Thyroiditis

Inflammation of the thyroid gland occurs as autoimmune thyroiditis (longterm inflammatory disease), postpartum thyroiditis, subacute granulomatous thyroiditis (self-limiting inflammation), Riedel's thyroiditis (rare, invasive fibrotic process), and miscellaneous thyroiditis (acute suppurative, chronic infective, and chronic noninfective). Thyroiditis is more common in women than in men.

Causes

Autoimmune thyroiditis is due to antibodies to thyroid antigens. It may cause inflammation and lymphocytic infiltration (Hashimoto's thyroiditis). Glandular atrophy and Graves' disease are linked to autoimmune thyroiditis.

Postpartum thyroiditis (silent thyroiditis) is another form of autoimmune thyroiditis that occurs in women within 1 year after delivery.

Subacute granulomatous thyroiditis usually follows mumps. influenza, coxsackievirus, or adenovirus infection. Riedel's thyroiditis is a rare condition of unknown etiology.

Miscellaneous thyroiditis results from bacterial invasion of the gland in acute suppurative thyroiditis; tuberculosis, syphilis, actinomycosis, or other infectious agents in the chronic infective form; and sarcoidosis and amyloidosis in chronic noninfective thyroiditis.

Signs and symptoms

Autoimmune thyroiditis is usually asymptomatic and commonly occurs in women, with peak incidence in middle age. It's the most prevalent cause of spontaneous hypothyroidism.

In subacute granulomatous thyroiditis, moderate thyroid enlargement may follow an upper respiratory tract infection or a sore throat. The thyroid may be painful and tender, and dysphagia may occur.

In Riedel's thyroiditis, the gland enlarges slowly as it is replaced by hard, fibrous tissues. This fibrosis may compress the trachea or the esophagus. The thyroid feels firm.

Clinical effects of miscellaneous thyroiditis are characteristic of pyogenic infection: fever, pain, tenderness, and reddened skin over the gland.

Diagnosis

Precise diagnosis depends on the type of thyroiditis:

autoimmune: high titers of thyroglobulin and microsomal antibodies present in serum
subacute granulomatous: elevated erythrocyte sedimentation rate, increased thyroid hormone levels, decreased thyroidal radioactive iodine uptake
chronic infective and noninfective: varied findings, depending on underlying infection or other disease.

Treatment

Appropriate treatment varies with the type of thyroiditis. Drug therapy includes levothyroxine for accompanying hypothyroidism, analgesics and anti-inflammatory drugs for mild subacute granulomatous thyroiditis, propranolol for transient thyrotoxicosis, and steroids for severe episodes of acute inflammation. Suppurative thyroiditis requires antibiotic therapy.

A partial thyroidectomy may be necessary to relieve tracheal or esophageal compression in Riedel's thyroiditis.

Prevention

Flu shots or immunizations for measles , mumps, and rubella may help prevent conditions associated with subacute thyroiditis. There is no known way to prevent other forms of thyroiditis.

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