Non-goitrous variant of autoimmune hypothyroidism (Ord’s thyroid disease): A case report

Abstract

Hypothyroidism is one of the thyroid diseases characterised by hypo-functioning of the thyroid gland. The notable causes include iodine deficiency, thyroidectomy-induced hypothyroidism and autoimmune causes, among others. Autoimmune hypothyroidism is a recognised and important cause of hypothyroidism. Ord’s hypothyroidism is a non-goitrous form of autoimmune hypothyroidism and is very rare. Thyroid function studies, thyroid ultrasonography and thyroid antibodies are crucial to establishing the diagnosis. Mrs EP is a 70-year-old Nigerian who presented with progressive weight gain and cold intolerance. The thyroid function tests, characterised by low free triiodothyronine (fT ³), low free thyroxine (fT ⁴), markedly raised thyroid-stimulating hormone and elevated thyroid peroxidase antibodies, were in keeping with autoimmune hypothyroidism. The patient was commenced on levothyroxine at 25 μg daily, which was later increased to 50 μg daily, with improvement in her clinical status. However, the thyroid ultrasound repeated on two occasions showed features that were not in keeping with the usual Hashimoto’s thyroiditis. This gave rise to a review of literature studies with the described features in keeping with Ord’s thyroiditis. Ord’s and Hashimoto’s hypothyroidism are not curable but can be managed with thyroid hormone replacement in the form of levothyroxine. The case report emphasises the need for endocrinologists to investigate patients who present with hypothyroid features, to identify the likely type of hypothyroidism. This may increase research studies in this aspect of thyroid disorders.