Thyroiditis Flashcards

1
Q

Define thyroiditis and its 2 main types

A

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

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2
Q

Aetiology of DeQuervain’s thyroiditis

A

Viral e.g. influenza, adenovirus, mumps, coxsackie, H1N1
Tends to occur after an URTI
HLA-Bw35
Familial cases (HDL-B35)

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3
Q

Aetiology of Hashimoto’s thyroiditis

A

Autoimmune of the thyroid gland with antibodies against thyroperoxidase (TPO), leaving the gland unable to produce T4/T3

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4
Q

Symptoms of Thyroiditis

A

DeQuervain’s:

  1. Thyrotoxicosis with viral prodrome (viral like illness, neck pain, fever, myalgia, malaise, pharyngitis)
  2. Hypothyroidism
  3. 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
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5
Q

What is a myxoedema coma

A

Complication of hypothyroidism

Hypothermia
Hypoventilation
Hyponatraemia
HF
Confusion
Coma
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6
Q

Signs of Hypothyroidism

A

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

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7
Q

Investigations for DeQuervain’s thyroiditis

A

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

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8
Q

Investigations for Hashimoto’s Thyroiditis

A

TFTs: TSH raised
Anti-thyroid peroxidase (TPO) antibodies: positive
Anti-Throglobulin (Tg) antibodies: postiive

FBC: mild, normocytic anaemia
U+Es: Hyponatraemia (myxoedema coma)

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9
Q

Management for DeQuervain’s thyroiditis

A

Hyperthyroid

  1. Supportive care
  2. Thyroid pain and tenderness -> analgesia/corticosteroid
  3. Tachycardia/anxiety/tremor -> beta-blocker
  4. Severe thyrotoxicosis -> potassium iodide + prednisolone

Hypothyroid
Mild (TSH<10-15): observe + re-assessment. Interference with ADLs -? levothyroxine
Moderate (TSH>15): levothyroxine PO

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10
Q

Complications of Thyroiditis

A

DeQuervain’s
Thyroid storm
Long-term hypothyroidism

Hashimoto’s:
MALT lymphoma
Myxoedema coma
Hypothyroidism

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11
Q

Prognosis for Thyroiditis

A

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

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