Thyroiditis Flashcards
Define thyroiditis and its 2 main types
Inflammation of the thyroid gland
DeQuervain’s thyroiditis/ subacute granulomatous thyroiditis: acute viral infection of the thyroid gland
Hashimoto’s thyroiditis: Autoimmune disease of the thyroid gland
Aetiology of DeQuervain’s thyroiditis
Viral e.g. influenza, adenovirus, mumps, coxsackie, H1N1
Tends to occur after an URTI
HLA-Bw35
Familial cases (HDL-B35)
Aetiology of Hashimoto’s thyroiditis
Autoimmune of the thyroid gland with antibodies against thyroperoxidase (TPO), leaving the gland unable to produce T4/T3
Symptoms of Thyroiditis
DeQuervain’s:
- Thyrotoxicosis with viral prodrome (viral like illness, neck pain, fever, myalgia, malaise, pharyngitis)
- Hypothyroidism
- Euthyroidism
Hashimoto’s:
Hypothyroidism
Large, firm swelling of the thyroid
Hypothyroidism: Cold intolerance Weight gain + increased appetite Constipation Bradycardia Hypotensions Deepening voice Depression and tiredness
What is a myxoedema coma
Complication of hypothyroidism
Hypothermia Hypoventilation Hyponatraemia HF Confusion Coma
Signs of Hypothyroidism
DeQuervain’s:
Tender, firm enlarged thyroid gland
Hashimoto’s:
Large, firm swelling of the thyroid gland
Hands: bradycardia, cold
Head/neck/skin: pale and puffy face, goitre, oedema, hair loss, dry skin, vitiligo
Chest: pericardial or pleural effusion
Abdomen: ascites
Neurological: slow relaxation of reflexes, signs of carpal tunnel syndrome
Investigations for DeQuervain’s thyroiditis
TFTs: Initially TSH suppressed/undetectable + T3/4 elevated, later TSH normal/raised
Radioactive iodine uptake: very low uptake, typically 1-3%
ESR + CRP: elevated
Antithyroid antibodies: normal/mildly elevated
Fine needle aspiration (not routine): Multi-nucleated giant cells, with a background of degenerated follicular epithelium cells, rare epithelioid granulomas, and mixed inflammatory cells
Investigations for Hashimoto’s Thyroiditis
TFTs: TSH raised
Anti-thyroid peroxidase (TPO) antibodies: positive
Anti-Throglobulin (Tg) antibodies: postiive
FBC: mild, normocytic anaemia
U+Es: Hyponatraemia (myxoedema coma)
Management for DeQuervain’s thyroiditis
Hyperthyroid
- Supportive care
- Thyroid pain and tenderness -> analgesia/corticosteroid
- Tachycardia/anxiety/tremor -> beta-blocker
- Severe thyrotoxicosis -> potassium iodide + prednisolone
Hypothyroid
Mild (TSH<10-15): observe + re-assessment. Interference with ADLs -? levothyroxine
Moderate (TSH>15): levothyroxine PO
Complications of Thyroiditis
DeQuervain’s
Thyroid storm
Long-term hypothyroidism
Hashimoto’s:
MALT lymphoma
Myxoedema coma
Hypothyroidism
Prognosis for Thyroiditis
DeQuervain’s: complete and spontaneous recovery in >90% of patients, while up to 10% required permanent levothyroxine placement. Low recurrence rate
Hashimoto’s: lifelong therapy required, generally excellent prognosis