Thyroiditis

Question 1

Thyroiditis

Answer 1

Inflammation of the thyroid

Question 2

Thyroiditis Aetiology

Answer 2

Hashimotos 
De Quervains (subacute) : Viral 
Post-partum 
Drug Induced (amiodarone, lithium) 
Radiation 
Acute Suppurative (bacterial)

Question 3

Subacute Thyroiditis

Answer 3

Female> Male
Ages 25-50
May be triggered by viral infection

Question 4

Subacute Thyroiditis Associations

Answer 4

may be associated with

• neck tenderness
• fever
• typical viral symptom

Usually self-limiting over a few months

Question 5

Amiodarone Effect on Thyroid

Answer 5

TFTs abnormal in up to 50% of patients

• Inhibition of DIO1.
• increased fT4
• Decreased fT3
• normal TSH

Hypothyroidism in 13%

hyperthyroidism in 2%

• Type 1: Similar to Graves
• Type 2: destructive thyroiditis
• Mixed

Question 6

Subclinical Thyroid Disease

Answer 6

Abnormal TSH with normal T3./T4

Question 7

subclinical Hypothyroidism

Answer 7

Increased TSH
Risk of progression to overt hypothyroidism
Higher risk if strongly TPO antibody positive
Treatment advised if TSH>10
Always treat in pregnancy to maintain normal TSH

Question 8

Subclinical Hyperthyroidism

Answer 8

Decreased TSH
Risk of progression to overt hyperthyroidism
Often seen in multi nodular goitre

Associations

• OSteoporosis
• AF

Treatment advised if TSH <0.1
(or if co-existing osteoporosis/ AF)

Question 9

Non-thyroidal illness

Answer 9

Sick Euthyroid Syndrome

Commonly encountered in unwell, hospitalised patients
Refers to impact of recurrent illness on HPT axis

Question 10

Sick Euthyroid Syndrome TSH

Answer 10

TSH typically surpassed initially then rises during recover

Avoid checking TFTs in unwell patients unless clinical suspicion of thyroid disease