Thyroiditis1 Flashcards
What is the most common inflammatory condition of the thyroid?
Chronic lymphocytic thyroiditis (Hashimoto thyroiditis), which is also the most common cause of goiter and hypothyroidism in the United States.
What is Hashimoto’s thyroiditis?
It is an autoimmune condition characterized by high titers of circulating antibodies against both thyroid peroxidase and thyroglobulin. It is also referred to asﾠchronic progressive thyroiditis, struma lymphomatosa,ﾠandﾠautoimmune chronic lymphocytic thyroiditis.
Is there any genetic predisposition associated with Hashimoto’s thyroiditis?
Yes, and is inherited as a dominant trait. In addition, it has been linked to many other autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, pernicious anemia, diabetes mellitus, primary biliary cirrhosis, and Sj�gren syndrome.
Is Hashimoto’s thyroiditis associated with any type of malignancy? If yes, which one?
Yes, thyroid lymphoma. These lymphomas, generally the B-cell non-Hodgkin type, tend to occur in women 50 to 80 years of age and are usually limited to the thyroid gland.
What are the classic physical exam findings of Hashimoto’s thyroiditis?
Physical examination generally reveals a firm, irregular, nontender goiter with or without cervical lymphadenopathy. An enlarged pyramidal lobe is often characteristic of Hashimoto thyroiditis.
When you suspect Hashimoto’s thyroiditis, how your confirm this diagnosis?
By documenting elevated antibody titers to thyroid-specific antigens: thyroglobulin, thyroid microsomal antigen, thyroid peroxidase, and thyrotropin receptor.
What is the surgical treatment for Hashimoto’s thyroiditis?
None. It is usually asymptomatic, and the goiter if is small, many patients do not require treatment. When hypothyroidism is present, treatment with levothyroxine (T4) is indicated.
What is the most common cause of paiful thyroid gland?
Subacute Granulomatous (De Quervain) Thyroiditis
What is the cause of Subacute Granulomatous (De Quervain) Thyroiditis?
It is most likely caused by a viral infection and is generally preceded by an upper respiratory tract infection. Numerous etiologic agents have been implicated, including mumps virus, echovirus, coxsackievirus, EpsteinﾖBarr virus, influenza, and adenovirus.
What is the usual clinical presentation and physical exam findings of Subacute Granulomatous (De Quervain) Thyroiditis?
It presents clinically with acute onset of thyroid pain. The pain is described as constant, starting in one lobe and extending bilaterally, and fever is common. Such pain may be exacerbated by turning the head or swallowing and may radiate to the ipsilateral jaw, ear, or occiput. The thyroid is firm, nodular, and exquisitely tender to palpation.
What is the usual course of disease for Subacute Granulomatous (De Quervain) Thyroiditis?
The course of disease follows one of initial destruction of thyroid follicles, corresponding with symptoms of hyperthyroidism such as tachycardia, palpitations, heat intolerance, weight loss, and nervousness. The thyrotoxic phase may last up to several weeks and is followed by a period of euthyroidism. In 20% to 30% of patients, biochemical hypothyroidism may subsequently ensue due to destruction of the gland. Approximately 5% of patients will go on to exhibit persistent hypothyroidism; however, most patients demonstrate complete resolution of the disease with return of normal thyroid function by 4 to 6 months.
What are the classic blood tests results for the diagnosis of Subacute Granulomatous (De Quervain) Thyroiditis?
Elevated ESR, decreased RAIU, and elevated serum thyroglobulin and thyroid hormone levels. A normal ESR essentially rules out the diagnosis of subacute granulomatous thyroiditis, as does a normal thyroglobulin level.ﾠ
What is the management of Subacute Granulomatous (De Quervain) Thyroiditis?
Initial phase - patient may need B-blockers for symptomatic thyrotixicosis. Anti-thyroid drugs not needed because the disorder is caused by the release of preformed thyroid hormone rather than synthesis of new T3 and T4.
Pts with sevre disease may need tapering dose of prednisone (20 to 40 mg per day, given over 2 to 4 weeks), with relief of symptoms generally seen within 24 to 48 hours.
Levothyroxine therapy may be instituted to decrease the duration of disease or to prevent relapse.
What are the two groups of Subacute lymphocytic thyroiditis?
Postpartum thyroiditisﾠandﾠsporadic painless thyroiditis
Which antibody is associated with Subacute lymphocytic thyroiditis?
Circulating antithyroid antibodies have been detected in most patients, with a higher incidence of antimicrosomal antibodies noted in the postpartum form (80%) compared with the sporadic form (50%) of the disease.
