Presentation
There are no unique symptoms of thyroiditis. In some cases, thyroiditis can cause slow and chronic cell damage and destruction, causing the thyroid levels to fall below normal, thus they suffer from hypothyroidism. Common symptoms of this group of patient are fatigue, constipation, depression, poor exercise tolerance, and weight gain.
When the thyroiditis causes rapid damage of the thyroid gland, the hormone (which is stored in the gland) leaks out, causing the level of hormone to increase, and the patients suffer from thyrotoxicosis, the symptoms of which are similar to hyperthyroidism such as anxiety, palpitations, fatigue, weight loss, insomnia and irritability.
In case of subacute and post-partum thyroiditis, there is a depletion of the hormone from the thyroid gland in the course of inflammation.
Entire Body System
- Weight Gain
“Hashimoto’s can often be associated with some weight gain — it’s mostly salt and water weight, which is why you look puffy,” she says. [health.clevelandclinic.org]
Typical hypothyroid symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. This would be the case in patients with Hashimoto’s thyroiditis. [thyroid.org]
At general clinical and biochemical exams he showed weight gain, statural growth deceleration, poor movements, sleepy expression, instability while walking, myxoedema, bradycardia, open anterior fontanelle, changes in the face habitus, macrocytic anaemia [ncbi.nlm.nih.gov]
[…] also retain water, which contributes to weight gain. [progressivehealth.com]
- Weight Loss
The thyrotoxic phase lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. [thyroid.org]
“However, the weight gain seen with Hashimoto’s thyroiditis is usually less dramatic than the weight loss seen with autoimmune hyperthyroidism (Graves disease).” [health.clevelandclinic.org]
Alexander et al, 2009 [9] 43/M (i) Fever, weight loss and neck pain (ii) Treated with NSAIDs, beta-blockers and steroids (iii) Hypothyroidism on follow-up Cunha et al, 2010 [10] 55/F (i) Fever, chills, and night sweats, weight loss, fatigue, headaches [hindawi.com]
- Asymptomatic
Patients are initially asymptomatic or hyperthyroid, progressing to hypothyroidism as the organ parenchyma is destroyed. Diagnosis is based on a combination of specific antibodies, thyroid function tests, and sonography of the thyroid. [amboss.com]
Asymptomatic Atrophic Thyroiditis Appendix: Pituitary Changes in Myxoedema and Chronic Thyroiditis 11. Diseases Associated with Autoimmune Thyroiditis 12. Atrophic Thyroiditis, Hypertension and Coronary Heart Disease 13. [elsevier.com]
In asymptomatic AT, preventive thyroid replacement therapy is indicated in patients with elevated basal TSH levels. Overt hypothyroidism always requires hormonal substitution. [link.springer.com]
After 5 months the patient remained asymptomatic and had returned to work. An atrophic thyroid gland was revealed at ultrasound. [elsevier.es]
- Chills
Symptoms include neck pain, pain with swallowing, tenderness, fever, chills, flu-like symptoms. You may have a tender neck mass you can feel externally. Thyroid function is usually not affected. [healthcentral.com]
Symptoms may include: Rapid onset of pain and tenderness in one side of your neck Fever and chills (a flu-like feeling) Enlarged thyroid gland or an enlargement in your neck area A movable lump in your neck A warm, red, or tender area in the neck Painful [thyroid.about.com]
[…] develops in the thyroid gland. this type of thyroiditis is different from others because it does not usually affect the thyroids ability to function and create the thyroid hormone. instead, acute thyroiditis will often present with neck pain, fever and chills [progressivehealth.com]
- Thyroid Tenderness
There is more lassitude and prostration than in other thyroid disorders. On physical examination, the thyroid is asymmetrically enlarged, firm, and tender. [msdmanuals.com]
There usually is thyroid tenderness and occasional dysphagia. The thyroid tenderness results from a stretching of the thyroid capsule due to the underlying inflammatory disease process. [ajnr.org]
The following are a list of the more common symptoms of Hashimoto’s Thyroiditis: Large thyroid or goiter Neck/thyroid tenderness Fatigue Weight gain Cold intolerance Joint/muscle pain Constipation Irregular menstrual periods Dry/thinning hair Depression [thyroidcancer.com]
Respiratoric
- Stridor
On examination she had inspiratory stridor, with a respiratory rate of 25 breaths/min and an oxygen saturation of 94% in room air. A large neck mass (10 cm) was visible, predominantly on the right side (fig 1 ⇓ ). [bmj.com]
Surgical Indications for surgery include: A large goitre with obstructive symptoms - eg, dysphagia or stridor. Presence of a malignant nodule. Presence of a lymphoma diagnosed on fine-needle aspiration. Cosmetic reasons for unsightly, large goitres. [patient.info]
If both recurrent laryngeal nerves are affected, stridor can result. Involvement of the parathyroid glands can cause hypoparathyroidism. [endocrinologyadvisor.com]
[…] radiation Hyperthyroidism generally resolves within one month Self-limited, but symptoms may be treated with beta blockers and nonsteroidal anti-inflammatory drugs Riedel thyroiditis (fibrous thyroiditis) ‡ Very firm goiter or compressive symptoms (dyspnea, stridor [aafp.org]
Musculoskeletal
- Myalgia
[…] symptoms mimic general hypothyroid conditions. [2] Signs and Symptoms: • Painless thyroid enlargement • Gland is sometimes easily palpable • Fatigue and lethargy • Cold intolerance • Pale, dry skin • Constipation • Hoarseness • Dysphagia • Weight gain • Myalgia [physio-pedia.com]
Patients may also complain of malaise, fatigue, myalgia, arthralgia, and a mild to moderate swinging fever. Symptoms usually peak within 3-4 days and completely disappear typically within weeks. [endocrinologyadvisor.com]
SX: - Subacute thyroiditis begins with a prodrome of generalized myalgias, pharyngitis, low-grade fever, and fatigue. - Patients then present with fever and severe neck pain, swelling, or both. - Up to 50 percent of patients have symptoms of thyrotoxicosis [enotes.tripod.com]
(ii) Neck pain was most common symptom in 90/94 patients (96%) with radiation to jaw and ear in 12 and 18 patients respectively (iii) Less common symptoms - dysphagia in 30, myalgia in 12, tremor in 19, sweating in 22 & weight loss in 15 patients. [hindawi.com]
The summer peak incidence of thyroiditis coincides with the peak incidences of coxsackievirus groups A and B and echovirus infections. 2 Symptoms and signs of subacute granulomatous thyroiditis include a prodrome of myalgias, pharyngitis, low-grade fever [aafp.org]
Psychiatrical
- Anxiety Disorder
Conditions that may be confused with Hashimoto’s include chronic fatigue syndrome, depression, fibromyalgia, an anxiety disorder, pre-menstrual syndrome (PMS), and cyclothymia. [medicalnewstoday.com]
Neurologic
- Irritability
The thyrotoxic phase lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. [thyroid.org]
Definitions of thyroiditis 1 n inflammation of the thyroid gland Type of: inflammation, redness, rubor a response of body tissues to injury or irritation; characterized by pain and swelling and redness and heat [vocabulary.com]
If there is consistent irritation, fatigue, anxiety, palpitations or sudden weight changes, it may be related to thyroid functioning. The altered levels of thyroxin (high or low) can cause such symptoms. [symptoma.com]
- Confusion
Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. [pesquisa.bvsalud.org]
Conditions that may be confused with Hashimoto’s include chronic fatigue syndrome, depression, fibromyalgia, an anxiety disorder, pre-menstrual syndrome (PMS), and cyclothymia. [medicalnewstoday.com]
It is often confused with dental pain, pharyngitis, or otitis and is aggravated by swallowing or turning of the head. Symptoms of hyperthyroidism are common early in the disease because of hormone release from the disrupted follicles. [msdmanuals.com]
May see giant cells Epithelium may have enlarged or overlapping nuclei with partial nuclear clearing, large squamous nests, hyperplastic follicles, ductal metaplasia ( Am J Surg Pathol 2006;30:774 ) Squamous metaplasia of follicular epithelium can be confused [pathologyoutlines.com]
- Agitation
A beta-blocker may be given to ease some of the symptoms of hyperthyroidism, like a racing heart, high blood pressure, feeling agitated or having tremors. Antithyroid medication is not usually necessary. [ada.com]
Workup
Acute thyroiditis: The laboratory data of the patients with acute thyroiditis is similar to acute systemic illness. Leukocytosis, increased sedimentation rate, and thyroid function test within the normal reference range.
Subacute thyroiditis: The data from the patients with subacute thyroiditis is similar to those with abnormal thyroid functions. Though initially the thyroid-stimulating hormone (TSH) level is decreased, sometimes, permanent hypothyroidism may also develop. White blood cell count in such patients is within the normal or slightly elevated reference range. C-reactive protein levels are also elevated in such patients.
Chronic thyroiditis: Laboratory data of patients with chronic thyroiditis are found to be abnormal with evidence of autoimmunity. In subclinical and overt hypothyroidism, TSH levels are increased, while in children with hyperthyroidism, this level is suppressed.
Elevated antithyroid peroxidase antibody levels are the most sensitive indicator of the autoimmunity.
Imaging Studies
Radioactive iodine thyroid scanning: Though this type of scanning is not necessary for acute suppurative thyroiditis and chronic thyroiditis, it can help to diagnose subacute thyroiditis.
Thyroid ultrasonography: Helps to reveal the formation of abscess patients with acute thyroiditis.
Degree of hyopoechogenicity on ultrasonography: Benefits are dependent on the degree of the thyroid dysfunction [7] [8].
Treatment
The treatment of thyroiditis depends on the type of the disease as well as the clinical presentation.
Thyrotoxicosis: The symptomatic relief can be brought out depending on the symptoms. In order to decrease the palpitations, beta blockers are used. With the improvement of the symptoms, the medications are reduced as the thyrotoxic phase was temporary. Antithyroid drugs are not used for the thyrotoxic stage.
Hypothyroidism: Hormone replacement therapy for hypothyroidism induced by Hashimoto’s thyroiditis is common. In patients with thyroiditis (subacute, painless and post-partum), thyroid hormone therapy can be indicated. This treatment must continue for 6-12 months and then tapered depending on the requirements.
Thyroidal pain: Subacute thyroiditis can cause pain. In such cases, mild anti-inflammatory medications are indicated. When these pains become severe, steroid therapy with prednisone is indicated [9] [10].
Prognosis
The prognosis of thyroiditis depends on the cause of the disease. Patients with Hashimoto’s disease may progress to complete thyroid failure, causing permanent hypothyroidism. On correct and early diagnosis, hypothyroidism responds well to the treatment. Goiter following autoimmune thyroiditis may not resolve completely. Other types of thyroiditis can be managed well with treatment with total resolution of the disease.
Complications
Some of the complications of the disease are hypothyroidism, thyroid abscesses, severe chest pain, hyperthyroidism, neck pain and goiter.
Etiology
Thyroiditis can be broadly classified into:
- Acute suppurative thyroiditis caused by bacterial infection
- Subacute thyroiditis caused by viral infection of the gland.
- Chronic thyroiditis is autoimmune in nature.
The most common type of thyroiditis is Hashimoto’s thyroiditis named after the Japanese physician. This disease is an autoimmune lymphocytic thyroiditis [1] [2].
Epidemiology
Depending on the screening procedures, the prevalence of chronic autoimmune thyroiditis varies. In some areas across the globe, the prevalence is as high as 12.5%. The region where the antibiotic use is less prevalent, acute thyroiditis is common.
Though there is no long-term mortality or morbidity due to thyroiditis, patients with autoimmune thyroiditis may develop hypothyroidism requiring treatment for life. Those patients, who suffer from subacute thyroiditis, may have hyperthyroidism, which may resolve on its own. Normal thyroid function is generally restored in patients with acute thyroiditis [5] [6].
Pathophysiology
Acute suppurative thyroiditis: This type of thyroiditis is rare among children. The most common organism that causes this type of thyroiditis belongs to genus Streptococcus; though some other aerobic and anaerobic bacteria may be involved.
Subacute thyroiditis: Viral infection is the cause of subacute thyroiditis. Some of the viral diseases that precede thyroiditis are mumps, influenza, adenoviral, malaria, myocarditis, measles or Q-fever.
Chronic thyroiditis: This type of thyroiditis is caused due to an autoimmune process [3] [4].
Prevention
To avoid the complications of thyroiditis, the most important step that one can take is to maintain personal hygiene. As mentioned above, the etiology of the disease lies in the pathogens: bacteria and virus. These interactions with such pathogens are possible by maintaining hygiene. Early diagnosis of the autoimmune thyroiditis can help the patient to learn about the management of the manifestations that may ensue as the disease progresses.
Summary
Thyroiditis is a group of disorders which are characterized by an inflammation of the thyroid gland and may manifest in a number of different ways, such as Hashimoto’s thyroiditis (which is the most common form), postpartum thyroiditis, and subacute thyroiditis. In some patients, drugs such as interferon and amiodarone can also cause this inflammation and this is often referred to as secondary thyroiditis [1].
Patient Information
Thyroiditis is a group of disorders which are characterized by an inflammation of the thyroid gland. If there is consistent irritation, fatigue, anxiety, palpitations or sudden weight changes, it may be related to thyroid functioning. The altered levels of thyroxin (high or low) can cause such symptoms. Hence, meeting up the family physician is a good idea.