Thyroiditis

General Illness Information

Medical Term:
THYROIDITIS (DE QUERVAIN’S THYROIDITIS, SUBACUTE THYROIDITIS, LYMPHOCYTIC THYROIDITIS, PAINLESS THYROIDITIS, POSTPARTUM THYROIDITIS)

Common Name: None Specified

Description: Thyroiditis is an acute inflammation of the thyroid gland. This inflammation often leads to destruction of cells of the thyroid gland. It may lead to hypothyroidism (under active thyroid) or hyperthyroidism (overactive thyroid) -as the thyroid gland cells are destroyed, thyroid hormone is released, thus often rendering the patient hyperthyroid. Complete resolution may occur.

Causes:

  • The causes of thyroiditis are thought to be associated with a viral infection autoimmune response to thyroid tissue – the most common type of thyroiditis e.g. Postpartum and Hashimoto’s thyroidits.
  • Genetic susceptibility.
  • Chronic inflammation (granulomatous or subacute thyroiditis)

Prevention: Not known

Signs & Symptoms

  • the patient may have an enlarged thyroid gland
  • the patient may have a very painful thyroid gland or a painless one
  • redness (erythema) and/or warmth may be present around the patient’s thyroid gland (signs of inflammation)
  • a very enlarged thyroid gland may result in compressive symptoms (hoarseness, pain, trouble swallowing (dysphagia), noisy breathing on inspiring air (stridor).
  • initially the patient with thyroiditis usually has hyperthyroid symptoms

HYPERTHYROID SYMPTOMS may include any or all of the following:

  • feeling very warm all the time;
  • sweaty moist palms;
  • tremor (especially of the hands);
  • itchy skin;
  • rapid heartbeat;
  • fluttering sensation in the chest (palpitations);
  • increased appetite;
  • weight loss (occasionally weight may remain stable or increase);
  • anxiety;
  • irritability;
  • panic attacks;
  • fatigue;
  • muscle weakness;
  • increased looseness or frequency of bowel movements;
  • hair loss.

Following this the patient will often develop hypothyroidism for a short period of time

HYPOTHYROID SYMPTOMS may include any or all of the following:

  • Excessive fatigue.
  • Decreased tolerance for cold.
  • Slow, rapid or irregular heartbeat.
  • Weight gain.
  • Coarse or slow-growing hair.
  • Decreased appetite.
  • Constipation.
  • Chest pain.
  • Sleepiness.
  • Placidity or nervousness.
  • Mental impairment, including depression, psychosis or poor memory.
  • Fluid retention, especially around the eyes.
  • Dull facial expression and droopy eyelids.
  • Coarse skin.
  • Decreased sex drive and infertility.
  • Menstrual disorders.
  • Anemia.
  • Numbness and tingling of the hands and feet.
  • Deepened or hoarse voice.
  • Swelling of the legs.

Eventually all symptoms resolve and the patient is euthyroid (i.e. not hyperthyroid or hypothyroid).

Risk Factors

  • Unknown but often preceded by a viral respiratory tract infections (e.g. sore throat, runny nose etc.)
  • In postpartum thyroiditis there is an association with other autoimmune diseases (e.g. lupus, vitiligo , Type 1 diabetes etc.) or a positive family history.

Diagnosis & Treatment

  • Diagnostic workup consists of a complete history and physical examination. Blood tests are often done to check the level of thyroid hormone (TSH and free T4) and also sometimes to check for signs of inflammation (erythrocyte sedimentation rate – ESR).
  • In order to differentiate between Graves’ hyperthyroidism and painless thyroiditis a radioactive iodine uptake scan is often performed. The patient is required to drink a radioactive iodine preparation and the thyroid is later scanned for its uptake of the iodine. Graves disease shows increased uptake whereas thyroiditis shows markedly decreased uptake of the iodine.

General Measures:

Analgesics for pain.

Medications:

  • The mainstay of treatment is non-steroidal anti-inflammatory (NSAID) medication- i.e. Advil or Aspirin
  • In severe cases unresponsive to NSAID therapy, steroid medication (Prednisone) can be used.
  • If the patient temporarily becomes hypothyroid, their thyroid hormones can be replaced with Levothyroxine (eltroxin, synthroid)
  • Propyl thiouracil for hyperthyroid symptoms.

Activity:

No restrictions unless hyperthyroid.

If hyperthyroid should not overexert oneself.

Diet:

No restrictions

Possible Complications:

Temporary hypothyroidism

Prognosis

Full recovery in 1-6 months time

Patients eventually become euthyroid (i.e. not left with hyper or hypothyroidism) Patients with lymphocytic thyroiditis — may develop persistent goiter (enlarged thyroid ) and thyroid failure, which can be treated with thyroid replacement therapy.

Other

‘Nothing Specified’.

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