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Thyroiditis


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.

Splenomegaly
  • […] use by Kubota et al, most patients had resolution of symptoms by 6-8 weeks, although the longest period of therapy was 40 weeks [12] Multiple system organ failure - May complicate the course of the disease in exceptionally rare cases Pancreatitis or splenomegaly[emedicine.medscape.com]
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]
  • […] 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]
Subcutaneous Nodule
  • CASE: A 45-year-old African American male, who received his third kidney transplant for renal failure secondary to Alport Syndrome, presented with numerous subcutaneous nodules and diffuse muscle pain in the neck.[ncbi.nlm.nih.gov]
Oligomenorrhea

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].

Viral Inclusion Body
  • (Viral inclusion bodies are not observed in thyroid tissue in subacute granulomatous thyroiditis.)[emedicine.medscape.com]
White Matter Lesions
  • Magnetic resonance imaging depicted unspecific, supratentorial white matter lesions and frontal accentuated brain atrophy. Electroencephalography was normal. Neuropsychological testing for attentional performance was below average.[ncbi.nlm.nih.gov]
Ventricular Hypertrophy
  • Patients can be extremely thyrotoxic during this period and can appear extremely ill, but concerns regarding left ventricular hypertrophy and osteoporosis are not as great as those associated with conditions of permanent hyperthyroidism.[emedicine.medscape.com]

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:

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].

Sex distribution
Age distribution

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.

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Last updated: 2019-07-11 22:28