Thyroiditis

Question 1

Define:

Answer 1

Inflammation of the thyroid gland

Question 2

Aetiology/risk factors:

Answer 2

Hashimoto’s thyroiditis (most common cause of hypothyroidism. This is an autoimmune condition where there is lymphocytic infiltration)

De Quervan’s (viral) –> hyper–> hpo –> euthyroidism (dysphagia and pyrexia)

Drug induced

post-partum

Acute or infectious

Question 3

Epidemiology:

Answer 3

Incidence is unknown

15-20 x more likely in women

usually occurs in 30-50 year olds

Question 4

Symptoms/signs:

Answer 4

Everything slows down.

Signs and symptoms of hypothyroidism:

• Fatigue
• Weight gain
• Reduced appetite
• Depression
• Menstrual irregularities
• Cold intolerance
• Dry skin
• Constipation

Due to enlarged thyroid:

• Dysphagia
• Dyspnoea
• Tenderness

Question 5

Investigations:

Answer 5

Usually a clinical diagnosis

TSH will be high

Histology - diffuse lymphocytic + plasma cell infiltration

Anti-TPO and anti-thyroglobulin antibodies

Thyroid US

Radionuclide isotope scanning (in viral there is NO uptake as thyroxine has been released)

Question 6

Management:

Answer 6

Levothyroxine sodium

Surgery if the thyroid is large and compressing surrounding structures

Question 7

Complications:

Answer 7

Myxoedema coma

Hashimoto’s encephalopathy

If too much thyroid hormone replacement - bone loss + tachycardia

Hyperlipidemia

Question 8

Prognosis:

Answer 8

Good if diagnosed early and levothyroxine sodium is taken