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thyroiditis

Etiology: 1) acute thyroiditis (infectious or suppurative) a) rare, most commonly in women 20-40 years of age b) painful thyroid, fever, dysphagia c) pre-existing thyroid disease in most patients 2) subacute granulomatous thyroiditis a) most frequent cause of painful thyroid b) seasonal (summer/fall) c) often preceded by upper respiratory tract infection (URI) 3) subacute lymphocytic thyroiditis a) painless thyroiditis b) 10% are postpartum 4) chronic lymphocytic (Hashimoto's) thyroiditis a) painless thyroiditis b) most patients are asymptomatic, finding of enlarged thyroid is incidental c) most common form of thyroiditis d) 95% in women 30-50 years of age 5) invasive fibrous (Reidel's) thyroiditis a) rarest form of thyroiditis b) painless enlargement of pre-existing goiter 6) 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: 1) thyroid function tests a) low serum TSH b) elevated free T4, serum T3 or free thyroxine index (FTI) c) serum thyroglobulin 2) thyroid auto-antibodies a) anti-thyroid peroxidase b) thyroid-stimulating immunoglobulin c) anti-thyroglobulin 3) complete blood count (CBC) 4) erythrocyte sedimentation rate (ESR) Radiology: - thyroid scintigraphy/radioactive iodine uptake (I-131 uptake, I-123 uptake) a) low during thyrotoxic phase because of inflammation b) may be above normal during hypothyroid recovery phase Management: 1) non-steroidal anti-inflammatory agents (NSAIDs) for inflammatory thyroiditis 2) prednisone may be useful - only if thyroid is tender, elevated ESR not enough [2] - NOT for infectious thyroiditis 3) beta blockers (atenolol, metoprolol preferred) for hyperthyroidism* * thionamides (methimazole & propylthiouracil) not useful because preformed thyroxine has already been released from the thyroid [2]

Interactions

disease interactions

Related

thyrotoxicosis

Specific

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

General

inflammation thyroid disease

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 646-650
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2022
  3. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003 Jun 26;348(26):2646-55. PMID: 12826640
  4. Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: an integrated approach. Am Fam Physician. 2014 Sep 15;90(6):389-96. PMID: 25251231 Free Article
  5. NEJM Knowledge+