thyroiditis
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THYROIDITIS
By, Himani MalhotraFinal MBBS Part 2
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What is thyroiditis ?
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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.
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The Types of ThyroiditisAcute/
Infectious thyroiditis
Subacute thyroiditis/granulomatous
Hashimoto’s thyroiditis /Chronic
lymphociticRiedel’s
thyroiditis
Drug-induced
thyroiditis
Radiation induced
Thyroiditis
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Autoimmune/Chronic lymphocytic thyroiditis-Hashomoto’s thyroiditis
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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.
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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.
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Morphology
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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.
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The symptoms-FatigueDrowsinessDifficulty with learningDry, brittle hair and nailsDry, itchy skinPuffy faceConstipation.Weight gainHeavy menstrual flowIncreased frequency of miscarriages
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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
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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.
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Presenting symptomsFeverBody achePainful enlargement of thyroid
glandSIGNS-• Gland enlarged• Tender• Soft to firm• Symptoms of hyperthyroidism
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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.
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TREATMENTPrednisone 10-20mg daily for 7
days, with dose gradually reduced over the next month.
Thyroxine until function recovers
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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.
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CLINICAL FEATURES
High dose steroids & thyroxine replacementThyroxine.
TREATMENT-
nonpainful, rapidly growing thyroid mass
Dysphagia, dyspnoea
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Differential diagnosisANAPLASTIC CARCINOMA
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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
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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.
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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-
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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.
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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.
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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
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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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THANKYOU