From WikiLectures

Acute thyroiditis[edit | edit source]

Acute thyroiditis is currently a relatively rare infectious purulent inflammation of the thyroid gland.

Etiology[edit | edit source]

It is usually caused by a bacterial inflammatory condition in the orofacial area or by septic metastasis in immunocompromised persons, or it may have a tuberculous origin.

Clinical picture[edit | edit source]

  • Local redness above the thyroid gland;
  • palpable pain;
  • fever.

Diagnostics[edit | edit source]

The clinical picture is the basis for diagnosis. There is increased sedimentation , leukocytosis and high CRP in the laboratory findings. These imaging methods are used: USG and thin needle aspiration biopsy (FNAB).

Thyroid ultrasound

Therapy[edit | edit source]

Broad-spectrum antibiotics in high doses, but best targeted after culture examination.

Subacute thyroiditis[edit | edit source]

Subacute thyroiditis (De Quervain's, granulomatous, giant cell thyroiditis) is a relatively common inflammation of the thyroid gland, more common in women. Unlike acute thyroiditis (which has bacterial etiopathogenesis), subacute is most often caused by viruses. The disease often begins immediately or very shortly after a viral infection of the upper respiratory tract.

Clinical picture[edit | edit source]

The symptoms are:

  • painful swelling in the thyroid gland, which can shoot into the jaw and ear,
  • general symptoms (fatigue, subfebrile),
  • symptoms of transient destructive hyperthyroidism (when a large part of the parenchyma is affected) – palpitations, sweating, nervousness.

Diagnostics[edit | edit source]

The basis for diagnosis is the clinical picture of the patient. In the laboratory, we find increased sedimentation and slightly increased CRP. In transient hyperfunction, there is a decrease in TSH and an increase in free-T4. Ultrasound and FNAB are used for imaging methods .

Therapy[edit | edit source]

The treatment consists of the administration of anti-inflammatory drugs: the first choice is non-steroidal anti-inflammatory drugs, if the difficulties do not subside, we administer glucocorticoids. Subacute thyroiditis, which affects a large part of the gland volume, can progress to hypothyroidism, then we indicate thyroxine.

Prognosis[edit | edit source]

Most patients are curable, 10% of patients turn into permanent hypothyroidism.

Chronic thyroiditis[edit | edit source]

Chronic thyroiditis (chronic autoimmune thyroiditis, Hashimoto's thyroiditis, etc.) is a chronic autoimmune thyroiditis. It is the most common cause of hypothyroidism, but it may not develop in all cases.

Epidemiology[edit | edit source]

A common disease, it occurs in about 5% of the population with a predominance of women (4:1).

Etiopathogenesis[edit | edit source]

The etiology is unknown, the production of antibodies and the sensitization of lymphocytes by thyroid antigen are involved in the pathogenesis.

Clinical picture[edit | edit source]

It usually occurs completely asymptomatically for a long time. Hypothyroidism is the most important clinical set of symptoms. In the initial phase, diffuse goiter may occur (usually painless), but in the further course, the thyroid gland usually shrinks (atrophication).

Diagnostics[edit | edit source]

Diagnosis is based on the card

  1. antibodies against thyroid Ag (TgAb, TPOAb),
  2. USG (hypoechogenic inhomogeneous thyroid gland).

We will also add an examination of thyroid function (free-T4, TSH).

Therapy[edit | edit source]

Thyroid hormone replacement therapy is initiated in hypothyroidism. We monitor a patient without a significant thyroid disorder.

Riedel's thyroiditis[edit | edit source]

Riedel's thyroiditis is a rare form of chronic thyroiditis, the incidence is estimated at 0.04-0.3%, it affects women more often. It is often associated with other disorders of the immune system in terms of autoimmune diseases. This is probably a manifestation of IgG4-associated disease.

The clinical manifestation is non-specific, the usual manifestation is solid goiter with manifestations of rather mechanical oppression. Thyroid hypofunction may be present in some patients, in another part it may develop during the course of the disease, but it is not a characteristic manifestation. A relatively common feature is local invasion. Histopathology is diagnostically important, Riedel's thyroiditis may be less distinguishable from the fibrous form of Hashimoto's thyroiditis and from tumor changes. Only one case report with a fatal course has been published, otherwise the disease does not seem to shorten life.

References[edit | edit source]

  • ČEŠKA, Richard – ŠTULC, Tomáš, et al. Internal medicine. 2. edition. 2015. 909 pp. ISBN 9788073878955.