Thyroiditis

Question 1

Definition

Answer 1

Inflammation of the thyroid gland

Question 2

Types

Answer 2

· Hashimoto’s thyroiditis - an autoimmune condition. The most common cause of hypothyroidism in the UK.

· Other types of thyroiditis:
o de Quervain's thyroiditis
o Postpartum thyroiditis
o Drug-induced thyroiditis
o Acute or infectious thyroiditis
o Riedel's thyroiditis

Question 3

Pathogenesis

Answer 3

o Aggressive destruction of thyroid cells by the immune system

o Environmental triggers have been hypothesised (e.g. smoking, infection)

Question 4

Epidemiology

Answer 4

· True incidence is UNKNOWN

· 15-20 x more common in WOMEN

· Usually occurs in 30-50 yrs

Question 5

Presenting symptoms (hypothyroidism)

Answer 5

· Symptoms of hypothyroidism

o Fatigue
o Constipation
o Dry skin
o Weight gain
o Cold intolerance
o Menstrual irregularities
o Depression
o Hair loss

Question 6

Presenting symptoms (enlargement of the thyroid gland)

Answer 6

· Symptoms caused by rapid enlargement of the thyroid gland

o Dyspnoea
o Dysphagia
o Tenderness

Question 7

Investigations

Answer 7

· Based on clinical observations

· Histology: diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles

· TSH - raised

· Antibodies:
o Anti-TPO antibodies
o Anti-thyroglobulin antibodies

· Thyroid ultrasound

· Radionuclide isotope scanning

Question 8

Management plan

Answer 8

· Pharmacological
o Thyroid hormone replacement - oral levothyroxine sodium
o Titrate dose based on patient’s needs

· Surgical
o Considered if there is a large goitre that is causing symptoms due to compression of surrounding structures or if there is a malignant nodule

Question 9

Possible complications

Answer 9

· Thyroid hormone over-replacement –> bone loss + tachycardia

· Hyperlipidaemia

· Hashimoto’s encephalopathy

· Myxoedema coma

Question 10

Prognosis

Answer 10

· GOOD PROGNOSIS with early diagnosis and levothyroxine replacement