THYROIDITIS
 
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THYROIDITIS

 

DEFINITION:

Several thryoiditis syndromes initially associated with hyperthryroidism but then eventually hypothryroidism.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • ?
  • risk factors:
    • F > M (4-7:1) - Hashimoto's Thyroiditis

PATHOGENESIS:

  • there are 3 forms of thyroiditis:

1. Chronic Thyroiditis

1. Hashimoto's Disease

  • a chronic lymphocytic thyroiditis
  • a slowly progressive T-cell-mediated destruction of the thyroid parenchyma
  • initial stimulus unknown
  • considered an autoimmune disorder where some of the immune mechanisms may stimulate the thyroid

2. Subacute Thyroiditis

1. Granulomatous Thyroiditis

  • granuloma formation found on histologic examination

2. Lymphocytic Thyroiditis

  • in both forms of subacute thyroiditis, disruption of the thyroid follicles empties thyroid hormone into the circulation producing hyperthyroidism -> decreased TSH -> decreased thyroid hormone synthesis -> depletion of thyroglobin stores -> hypothyroidism

CLINICAL FEATURES:

1. Hashimoto's Thyroiditis

  • 5-10% present with thyrotoxicosis (mild)
  • may be asymptomatic and/or self-resolving
  • thyroid - enlarged, firm, bosselated, nontender

2. Granulomatous Thyroiditis

  • often preceded by an upper respiratory tract infection (malaise)
  • may present with a 1-5 month history of mild -> moderate hyperthyroidism and then becomes hypothyroid
  • thyroid - painful, no rubor or heat of overlying skin

3. Lymphocytic Thyroiditis

  • presentation similar to that of Granulomatous Thyroiditis
  • thyroid - painless

INVESTIGATIONS:

1. Serum

1. Thyroid Function Tests

  • elevated T4, T3; decreased TSH

2. Antibodies

  • 1. Hashimoto's
    • antibodies against microsomal antigens (anti-thyroid microsomal antibodies [ATM]), and thyroglobulin (anti-thyroglobulin antibodies [ATA]) are usually found in the serum
  • 2. Granulomatous
    • antithyroid antibodies are found transiently
  • 3. Lymphocytic
    • antithyroid antibodies usually not found

    • 3. ZSR

    • normal in Hasimoto's and Lymphocytic forms
    • increased in Granulomatous form

    2. Imaging Studies

    1. Thyroid Scan (131I)

    • Hashimoto's - nodular increased uptake
    • Subacute - decreased uptake on thyroid scan due to inflammatory process

    3. Aspiration Cytology

    • characteristic for each form

    MANAGEMENT (see "Hyperthyroidism"):

    1. Medical

    1. Thioureylenes

    • propylthiouracil, carbimazole, methimazole

    2. Antihypertensives

    • propranolol

    2. Radiation

    1. 131 Radioiodine

    3. Surgery

    1. Thyroidectomy

     

     

     

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