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25: HASHIMOTO THYROIDITIS

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Chronic lymphocytic thyroiditis

  • Autoimmune thyroiditis

ICD-9-CM CODES

  • 244.0 Postsurgical hypothyroidism

  • 244.1 Other postablative hypothyroidism

  • 244.2 Iodine hypothyroidism

  • 244.3 Other iatrogenic hypothyroidism

  • 244.8 Other specified acquired hypothyroidism

  • 244.9 Unspecified acquired hypothyroidism

  • 245.0 Acute thyroiditis

  • 245.2 Chronic lymphocytic thyroiditis

  • Associated ICD-9-CM PT diagnoses/treatment diagnoses that may be directly related

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joints of pelvic region and thigh

    • 719.70 Difficulty in walking involving joint site unspecified

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere specified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

ICD-10-CM CODES

  • E06.0 Acute thyroiditis

  • E06.3 Autoimmune thyroiditis

  • E89.0 Postprocedural hypothyroidism

PREFERRED PRACTICE PATTERNS1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

FIGURE 25-1

The human thyroid. (Redrawn with permission from Ganong WF. Review of Medical Physiology. 22nd ed. McGraw-Hill; 2005.)

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FIGURE 25-2

Thyroid cell. Left: normal pattern. Right: after TSH stimulation. The arrows on the right show the secretion of thyroglobulin into the colloid. On the right, endocytosis of the colloid and merging of a colloid-containing vacuole with a lysosome are also shown. The cell rests on a capillary with gaps (fenestrations) in the endothelial wall. (From Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong’s Review of Medical Physiology. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 46-year-old female has been referred to PT for sarcopenia and fatigue. She is a high school teacher, and describes barely being able to get through a day. She complains of generalized achiness and has been treated for depression over the past 3 months but has not seen any improvement. Up until about a year ago she was an avid walker, and walked with colleagues at least three to four times a week. Her history indicates weight gain without change in diet. During postural assessment, the PT notes what appears to be a swelling in her neck, which she attributes to the weight gain. There is a nontender palpable mass in her neck. When tested, her muscle performance demonstrated extremity and core weakness, with easy fatigability.

KEY FEATURES

Description

  • Autoimmune disease

  • Thyroid gland is gradually destroyed

  • Results in hypothyroidism

  • Enlargement of the thyroid

Essentials of Diagnosis

  • Thyroid gland becomes lobulated

  • Decreased activity tolerance

  • Sensitivity to cold

    ...

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