Condition- Thyroiditis

Question 1

What is thyroiditis?

Answer 1

Inflammation of the Thyroid Gland

Question 2

What is the most common cause of Thyroiditis?

Answer 2

HASHIMOTO’S THYROIDITIS - an autoimmune condition and is the most common cause of hypothyroidism in the UK

Question 3

List some of the causes of thyroiditis…

Answer 3

• Hashimoto’s Thyroiditis- autoimmune lymphocytic infiltration of the thyroid
• De Quervain’s thyroiditis (viral thyroiditis): painful dysphagia, pyrexia. Virus attacks the thyroid gland – patient first presents with hyperthyroidism as stored thyroid hormone is released, then patient becomes hypothyroid. Once virus clears, patient becomes euthyroid.
• Postpartum thyroiditis
• Drug-induced thyroiditis- lithium, amiodarone, iodine
• Acute or infectious thyroiditis
• Riedel’s thyroiditis- chronic inflammatory disease of thyroid (causes thyroid fibrosis)

Question 4

List some of the common causitive viruses of thyroiditis

Answer 4

• Common URTIs
• influenza
• adenovirus
• mumps
• coxsackie
• echo
• H1N1

Question 5

List some of the presenting symptoms of thyroiditis…

Answer 5

• If Viral thyroiditis: thyrotoxicosis –> hypothyroid –> euthyroid
  
  • neckpain + painful swallow
  • symptoms of viral infection: fever, myalgia, malaise
  • • symptoms of thyrotoxicosis: palpitations, tremor, heat intolerance
  • Tender, firm, enlarged goitre
• If Hashimoto’s
  
  • Symptoms of hypothyroid: dry skin, fatigue, depression, weight gain, constipation, oligomenorrhoea
  • Small, non-tender goitre

Question 6

List some investigations you could peform on someone with thyroiditis

Answer 6

• BLOODS: elevated TSH, anti-TPO and anti- TG antibodies, elevated ESR/CRP
• IMAGING:
  
  • Thyroid ultrasound
  • Radionuclide isotope scanning – in viral thyroiditis, there will be no uptake as stored thyroxine is released
  • Histology:
    
    • Hashimoto’s: diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles
    • Viral: Multi-nucleated giant cells, degenerated follicular epithelium cells, granulomas

Question 7

How would you manage a patient with thyroiditis?

Answer 7

1. PHARMACOLOGICAL
   
   • Thyrotoxic: Beta-blockers (+hydrocortisone)
   • Hypothyroid: Thyroid hormone replacement - oral levothyroxine sodium
2. SURGICAL: If symptomatic large goitre compressing surrounding structures/ malignant nodule
   
   • Hashimoto’s: Radioactive/ Surgical ablation if recurrent thyroiditis

Question 8

List some of the potential complications of thyroiditis…

Answer 8

• Thyroid storm
• AF from thyrotoxicosis
• Exacerbation of IHD/ CHF
• Long-term hypothyroidism
• Myxoedema Coma

Question 9

Describe what you would see on a radioisotope scan of someone with:

• Grave’s disease
• De Quervain’s thyroiditis
• Toxic Multinodular Goitre
• Adenoma

Answer 9

• Grave’s disease- diffuse increased uptake
• De Quervain’s thyroiditis- NO uptake
• Toxic Multinodular Goitre- multiple areas of increased uptake
• Adenoma- single area of increased uptake

Question 10

How is DeQuervain’s thyroiditis managed?

Answer 10

Usually self-limiting

If pain- advise to take NSAIDs