Thyroiditis

Thyroiditis

Thyroiditis is inflammation of the thyroid gland.

Acute (Suppurative) Thyroiditis

Acute thyroiditis is a rare bacterial infection (abscess) of thyroid tissue seen in immunocompromised patients. It can be caused by a persistent pyriform sinus fistula or trauma. The most common causes are Staphylococcus aureus and Streptococcus.

• Risk factors
  • immunosuppression
• Signs and symptoms
  • Pain and tenderness: anterior neck pain radiating to the jaw and ears
  • Erythema over the thyroid gland
  • Fever
• investigations
  • TFTs: normal
  • CBC: Leukocytosis
  • CT-scan neck: best diagnostic step
  • Needle aspiration and culture of the suppuration
  • HIV test
• Treatment
  • Incision and Drainage of the abscess
  • Broad-spectrum antibiotics (piperacillin/tazobactam + vancomycin)

Subacute (de Quervain) Thyroiditis

Subacute thyroiditis is inflammation of the thyroid gland occurring as a post-viral inflammatory response. It is associated with viral infections (coxsackievirus, mumps, measles, adenovirus, infectious mononucleosis). It is the most common cause of a painful thyroid gland. Another painless subtype exists as an autoimmune-driven phenomenon in post-partum women.

• Signs and symptoms
  • Enlarged, painful thyroid gland that is firm
  • Hyperthyroid symptoms
• Stages of subacute thyroditis
  • Hyperthyroidism → euthyroidism → transient hypothyroidism → resolution of symptoms
• Treatment
  • Pain management (NSAIDs)
  • Treatment of hyper- and hypothyroidism
  • Steroids (if there is severe swelling)

Reidel’s Thyroidisits

Reidel’s thyroiditis is an idiopathic, rare condition where the thyroid becomes densely fibrotic. Commonly associated with hypothyrodism. Possibly autoimmune in etiology. Patient usually present with compressive symptoms and hypothyroidism.

• Patient history
  • Middle-aged woman presenting with a rock hard thyroid on exam
• Signs and symptoms
  • Hypothyroidism
  • Symptoms related to compression: dyspnoea, dysphagia, tightness, neck pressure, hoarseness, cough
• Physical exam
  • Firm, non-tender thyroid
• Investigations
  • Biopsy: to exclude carcinoma
• Medical treatment
  • Prednisone
  • Levothyroxine for hypothyroidism
• Surgical treatment
  • Considered for compressive symptoms

Hashimoto’s Thyroiditis (Chronic Lymphocytic Thyroiditis)

Hashimoto’s thyroiditis is an autoimmune inflammation of the thyroid gland caused

• Associations
  • Increased risk of thyroid lymphoma and thyroid cancer
• Signs and symptoms
  • Hyperthyroid symptoms (rare – Hashitoxicosis) → Hypothyroid symptoms
  • Painless goiter
• Physical examination
  • Small firm thyroid → enlarged goiter
  • Hypothyroidism
• Investigations
  • Thyroid funciton tests
    • Increased TSH
    • Increased T3 or T4
  • Anti-TPO antibodies: present (90-100%). As well as other antibodies for the thyroid.
  • Anti-Tg antibodies
  • Thyroid biopsy
• Treatment
  • Daily levothyroxine
  • Surgery for goiter with compressive symptoms