Thyroiditis Flashcards
What does the term “Thyroiditis” mean?
- A diverse group of disorders characterized by some form of thyroid inflammation
- Multifaceted disease
What are 3 common types of thyroiditis?
- Painful
- Painless
- Hashimotos
What are the 2 painful types?
- Subacute Thyroiditis (de Quervains)
- Infectious Thyroiditis (Supperative)
What is the painless type?
Silent Thyroiditis or Postpartum Thyroiditis
What is the Hashimotos type?
Chronic Autoimmune Thyroiditis
What are the 3 phases of Thyroiditis?
- Hyper
- Hypo
- Euthyroid
What occurs during the hyper phase?
- Inflammation damages thyroid follicles
- Releases the preformed TH into circulation (thyrotoxic stage)
How long does the hyper phase last?
- This lasts ~ 4-10 wks
- Spontaneous remission begins ~4-8 wks
What occurs during the hypo phase?
- All the preformed TH is exhausted
- New TH has ceased
How long does the hypo phase last?
- This lasts ~ 2 mos
- Usually no TH therapy is needed as it is mild, unless pt has S/Sxs of hypothyroidism
What occurs during the Euthyroid phase?
- As the follicles regenerate, a state of euthyroid is restored
- Etiology dependent, 90-95% of pts return to normal thyroid fxn
What are the causes of Painful Thyroiditis: Subacute (de Quervains)?
- Postviral: Coxsackie, Mumps, Influenza, Adenovirus
- 30-50yo W>M
What are the clinical presentations of Painful Thyroiditis: Subacute (de Quervains)?
- Onset: acute and severe
- Sore throat
- Exquisitely tender, enlarged thyroid (a small goiter)
- Febrile
- Signs of: Hyperthyroidism followed by Hypothyroidism
What are the causes of Painful Thyroiditis: Infectious (Suppurative)?
- Staph or Strep
- Esp. in immunocompromised pts or Children (acute/chronic)
What is the clinical presentations of Painful Thyroiditis: Infectious (Suppurative)?
- Onset – sudden, severe neck pain
- Focal tenderness of involved area (a small asymmetrical goiter)
- Febrile
- Dysphagia
- Erythema of the overlying skin
What are the dx test for painful subacute (de quiervans) thyroiditis?
- Thyroid function x 6 mo.
- WBC: ↑-left shift
- ESR: ↑
- FNA Bx: if in doubt
- Thyroid Antibodies: Negative (TPOAb-)
What are the dx test for painful infectious (Suppurative) thyroiditis?
- Thyroid Function: Normal
- WBC: ↑-left shift
- ESR: ↑
- FNA Biopsy: Polymorphonuclear Leuks.
What is the tx for painful subacute (de quiervans) thyroiditis?
- Symptoms: ASA/NSAIDs
- If systemic: Prednisone
- Monitor thyroid Fxn: q2-4 wks. (TSH/T4)
- Hypothyroid phase: Levothyroxine
What are the tx for painful infectious (Suppurative) thyroiditis?
- Antibx: determined by C&S
- Poss. Surgery: drain abscess
Painless Thyroiditis (Silent or Postpartum Thyroiditis) occurs in what type of pts?
Underlying autoimmune pts
Painless Thyroiditis (Silent or Postpartum Thyroiditis) has the same sxs as subacute except for what?
Little or No Thyroid Tenderness
When is Painless Thyroiditis coined Postpartum Thyroiditis?
3-6 months postpartum
What is the typical course of Painless Thyroiditis (Silent or Postpartum Thyroiditis)?
- Brief thyrotoxicosis (2-4wks)
- Then hypothyroidism (4-12 wks)
- Usually, only one phase is apparent
What are the dx test for Painless Thyroiditis (Silent or Postpartum Thyroiditis)?
- TPOAb: + Antepartum
- RAIU: Suppressed
- ESR: Normal (this helps to differentiate b/w Subacute Thyroiditis)
What are the tx for Painless Thyroiditis (Silent or Postpartum Thyroiditis)?
- Severe Thyrotoxic Sxs: Short course of propranolol 20-40mg TID-QID
- During hypothyroid phase: Thyroxine then w/d after 6-9 mos
When should a pt f/u if they have Painless Thyroiditis (Silent or Postpartum Thyroiditis)?
- Annual F/U, d/t potential for permanent Hypothyroidism
- Can recur with other pregnancies
What is the MC hypothyroid disease in the US?
Hashimotos Disease
Hashimotos disease is the MC in what population, approx age, and gender?
- MC in Japanese population
- Dx ~ 60yo
- Women > Men
What likely represents end stage Hashimoto’s Thyroiditis (rather than a distinct disorder)?
Atrophic Thyroiditis
What are the clinical features of Hashimotos Disease?
- Initially Hyperthyroidism Occurs then Signs of Hypothyroidism
- Goiter: irregular and firm
What are the dx studies for Hashimotos Disease?
↑TSH
↓TH (T4)
What are the tx for Hashimotos Disease?
Same as hypothyroidism
- Levothyroxine (dose adjust for CAD and elderly)
