Thyroiditis

Question 1

defintion

Answer 1

heterogenous group of inflammatory thyroid disorders which are caused by inflammation of the thyroid gland

Question 2

types of thyroiditis

Answer 2

• hashimotos thyroiditis
• dequervians thyroiditis (subacute thyroiditis)
• postpartum thyroiditis
• drug induced thyroiditis (amidarone and lithium)
• radiation induced thyroiditis
• acute suppurative thyroiditis (bacterial)

Question 3

subacute thyroiditis definiotion

Answer 3

granulomatous giant cell mediated inflammation of the thyroid likely in response to a viral infections

Question 4

presentation of subacute thyroiditis

Answer 4

painful goitre
neck tenderness
fever

Question 5

progression of subacute thyroiditis

Answer 5

begins as a hyperthyroid phase (which may be clinically silent) and then becomes a euthyroid phase and then to a hypothyroid phase

Question 6

subacute thyroiditis management

Answer 6

self-limiting, inflammation can be treated with hydrocortisone and the palpitations can be treated with propranolol

Question 7

drug induced thyroiditis causes

Answer 7

amiodarone, lithium, interferon alpha and IL-2

Question 8

amiodarone causes

Answer 8

abnormal thyroid function tests in up to 50% of people it inhibits DI01 causing increased fT4 reduced free T3 and normal TSH

Question 9

amiodarone can result in

Answer 9

hypothyroidism or hyperthyroidism
- hypothyroidism is most common occurring in 13% of people who take amiodarone and tends to occur in iodine rich areas
- hyperthyroidism occurs in 2% and tends to occur in iodine deficient areas

Question 10

what is subclinical thyroid disease

Answer 10

abnormal TSH levels with normal thyroid hormones with little or no symptoms

Question 11

subclinical hypothyroidism

Answer 11

• elevated TSH but normal fT3/T4
• asymptomatic
• risk of progression to overt hyperthyroidism which is greater if the person in TPO antibody positive

Question 12

when is subclinical hypothyroidism treated

Answer 12

always treated in pregnancy and otherwise is only treated if TSH its greater than 10

Question 13

subclinical hyperthyroidism

Answer 13

• reduced TSH but normal fT3/T4
• risk of progression to overt hyperthyroidism
• often seen in multi nodular goitre
• associated with osteoporosis and atrial fibrillation

Question 14

when is subclinical hyperthyroidism treated

Answer 14

if TSH is less than 0.1 or if there is co-exisiting osteoporosis or atrial fibrillation

Question 15

non-thyroidal illness

Answer 15

also called sick euthyroid syndrome, commonly encountered in the unwell hospitalised patient

Question 16

why does non-thyoidal illness occur

Answer 16

because severe illness impacts the HPT axis and causes ca suppression of TSH

Question 17

what should you not carry out in acutely unwell patients

Answer 17

thyroid function tests unless you clinically suspect a thyroid disease