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Endocrinology > Thyroiditis > Flashcards

Thyroiditis Flashcards

1
Q

What does the term “Thyroiditis” mean?

A
  • A diverse group of disorders characterized by some form of thyroid inflammation
  • Multifaceted disease
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2
Q

What are 3 common types of thyroiditis?

A
  • Painful
  • Painless
  • Hashimotos
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3
Q

What are the 2 painful types?

A
  • Subacute Thyroiditis (de Quervains)

- Infectious Thyroiditis (Supperative)

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4
Q

What is the painless type?

A

Silent Thyroiditis or Postpartum Thyroiditis

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5
Q

What is the Hashimotos type?

A

Chronic Autoimmune Thyroiditis

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6
Q

What are the 3 phases of Thyroiditis?

A
  • Hyper
  • Hypo
  • Euthyroid
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7
Q

What occurs during the hyper phase?

A
  • Inflammation damages thyroid follicles

- Releases the preformed TH into circulation (thyrotoxic stage)

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8
Q

How long does the hyper phase last?

A
  • This lasts ~ 4-10 wks

- Spontaneous remission begins ~4-8 wks

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9
Q

What occurs during the hypo phase?

A
  • All the preformed TH is exhausted

- New TH has ceased

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10
Q

How long does the hypo phase last?

A
  • This lasts ~ 2 mos

- Usually no TH therapy is needed as it is mild, unless pt has S/Sxs of hypothyroidism

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11
Q

What occurs during the Euthyroid phase?

A
  • As the follicles regenerate, a state of euthyroid is restored
  • Etiology dependent, 90-95% of pts return to normal thyroid fxn
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12
Q

What are the causes of Painful Thyroiditis: Subacute (de Quervains)?

A
  • Postviral: Coxsackie, Mumps, Influenza, Adenovirus

- 30-50yo W>M

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13
Q

What are the clinical presentations of Painful Thyroiditis: Subacute (de Quervains)?

A
  • Onset: acute and severe
  • Sore throat
  • Exquisitely tender, enlarged thyroid (a small goiter)
  • Febrile
  • Signs of: Hyperthyroidism followed by Hypothyroidism
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14
Q

What are the causes of Painful Thyroiditis: Infectious (Suppurative)?

A
  • Staph or Strep

- Esp. in immunocompromised pts or Children (acute/chronic)

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15
Q

What is the clinical presentations of Painful Thyroiditis: Infectious (Suppurative)?

A
  • Onset – sudden, severe neck pain
  • Focal tenderness of involved area (a small asymmetrical goiter)
  • Febrile
  • Dysphagia
  • Erythema of the overlying skin
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16
Q

What are the dx test for painful subacute (de quiervans) thyroiditis?

A
  • Thyroid function x 6 mo.
  • WBC: ↑-left shift
  • ESR: ↑
  • FNA Bx: if in doubt
  • Thyroid Antibodies: Negative (TPOAb-)
17
Q

What are the dx test for painful infectious (Suppurative) thyroiditis?

A
  • Thyroid Function: Normal
  • WBC: ↑-left shift
  • ESR: ↑
  • FNA Biopsy: Polymorphonuclear Leuks.
18
Q

What is the tx for painful subacute (de quiervans) thyroiditis?

A
  • Symptoms: ASA/NSAIDs
  • If systemic: Prednisone
  • Monitor thyroid Fxn: q2-4 wks. (TSH/T4)
  • Hypothyroid phase: Levothyroxine
19
Q

What are the tx for painful infectious (Suppurative) thyroiditis?

A
  • Antibx: determined by C&S

- Poss. Surgery: drain abscess

20
Q

Painless Thyroiditis (Silent or Postpartum Thyroiditis) occurs in what type of pts?

A

Underlying autoimmune pts

21
Q

Painless Thyroiditis (Silent or Postpartum Thyroiditis) has the same sxs as subacute except for what?

A

Little or No Thyroid Tenderness

22
Q

When is Painless Thyroiditis coined Postpartum Thyroiditis?

A

3-6 months postpartum

23
Q

What is the typical course of Painless Thyroiditis (Silent or Postpartum Thyroiditis)?

A
  • Brief thyrotoxicosis (2-4wks)
  • Then hypothyroidism (4-12 wks)
  • Usually, only one phase is apparent
24
Q

What are the dx test for Painless Thyroiditis (Silent or Postpartum Thyroiditis)?

A
  • TPOAb: + Antepartum
  • RAIU: Suppressed
  • ESR: Normal (this helps to differentiate b/w Subacute Thyroiditis)
25
Q

What are the tx for Painless Thyroiditis (Silent or Postpartum Thyroiditis)?

A
  • Severe Thyrotoxic Sxs: Short course of propranolol 20-40mg TID-QID
  • During hypothyroid phase: Thyroxine then w/d after 6-9 mos
26
Q

When should a pt f/u if they have Painless Thyroiditis (Silent or Postpartum Thyroiditis)?

A
  • Annual F/U, d/t potential for permanent Hypothyroidism

- Can recur with other pregnancies

27
Q

What is the MC hypothyroid disease in the US?

A

Hashimotos Disease

28
Q

Hashimotos disease is the MC in what population, approx age, and gender?

A
  • MC in Japanese population
  • Dx ~ 60yo
  • Women > Men
29
Q

What likely represents end stage Hashimoto’s Thyroiditis (rather than a distinct disorder)?

A

Atrophic Thyroiditis

30
Q

What are the clinical features of Hashimotos Disease?

A
  • Initially Hyperthyroidism Occurs then Signs of Hypothyroidism
  • Goiter: irregular and firm
31
Q

What are the dx studies for Hashimotos Disease?

A

↑TSH

↓TH (T4)

32
Q

What are the tx for Hashimotos Disease?

A

Same as hypothyroidism

- Levothyroxine (dose adjust for CAD and elderly)

Endocrinology (18 decks)

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