11. Thyroiditis Flashcards
what are the several form of thyroiditis ?
acute - bacterial and fungal
subacute = within few days
after viral infections = granulomatous thrydoiditis of de quervain
silent and postpartum thyroiditis
chronic
hashimoto = autoimmune lymphocytic thyroiditis
what are the bacterial / fungal causes of acute thyroiditis ?
staph areas and staph progenies
fungi = aspergillus , candida , pneumocystis
what increases the risk for getting acute thyroiditis ?
persistant thyroglossal duct
pyriiform sinus fistula
immunosuppression
what re the clinical findings of acute thyroiditis ?
skin erythema (rubborr) swelling (tumor) local heat pain neck and radiates to ears and jaw difficulty neck movement
what is the diagnosis of acute thyroiditis ?
lab: ESR and CRP
leukocytosis
slightly elevated or NORMAL THYROID HORMONES
us = ABCESS USUALLY UNILATERALLY
x ray
CT
fine needle aspiration with microbiology and bacterial culture
what is the treatment of acute thyroiditis ?
IV antibiotics
cephalosporins 3rd gen (cefotaxime) , gentamycin
in children - clindamycin and 2nd (ceforoxim) gen cephalosporin
metronidazole of anaerobes
draining of abcess
what are the complication of acute thyroiditis ?
mediastinitis
vocal cord paralysis
transient thyrotoxicosis = destruction of follicular cels
followed by transient hypothyroidism
what is the etiology of de quervian thyroididitis ( granulomatous thyroiditis )
destruction of the thyroid gland = coxackie virus , adenovirus , influenza
HLAB35 AND HLAB67
what is a characteristic of de quiervian subacute granulomatous disease ?
multiphase
1) prodromal phase with hyperthyroidism
3-6 weeks
thyroid pain which can go to ear and lower jaw
vomitting , difficulty swallowing , pharyngitis , muscle and joint pain
fever
destruction of thyroid follicles = release of t3 and t4 = hyperthyroidism symptoms
2) euthyroidism lasts 1-3 weeks
asymptomatic phase
increase t3 and T4 - inhibit TSH
3) hypothyroidism can last week up to months and lifelong sometimes reduced performance weakness weight gain bradycardia hypotension
4) recovery phase - last up to 1 year till cycle begins again
how can we diagnose de querivain thyroiditis ?
enlarged thyroid gland
US
FNAB = multinucleate giant cells
reduced radionuclide uptake scintigraphy
what is the treatment for de querivian thyroiditis ?
systemic NSAIDS
prodromal thyrotoxicosis phase = prednisone with gradual dose reduction
beta blockers
DO NOT USE THYROSTATIC DRUGS = cannot stop the release of t3 and t4 from destroyed cells and can cause further damage
what is the pathogenesis of hashimoto thyroiditis
it is organ specific autoimmune disease
defect in the function of the t suppressors
the t cells sensitised to thyroid antigens causing autoantibodies to be produced
thyroglobulin antibody
TPO antibody
TSH-R BLOCKING ANTIBODY
DESTRUCTION OF THE THYROID GLAND = hashitoxicosis AND THEN HYPOTHYROIDISM with rise in TSH
what are the risk factors for hashimoto thyroiditis ?
women
HLA-DR5 - familial hereditary
diabetes type 1 and addison disease combination
what re the sign and symptoms of hashimoto thyroiditis
thyroid - GOITER - DIFFUSE INFLAMMTORY EDEMA = enlarged thyroid = dysphagia
NOT PAINFUL
SYMMETRICAL
Early-stage
Primarily asymptomatic
Goiter: non-tender or painless, rubbery thyroid with moderate and symmetrical enlargement
Hashitoxicosis may occur: transient hyperthyroidism due to follicular rupture of hormone-containing thyroid tissue that manifests with, e.g., irritability, heat intolerance, diarrhea.
Late-stage
Thyroid may be normal-sized or small if extensive fibrosis has occurred.
Hypothyroidism (e.g., cold intolerance, constipation, fatigue)
later stages = atrophy of the thyroid due to autoimmune disease
the thyroid function changes from hyperthyroidism , euthryoidism and hypothyroidism
why is hashimoto thryoditis the chameleon of thyroldolgy ?
there can be hyper , eu , hypothyroidism
goiter showing , normal size and atrophy
can have hypothyroidism due destruction of cells but have goiter at same time due to inflammatory edema
