thyroiditis
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Etiology
- acute thyroiditis (infectious or suppurative)
- rare, most commonly in women 20-40 years of age
- painful thyroid, fever, dysphagia
- pre-existing thyroid disease in most patients
- subacute granulomatous thyroiditis
- most frequent cause of painful thyroid
- seasonal (summer/fall)
- often preceded by upper respiratory tract infection (URI)
- subacute lymphocytic thyroiditis
- painless thyroiditis
- 10% are postpartum
- chronic lymphocytic (Hashimoto's) thyroiditis
- painless thyroiditis
- most patients are asymptomatic, finding of enlarged thyroid is incidental
- most common form of thyroiditis
- 95% in women 30-50 years of age
- invasive fibrous (Reidel's) thyroiditis
- rarest form of thyroiditis
- painless enlargement of pre-existing goiter
- amiodarone-induced thyroiditis[2]
Epidemiology
- thyroiditis is the most common thyroid abnormality encountered in clinical practice
Pathology
- self-limiting inflammatory thyroid disorder resulting in release of preformed thyroid hormone
- thyrotoxic release phase (2-6 weeks)
- hypothyroid recovery phase (6-12 weeks)
- return to euthyroid state if destruction is reversible
Clinical manifestations
- thyrotoxic release phase
- myalgia
- low-grade fever
- anterior neck pain
- tachycardia[5]
Laboratory
- thyroid function tests
- low serum TSH
- elevated free T4, serum T3 or free thyroxine index (FTI)
- serum thyroglobulin
- thyroid auto-antibodies
- complete blood count (CBC)
- erythrocyte sedimentation rate (ESR)
Radiology
- thyroid scintigraphy/radioactive iodine uptake (I-131 uptake, I-123 uptake)
- low during thyrotoxic phase because of inflammation
- may be above normal during hypothyroid recovery phase
Management
- non-steroidal anti-inflammatory agents (NSAIDs) for inflammatory thyroiditis
- prednisone may be useful
- only if thyroid is tender, elevated ESR not enough[2]
- NOT for infectious thyroiditis
- beta blockers (atenolol, metoprolol preferred) for hyperthyroidism*
* thionamides (methimazole & propylthiouracil) not useful because preformed thyroxine has already been released from the thyroid[2]
More general terms
More specific terms
- chronic thyroiditis (Riedel's thyroiditis, Hashimoto's thyroiditis)
- idiopathic primary hypothyroidism; atrophic autoimmune thyroiditis
- infectious thyroiditis; suppurative thyroiditis; acute thyroiditis
- subacute granulomatous thyroiditis; De Quervain's thyroiditis; giant-cell thyroiditis
- subacute lymphocytic thyroiditis
- subacute thyroiditis
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 646-650
- ↑ Jump up to: 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2022
- ↑ Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003 Jun 26;348(26):2646-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12826640
- ↑ Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: an integrated approach. Am Fam Physician. 2014 Sep 15;90(6):389-96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25251231 Free Article
- ↑ Jump up to: 5.0 5.1 NEJM Knowledge+