thyroiditis

THYROIDITIS

By, Himani MalhotraFinal MBBS Part 2

What is thyroiditis ?

Thyroiditis is a general term that refers to “inflammation of the thyroid gland”.

Thyroiditis includes a group of individual disorders that all cause thyroidal inflammation and, as a result, causes many different clinical presentations.

The Types of ThyroiditisAcute/

Infectious thyroiditis

Subacute thyroiditis/granulomatous

Hashimoto’s thyroiditis /Chronic

lymphociticRiedel’s

thyroiditis

Drug-induced

thyroiditis

Radiation induced

Thyroiditis

Autoimmune/Chronic lymphocytic thyroiditis-Hashomoto’s thyroiditis

Common condition associated with raised titres of thyroid antibodies- THYROID PEROXIDASE & THYROGLOBULIN.

CLINICALY-Usually presents as goitre, which

maybe diffused or nodular with a charecteristic “bosselated” feel or with established or subclinical thyroid failure.

PathogenesisHashimoto thyroiditis is an

autoimmune disease in which the immune system reacts against a variety of thyroid antigens.

There is progressive depletion of thyroid epithelial cells (thyrocytes), which are gradually replaced by mononuclear cell infiltration and fibrosis.

Morphology

The thyroid is often diffusely enlarged, firm & rubbery in consistency, smooth or irregular, may involve one lobe or both.

The capsule is intact.

the gland is well demarcated from adjacent structures.

The cut surface is pale, yellow-tan, firm, and somewhat nodular.

On deep eosinophilic staining thyroid follicular cell- ASKANAZY CELL is characteristic of hashimoto’s thyroiditis.

The symptoms-FatigueDrowsinessDifficulty with learningDry, brittle hair and nailsDry, itchy skinPuffy faceConstipation.Weight gainHeavy menstrual flowIncreased frequency of miscarriages

Diagnosis 1- Thyroid function test, In many cases thyroid

antibodies are raised, suggesting autoimmune disorder. 2- FNAC 3- Diagnostic lobectomy

Treatment1- Replacement dose of thyroxine 0.2mg/day.2-Isthmusectomy.3- Thyroidectomy

Subacute thyroiditis/ Granulomatous thyroiditis/ de Quervain’s thyroiditis

is a self-limited thyroid condition.

associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function.

It is caused by a viral infection usuaaly follows a sore throat or mumps infection.

Presenting symptomsFeverBody achePainful enlargement of thyroid

glandSIGNS-• Gland enlarged• Tender• Soft to firm• Symptoms of hyperthyroidism

DIAGNOSIS-blood tests to measure :increased levels of thyroid hormone in

the bloodstream .the abnormal antibodies, anti-

microsomal and antithyroglobulin antibodies

A fine needle aspiration biopsy of the thyroid gland during this phase would reveal inflammatory cells attacking the thyroid gland.

ESR is increased.

TREATMENTPrednisone 10-20mg daily for 7

days, with dose gradually reduced over the next month.

Thyroxine until function recovers

Riedel’s ThyroiditisRare disease Replacement of the normal

thyroid parenchyma by a dense fibrosis.

Painless goiter “woody”Open biopsy often needed to

diagnoseAssociated with focal sclerosis

syndromes.

CLINICAL FEATURES

High dose steroids & thyroxine replacementThyroxine.

TREATMENT-

nonpainful, rapidly growing thyroid mass

Dysphagia, dyspnoea

Differential diagnosisANAPLASTIC CARCINOMA

SURGERYA wedge resection of the thyroid

isthmus

Surgery is indicated when tissue is needed for diagnosis, medical treatment shows no benefit, or compressive symptoms are very severe

Drug-induced thyroiditisCAUSE: Drugs include: amiodarone, lithium,

interferons, cytokines, cancer treatment drugs.

CLINICAL FEATURES: Either thyrotoxicosis or hypothyroidism.

DURATION AND RESOLUTION: Often continues as long as the drug is

taken.

CAUSE:1. Follows treatment with radioactive

iodine for hyperthyroidism 2. external beam radiation therapy

for certain cancers.

CLINICAL FEATURES:3. Occasionally thyrotoxicosis4. more frequently hypothyroidism.

Radiation induced-

Acute/Infectious thyroiditisacute suppurative thyroiditis is quite rare

in modern times.Cause: It is caused by a bacterial infection in the

thyroid which causes pus to collect and form an abscess within the thyroid gland.

The bacterial infection may be carried in the bloodstream from anywhere in the body or it may come from the throat itself.

post-partum thyroiditisThis is the type of thyroiditis that may

occur in women after they give birth.2 Phases:

Over Active Phase.

Under Active Phase.

Then, return to Normal state.

Over Active Phase: Within the first one to four months after delivery. This phase can be characterized by :

1. slight enlargement of the thyroid .2. Anxiety.3. Restlessness.4. Insomnia.5. weight loss.6. difficulty concentrating. Diagnosis: blood tests to measure : increased levels of thyroid hormone in the

bloodstream . the abnormal antibodies, anti-microsomal and

antithyroglobulin antibodies. FNAC

Under Active Phase:occurs 3 to 8 months

postpartum.This phase can be characterized

by:

1. slight enlargement of the thyroid gland.

2. weight gain.3. Fatigue.4. lack of energy .5. depression.

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