Thyroiditis

Question 1

Define

Answer 1

inflammation of the thyroid gland.

Question 2

Causes

Answer 2

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

Other types of thyroiditis:

• de Quervain’s thyroiditis
• Postpartum thyroiditis
• Drug-induced thyroiditis
• Acute or infectious thyroiditis
• Riedel’s thyroiditis

Pathogenesis of Hashimoto’s thyroiditis

• Aggressive destruction of thyroid cells by the immune system
• Environmental triggers have been hypothesised (e.g. smoking, infection)

Question 3

Epidemiology

Answer 3

True incidence is UNKNOWN

15-20 x more common in WOMEN

Usually occurs in 30-50 yrs

Question 4

Symptoms

Answer 4

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

Question 5

Investigations

Answer 5

Based on clinical observations

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

TSH - raised

Antibodies:

• Anti-TPO antibodies
• Anti-thyroglobulin antibodies

Thyroid ultrasound

Radionuclide isotope scanning

Question 6

Management

Answer 6

Pharmacological

• Thyroid hormone replacement - oral levothyroxine sodium
• Titrate dose based on patient’s needs

Surgical

• 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 7

Complications

Answer 7

Thyroid hormone over-replacement –> bone loss + tachycardia

Hyperlipidaemia

Hashimoto’s encephalopathy

Myxoedema coma

Question 8

Prognosis

Answer 8

GOOD PROGNOSIS with early diagnosis and levothyroxine replacement