Sunday, March 2, 2014

Thyroiditis | Acute and Chronic | Symptoms and Thyroiditis Diagnosis

Thyroiditis | Acute and Chronic | Symptoms and Thyroiditis Diagnosis .

Thyroiditis usually results from an infective or auto-immune process. Rarely, it is a consequence of radiation or chemical injury.

Acute thyroiditis- it can be bacterial, viral or fungal in origin or radiation induced.
Sub-acute thyroiditis- it can be either de Quervain’s thyroiditis or painless thyroiditis.
Chronic thyroiditis- it can be either auto-immune (Hashimoto’s) or Reidel’s thyroiditis.

People with acute thyroiditis complain of a painful, sudden swelling in the anterior neck with some local pressure symptoms and fever.
This is often associated with upper respiratory tract infection or systemic infection or presence of suppurative lesion in the anterior neck.

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Person remains euthyroid and rarely a transitory hormonal disturbance may occur.

It is also called as de Quervain’s thyroiditis.
It is probably a viral infection.
Person has history upper respiratory catarrh in previous 7-10 days and complaints of pain in thyroid region with low grade fever.
Gland is enlarged and is tender to touch.
Histologically, some disruption of thyroid follicles and granuloma formation is seen.
Bio-chemically, iodinated thyroproteins are increased. T3, T4 and TSH may be normal. ESR is raised and the thyroid I-131 uptake is reduced.
The disease is self-limiting due to the leakage of thyroid hormones in initial stages; some symptoms of hyper-metabolic state may be present.

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They respond to beta-blockers.
The disease subsides on its own in a few weeks or months.

Also includes silent thyroiditis and post-partum thyroiditis.
It occurs due to transitory auto-immune process.
Clinically it is seen as symmetrical thyroid enlargement 2-3 times its normal size.
Some people present with thyrotoxicosis while in others goiter is the only presentation with a euthyroid status.
There is a tendency of relapses over a period of years; some people may proceed to become permanently hypothyroid.
Occurrence of thyrotoxicosis in immediate post-partum period is suggestive of silent thyroiditis.
Histologically, there is predominance of lymphocytic infiltration.
Low I-131 thyroid uptake is seen with symptoms of thyrotoxicosis.
A thyroid biopsy showing lymphocytic thyroiditis confirms the diagnosis.

or auto-immune thyroiditis (Hashimoto’s thyroiditis)

It is commonly affects age group of 35-45yrs and seen 10-15 times more in females.
Individual has a goitrous swelling, defined as firm or of rubbery consistency.
There may be asymmetrical enlargement of gland. Dalphain node may also be palpable.
Histologically, marked lymphocytic infiltration is seen with presence of Askanazy cells.
Thyroid functional status is variable.
Initial presentation of Hashimoto’s thyroiditis may be with frank symptoms of thyrotoxicosis.
Up to 50% people have a euthyroid state.
Serological tests show a high microsomal antibody titer; also presence of anti-thyroglobulin antibodies is seen.
IgG levels is high.

In an effort to suppress TSH (thyroid stimulating hormones) and reduce goiter size and immune response, person of chronic auto-immune thyroiditis are prescribed thyroxine.
TSH is monitored during maintenance therapy.