(!) Thyroiditis

Question 1

Define thyroiditis

Answer 1

several disease included-but part of the spectrum of autoimmune thyroid diseases
characterised by transient Hyperthyroidism followed by permanent hypothyroidism or recovery

destructive-Dequervains//Subacute granulomatous thyroiditis-viral origin/cause
Can also be radio induced, amiodarone induced

Painless lymphocytic thyroditis

Question 2

Aetiology and risk factors of thyroditis

Answer 2

painless thyroiditis has unclear aetiology but same HLADR3/5 risks as hashimotos etc
De quervains seems to have a causative viral infection-often upper respiratory infection-adeno, mumps
Destructive-damage to thyroid causes release of preformed T3/4-hyper, then damage causes hypo
Painless-lymphoid infiltrates cause damage and relaase

Risk factors:
Destructive-radiotherapy, amiodarone
2x more likely in women

Question 3

Epidiemology of thyroditis

Answer 3

Unclear for painless, but might be very common according to some studies

subacute-3 in 100000

Question 4

Signs and Sx of Thyroiditis

Answer 4

Both have a smooth goitre due to TPO AB
Subacute granulomatous thyroiditis–present with viral Sx (fever, myalgia, malaise, sore throat)
and Sx of hyperthyroidism
neck pain and thyroid gland pain-radiate to jaw/ears
often over 2-3 weeks, fluctuate for up to 6
often followed by hypothyroidism

90% go back to euthyroid after

painless-often post natal
2-3 months of hyperthyroid symptoms
often followed by hypothyroidism
most go back to euthyroid after
NO thyroid pain, no Sx of viral

Question 5

Investigations of thyroiditis

Answer 5

Initial phase-
TSH surpassed, T3/4 high

After-often when present-TSH high, T3/4 down

TPO antibodies-frequently positive

4/6/24h radioiodine uptake–low uptake

De quervains-ESR and CRP raised

Question 6

Management of thyroiditis

Answer 6

Subacute granulomatous thyroiditis--
focus of Sx management and pain relief
NSAIDS
Steroid if unresponsive
B-blockers are great to reduce Sx-propanolol
Calcium channel blockers too-verapramil

Hypothyroid-give mild levothyroxine

painless-
If not CVD-nothing
with CVD-B blocker or CCb-propanolol or verapamil

levothyroxine if needed after

Question 7

Complications of thyroiditis

Answer 7

thyroid storms are a complication that can’t be ignored-safeguard

can also lead to Atrial Fibrillation/arrythmias

Exarcebate CVD

Long term hypothyroidism-not common but can happen after thyroditis

Question 8

Prognosis of thyroiditis

Answer 8

90% tend to resolve over time and barely need treatment
a few stay chronically low
and some keep the goitre

Painless post natal-can be recurrent
De quervains is very unlikely to recur