Thyroiditis Flashcards
define thyroiditis?
inflammation of thyroid gland
1) Increased thryoid hormone synthesis: Hyperthyroidism
2) increased release of stored thyroid hormones: thyroiditis-> hypothyroidism
what is a typical presentation of riedel’s thyroiditis?
iron hard/ woody /craggy painless lump
no lymphadenopathy-> Associated with psc
what is Hashinmoto’s thyroiditis?
an autoimmune condition. The most common cause of hypothyroidism in the UK.
what are the different types of thyroiditis?
Hashimoto’s thyroiditis - an autoimmune condition
Other types of thyroiditis:
de Quervain’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis
Acute or infectious thyroiditis
Riedel’sthyroiditis
what is De Quervain’s Thyroiditis
- Post-viral infection
- Transient hyperthyroidism-> hypo -> euthyroid
- Painful goitre, fever,↑ESR
what is riedels thyroiditis?
dense fibrosis that replaces normal thyroid parenchyma – thyroid becomes very hard and may be described as being woody
pts will usually be euthyroid however some may become hypothyroid- this may extend beyond the gland, causing dysphagia and tracheal compression. The diagnosis is confirmed histologically following biopsy
outline the pathogenesis of Hashimoto’s thyroiditis?
agressive destruction of thyroid cells by immune system
environmental triggers-> smoking, infection
summarise the epidemiology of thyroiditis?
True incidence is UNKNOWN
15-20 x more common in WOMEN
Usually occurs in 30-50 yrs
what are the presenting symptoms of thyroiditis?
Symptoms of hypothyroidism
- Fatigue
- Constipation
- Dry skin
- Weight gain
- Cold intolerance
- Menstrual irregularities
- Depression
- Hair loss
Symptoms caused by rapid enlargement of the thyroid gland
- Dyspnoea
- Dysphagia
- Tenderness
what are the appropriate investigations for thyroiditis?
TSH- raised
antibodies for Hashinmoto’s
- Anti-TPO antibodies
- Anti-thyroglobulin antibodies
- AMA
Thyroid ultrasound
Radionucleotide isotope scanning ( usually low)
Histology: diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles
outline a management plan for thyroiditis?
Thyroid hormone replacement -oral levothyroxine sodium
Titrate dose based on patient’s needs
Surgical
- Considered if large goitre that is causing symptoms-> compression of surrounding structures or if there is a malignant nodule
- Pts with goitre who are euthyroid but have compressive symptoms may need subtotal thyroidectomy
- Thyroid carcinomas would have a total thyroidectomy
what are the possible complications of thyroiditis?
- Thyroid hormone over-replacement –> bone loss + tachycardia
- Hyperlipidaemia
- Hashimoto’s encephalopathy
- Myxoedema coma
summarise the prognosis of patients with thyroiditis?
GOOD PROGNOSIS with early diagnosis and levothyroxine replacement
