THYROIDITIS - Overview, Facts, Types and Symptoms, etc.


Thyroiditis may sound like one disease, but it is not. It is a heterogeneous group of things that share some stuff in common.  These diseases all involve inflammation of the thyroid. The treatments, causes, and symptoms are different. Aside from the inflammation of the thyroid, they also caused a perceived enlargement of the thyroid gland. This is usually felt on a physical exam. Most of them go through either hyperthyroid or hypothyroid stages. Significant expansions may cause dyspnea and dysphagia. These problems are more common among females.


Subacute Thyroiditis . It is a granulomatous giant cell-mediated inflammation of the thyroid, which is probably due to a viral infection. If the patient has pain, it is more than likely subacute thyroiditis. This pain radiates over the thyroid, around the neck, to the cervical spine of the jaw, down to upper arms. The thyroid is enlarged and firm. The symptoms may be unreliable early on; usually, the patient will start in a hyperthyroid like state, but you might not see signs. Eventually, the patient will go into a hypothyroid state. Laboratory examinations that can be done are ESR and TSH. ESR should be elevated that indicates that there is inflammation going on while TSH will help you determine what phase the patient is at. The differential here is with Graves Disease, where the period is going to persist. It is not going down into a new thyroid. Then to a hypothyroid stage, This disease also gives more pronounced symptoms and have exophthalmos, which is bulging of the eyes due to the inflammation of the ocular muscles.

Because it is self-limited, patients don’t need to take any significant interventions. Prednisone is usually taken for thyroid inflammation, and pain is treated with aspirin, while other symptoms are treated with propranolol. For hypothyroid cases, there is no need to replace the thyroid hormone because it will go away and be self-limited.

On the other hand, hyperthyroid symptoms can be problematic. This can lead to a fatal arrhythmia. 

Hashimoto’s thyroiditis. In the US, Hashimoto’s thyroiditis is the number one cause of hypothyroidism. This is a chronic autoimmune lymphocytic infiltration of the thyroid, which is going to be associated with specific antibodies and with other autoimmune disorders. The thyroiditis is Hashimoto’s painless and is an enlarged goiter, and It is not necessarily symmetric. The hypothyroid symptoms will tend to predominate. These symptoms include weight gain, depression, dry skin, loss of appetite, nail changes, and many more. It is very insidious. The way to diagnose this is TSH since it is hypothyroidism. This should be elevated while the T3 and T4 are low. The diagnosis can be corroborated by running titers associated with Hashimotos, which is an anti-thyroid peroxidase antibody and thyroglobulin antibody.

Patients with Hashimoto’s should be checked often for nodules because they are at a higher risk of developing malignancy with their buds. So approximately 8% of nodules and patients with Hashimoto’s thyroiditis are malignant nodules.

Riedel’s Thyroiditis. This type of disease is sporadic, in which the thyroid becomes densely fibrotic. This fibrosis extends to other cervical structures such as the esophagus, trachea, musculature, and there may even be fibrosis in other parts of the body such as mediastinum and retroperitoneum. Riedel is most commonly associated with hypothyroidism. The presenting symptoms will be related to compression: dyspnea, dysphagia, tightness, neck pressure, hoarseness, and cough. The thyroid itself is painless and not comparable. The best diagnosis for Riedel’s thyroiditis is a surgical biopsy, which is the only way to differentiate it from the other types of thyroiditis. This will show proliferative fibrosis. The initial therapy for Riedel’s is prednisone. This will improve fibrosis. Hypothyroid is treated with levothyroxine.

Lymphocytic or Postpartum Thyroiditis. Lymphocytic infiltration in the thyroid results in a small painless goiter, and it is self-limited and has distinct phases such as hyperthyroid, transient euthyroid, hypothyroid, and euthyroid or recovered. Symptoms of the lymphocytic or postpartum thyroiditis may include small, painless goiter. There is no pain and symptoms depend on the stage of the disease. Often, a TSH and RAIU are needed for staging. These diagnoses will follow standard patterns like low TSH, low RAI uptake high TSH, low RAI uptake. To differentiate this from Graves, TSH should be small, and RAI is top in absorption. The treatment for this is only needed if pt goes into thyrotoxicosis, in which case the best initial therapy is beta-blocker propranolol.

Drug Infused Thyroiditis. This includes amiodarone for antiarrhythmic, lithium for a mood stabilizer, IFN-alfa for Hep B, Hep C and chemotherapeutic, and IL-2 for the chemotherapeutic and immune stimulator. 

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