Thyroiditis

Question 1

Define Thyroiditis

Answer 1

inflammation of the thyroid

Question 2

What is Hashimoto’s thyroiditis?

Answer 2

AI condition involving aggressive destruction of thyroid cells by the immune system

Question 3

List 5 other types of thyroiditis

Answer 3

de Quervain’s: viral- hyper then hypo
Postpartum: 6 months post, hyper then hypo
Drug-induced: amiodarone, lithium, interferons- either
Acute or infectious: bacterial- either
Riedel’s: AI, woody painless lump, no lymphadenopathy, associated with PSC

Question 4

What 5 environmental triggers are associated with Hashimoto’s thyroiditis?

Answer 4

Smoking
Iodine
Infection
Medication 
Diet

Question 5

Give 2 facts on the epidemiology of Hashimoto’s thyroiditis

Answer 5

15-20X more common in F

Usually 30-50 yrs

Question 6

List 10 symptoms of Hashimoto’s thyroiditis

Answer 6

Fatigue  
Cold intolerance 
Decreased sweating
Peripheral neuropathy 
Depression  
Constipation  
Weight gain  
Menstrual irregularities 
Dry skin  
Hair loss

Question 7

List 3 symptoms caused by rapid enlargement of the thyroid gland in thyroiditis

Answer 7

Dyspnoea
Dysphagia
Tenderness

Question 8

What may eventually occur to the thyroid in thyroiditis?

Answer 8

Thyroid atrophy + myxoedmea

Question 9

What is seen in histology in thyroiditis?

Answer 9

diffuse lymphocytic + plasma cell infiltration with formation of lymphoid follicles

Question 10

What do TFTs show in thyroiditis?

Answer 10

Raised TSH

Question 11

What antibodies may be present in Hashimoto’s thyroiditis?

Answer 11

Anti-TPO antibodies

Anti-thyroglobulin antibodies

Question 12

How may ultrasound imaging be useful in a patient with thyroiditis?

Answer 12

To assess thyroid size, echotexture + presence of thyroid nodules.
Not necessary in diagnosing Hashimoto’s thyroiditis

Question 13

Why are radioactive iodine uptake and scans used in thyroiditis?

Answer 13

to classify a nodule as hot or cold.

Cold = higher risk for malignancy + needs FNA biopsy.

Question 14

Describe the pharmacological management of a patient with hashimotos thyroiditis

Answer 14

Thyroid hormone replacement: oral levothyroxine sodium

Titrate dose based on patient’s needs

Question 15

In which 2 situations is surgical management required in a patient with hashimotos thyroiditis?

Answer 15

If a large goitre that’s causing symptoms due to compression of surrounding structures
If there is a malignant nodule

Question 16

List 4 complications of hashimotos thyroiditis

Answer 16

Over-replacement with thyroxine, causing accelerated bone loss or increased HR
Hyperlipidaemia
Hashimoto’s encephalopathy
Myxoedema coma (due to extreme hypothyroidism)

Question 17

What is the prognosis for hashimotos thyroiditis?

Answer 17

GOOD PROGNOSIS with early diagnosis + levothyroxine replacement