. Heliyon.

2024;1016:e35114. 10.1016/j.heliyon.2024.e35114.

10. Williams DE, Le SN, Godlewska M, Hoke DE, Buckle AM. Thyroid Peroxidase as an Autoantigen in

Hashimoto's Disease: Structure, Function, and Antigenicity. HormMetab Res. 2018 Dec;50(12):908-

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11. Avramidou E, Gkantaras A, Dermitzakis I, Sapalidis K, Manthou ME, Theotokis P. Histological

Alterations in Hashimoto's Disease: A Case-Series Ultrastructural Study. Medicines (Basel). 2023 Sep

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10th Edition.