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Hashimoto's Thyroiditis C034

Last amended 
12 November 2019
Current RMA Instruments
Reasonable Hypothesis SOP
31 of 2013
Balance of Probabilities SOP
32 of 2013
Changes from previous Instruments

SOP Bulletin 165

 ICD Coding
  • ICD-9-CM Codes: 245.2
  • ICD-10-AM Codes: E06.3
Brief description

This is a chronic autoimmune inflammation of the thyroid gland (named after Japanese surgeon Dr Hakuru Hashimoto in 1912) in which the body develops cytotoxic antibodies to the thyroid gland - anti thyroid peroxidase (TPO) and anti thyroglobulin antibodies (Tg).  The condition is characterized by gradual thyroid failure, with or without goitre formation.

Hashimoto's disease is a common cause of hypothryoidism.  There is a separate SOP for hypothyroidism, which covers other causes of decreased thyroid function, but excludes Hashimoto's disease.  Similarly, Hashimoto's disease may cause a goitre.  There is a separate SOP for goitre, which covers other causes of thyroid enlargement, but excludes Hashimoto's disease.

Confirming the diagnosis 

Diagnosis is based on clinical manifestations and blood tests assessing thyroid function and the presence of thyroid antibodies. 

The appropriate medical specialist is an endocrinologist.

Additional diagnoses covered by SOP
  • Chronic lymphocytic thyroiditis
  • Hashimoto’s disease
  • Hashitoxicosis
  • Ord’s disease – primary hypothyroidism with thyroid atrophy
Conditions excluded from SOP
  • Acute thyroiditis
  • Goitre (other than due to Hashimoto’s thyroiditis)*
  • Hyperthyroidism*
  • Hypothyroidism (other than due to Hashimoto’s thyroiditis)*
  • Non-autoimmune chronic thyroiditis#
  • Subacute thyroiditis#  

* another SOP applies

non-SOP condition

Clinical onset

The clinical presentation is variable.  In some people there may be an intial, transient hyperthyroidism.  More usually, there will be an insidious onset with gradual decline in thyroid function.  Some further patients may present with a goitre or, more rarely, local thyroid symptoms of pain and tenderness.

Clinical worsening

The usual course is gradual loss of thyroid function.  The mainstay of treatment is thyroid replacement therapy.  Standard treatment is not aimed at modifying the course of the disease or effecting a cure for the condition.