Endocrine #4 (Thyroiditis and Thyroid Cancer) Flashcards
(42 cards)
Hashimoto’s Thyroiditis AKA _________, is the MCC of hypothyroidism in the US.
Explain the pathophysiology of this
-Chronic Lymphocytic Thyroiditis
-Autoimmune thyroid cell destruction by anti-thyroid peroxidase and anti-thyroglobulin antibodies
How do you differentiate Hashimoto’s Thyroiditis from other thyroiditis diseases?
The patients with this condition usually have what symptoms?
It is usually paired with another autoimmune disease (Sjogren’s, MG, Celiac, Addison’s)
Symptoms of hypothyroidism. Enlarged, nontender thyroid/goiter, neck/throat tightness.
What is the treatment for Hashimoto’s Thyroiditis?
Levothyroxine (synthetic T4)
-Synthroid
Subacute Thyroiditis AKA (Granulomatous, Dequervain, Giant Cell) Thyroiditis, is thought to be caused by a _______.
What is it associated with (gene defect)
Antecedant viral respiratory tract infection or post-viral inflammation
HLA-B35
What is the presentation of a patient with subacute thyroiditis (not symptoms, just what do the diagnostics show?)
-Hyperthyroidism followed by euthyroidism, then hypothyroidism, then restoration of normal thyroid function
-It changes as time goes by
Symptoms of subacute thyroiditis
-Painful thyroid gland worse with head movements and swallowing
-Acute pain that radiates to the jaw and ear
-Low grade fever, myalgias, fatigue, malaise
-Diffusely tender goiter!
What do labs show for subacute thyroiditis (think about what should be negative, and what an infection does)
-High ESR + negative thyroid antibodies
-Hyperthyroid early in disease (decreased TSH + increased T4)
On radioactive uptake scan for subacute thyroiditis, what is expected?
Diffuse, decreased iodine uptake (much like Hashimoto’s and Postpartum Thyroiditis)
On biopsy for subacute thyroiditis, what is seen?
Granulomatous inflammation with multinucleated giant cells
Treatment for subacute thyroditis
-Supportive: reassurance because 95% return to euthyroid state
-NSAIDs, Aspirin for pain
-Prednisone if needed for severe pain
Postpartum thyroiditis occurs in 4-7% of women in what time frame after delivery?
Often, this condition is ______
In the first six months after delivery
Painless!
Often postpartum thyroiditis’ cause is due to _________ and what is present on labs that you should remember?
Autoimmune
+ Thyroid antibodies: thyroglobulin antibodies, thyroid peroxidase antibodies (like Hashimoto’s)
Treatment for postpartum thyroidits
-Supportive: Aspirin, NSAIDs
Reidel Thyroiditis, is a rare chronic autoimmune thyroiditis characterized by dense fibrosis that invites the thyroid and adjacent neck structures. What is secreted in this condition?
IgG4-secreting plasma cells
On clinical presentation for Reidel Thyroiditis, what symptoms do you get?
Hypothyroidism Symptoms
-Presents like thyroid malignancy: rock hard, nontender, rapidly growing, fixed goiter
-Compression Symptoms: hoarseness, dysphagia, choking, coughing, increased RR due to airway compression
-NO CERVICAL LAD
What diagnostics are done for Reidel Thyroiditis?
-Increased TSH + decreased T4/T3 (euthyroid or hypothyroid)
-IgG4 serum levels
What diagnostic should you do to distinguish anaplastic thyroid cancer from Reidel Thyroiditis?
Biopsy
What is seen on biopsy for Reidel Thyroiditis?
-Dense fibrosis
Treatment for Reidel Thyroiditis
-Surgical treatment to reduce compression
What is suppurative thyroiditis?
Who does it MC occur in?
-bacterial infection of thyroid gland by Staph Aureus
MC occurs in children, but rare
Symptoms of suppurative thyroiditis
-Thyroid pain and tenderness: sudden neck pain and tenderness. Worse with hyperextension and better with neck flexion
-Overlying erythema of the skin
-Fever, chills, pharyngitis, dysphagia, hoarseness
What diagnostics are done for suppurative thyroiditis?
-Labs: Leukocytosis, increased ESR (due to infection)
-FNA with gram stain and culture
-Thyroid US
Treatment for suppurative thyroiditis
-ABX
-Surgical drainage if fluctuant
The only two causes of a painful thyroid are ______ and _______
Subacute Thyroiditis and Suppurative Thyroiditis
