Thyroiditis

Hashimoto's Thyroiditis, Chronic Lymphocytic Thyroiditis, Thyroadenitis, Riedel's Thyroiditis

What is Thyroiditis?

Thyroiditis is an inflammation of the thyroid gland located in the front of the neck. The thyroid gland secretes hormones (thyroxine and triiodothyronine) that play an important role in controlling the body's metabolism. The four types of thyroiditis are acute or suppurative (typically a short-term condition caused by infection), subacute, Riedel's, and Hashimoto's. Hashimoto's thyroiditis (also called chronic lymphocytic thyroiditis) is the most common of the four types of thyroiditis, and is probably the most common type of thyroid disorder.

Hashimoto's thyroiditis is an autoimmune disorder in which the body's immune system develops antibodies against its own thyroid gland cells. As a result, the thyroid gland becomes unable to produce enough hormones. Although treatable, Hashimoto's thyroiditis is often not diagnosed until it has suppressed thyroid production, causing a state of hypothyroidism (insufficient amount of thyroid hormones). Life-long thyroid replacement therapy may be required.

Hashimoto's thyroiditis appears to be hereditary, and affects women eight times more often than men. It can occur at any age. Hashimoto's thyroiditis is associated with other autoimmune diseases such as diabetes, pernicious anemia, Addison's disease, lupus, chronic hepatitis, and Graves' disease.

Postpartum thyroiditis is a temporary form of autoimmune thyroiditis that occurs in women who have recently given birth. Normal thyroid function returns in most cases.

How is it diagnosed?

Thyroiditis signs and symptoms

Symptoms of thyroiditis usually include an enlarged thyroid gland, tiredness, muscle weakness, and weight gain. Occasionally (especially in acute suppurative and subacute thyroiditis), there is discomfort or pain in the thyroid area.

Symptoms of the resulting hypothyroidism include dry cool skin, puffy extremities and face, and a husky voice.

Physical exam: On physical exam, the thyroid gland is generally enlarged (goiter).

Tests: Laboratory tests include thyroid function (TSH, T3, T4, FTI), which measures hormone levels in the blood. A radioactive iodine uptake test is useful in differentiating between the forms of thyroiditis. In this test, the individual is given a small quantity of radioactive chemical (either orally or by injection). The chemical is absorbed by either healthy or diseased tissue (depending on the disease process and the type of scan). The emitted radioactivity produces an image of the thyroid on film for evaluation of abnormalities.

In Hashimoto's thyroiditis, a high titer of thyroid autoantibodies are detected. Because titers may also prove abnormal in other goiters, thyroid cancer, or thyrotoxicosis, a biopsy (a small sample of tissue removed from the thyroid gland for microscopic examination) may be necessary to confirm the diagnosis. Biopsy and culture is necessary to identify microorganisms responsible for acute suppurative thyroiditis.

How is Thyroiditis treated?

If thyroiditis is caused by an infection (acute suppurative), antibiotics are directed against the specific organism. Incision and drainage may be necessary. Occasionally, a thyroid lobectomy (surgically removing the infected lobe) is necessary to control a stubborn infection. In general, treatment consists of thyroid replacement therapy, usually to be continued for the rest of the individual's life. If an enlarged thyroid gland is causing complications (obstructing breathing or swallowing), it may need to be surgically removed (thyroidectomy).

Medications

Information Brand Generic Label Rating
http://www.nmihi.com/l/levothyroxine.html Synthroid Levothyroxine On-Label
http://www.nmihi.com/i/ibuprofen.html Motrin Ibuprofen Off-Label

Tenormin (Atenolol), Inderal (Propranolol)

What might complicate it?

In thyroiditis caused by infection, any complications of infection may occur. Hashimoto's thyroiditis may lead to hypothyroidism.

Predicted outcome

Recurrences and remissions (temporary periods when symptoms lessen or disappear) may occur. Life-long treatment with thyroid replacement therapy is often required.

Individuals with Hashimoto's thyroiditis can develop hypothyroidism, sometimes years after treatment, and will require lifelong thyroid replacement. Some individuals regain normal thyroid function after treatment, with no need for further therapy. In general, individuals with Hashimoto's thyroiditis have an excellent prognosis since the disease either remains stable for years or slowly progresses to hypothyroidism.

The individual's age and condition improves chances for full recovery of thyroid function. Research also indicates that individuals who have a family history of thyroid problems also tend to have higher success rates in reversing hypothyroidism.

Alternatives

Symptoms of thyroiditis are similar to those of thyroid cancer.

Appropriate specialists

Endocrinologist and internist.

Last updated 27 May 2012


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