thyroiditis

Thyroiditis: description

Thyroiditis (thyroiditis) is relatively rare. It accounts for only one to three percent of all thyroid disorders.

Different clinical pictures

In most cases, thyroiditis develops as part of an autoimmune disease. There are many other reasons why the thyroid can be inflamed. These include bacteria, injuries, certain medications and radiation therapy. Apart from the one thing in common – an inflammation of the thyroid tissue – are very different and distinct diseases. After their course, they can be divided into three groups:

• Acute thyroiditis: purulent thyroiditis (by bacteria), non-lateral thyroiditis (after injury, radiotherapy or radioiodine therapy)
• Subacute thyroiditis: Thyroiditis de Quervain (by viruses), Silent thyroiditis
• Chronic thyroiditis: Hashimoto’s thyroiditis, Graves’ disease, postpartum thyroiditis, drug-related thyroiditis etc.

Hashimoto’s thyroiditis

In Hashimoto’s thyroiditis, the body’s immune system attacks the gland. Read more in the article Hashimoto’s Thyroiditis.

Graves’ disease

Also in Graves’ disease, the immune system is the trigger of inflammatory processes of the thyroid gland. More about this under Graves’ disease.

Thyroiditis: symptoms

The symptoms appear depend on the type of thyroiditis:

Acute thyroiditis: symptoms

Acute forms of thyroiditis (purulent thyroiditis, non-lateral thyroiditis) cause severe pain, bulging swelling, redness and overheating (hyperthermia) in the thyroid gland. In addition, the lymph nodes are swollen, and patients suffer from dysphagia and high fever.

Subacute thyroiditis: symptoms

Subacute thyroiditis, unlike acute thyroiditis, begins insidiously. In the Thyroiditis de Quervain There is pain in the area of ​​the thyroid, which can radiate into the jaw, the ears, the whole head or the chest area. Patients feel tired and weakened, have trouble swallowing and often have headaches, muscle aches and fever.

Subacute thyroiditis can be almost symptom-free. Doctors then speak of a silent or Silent thyroiditis, In this case, the inflammation of the thyroid gland can cause an overfunction of the organ (hyperthyroidism), which leads to symptoms such as loss of appetite, weight loss, nervousness, restlessness, constant warmth and lack of concentration.

Chronic thyroiditis: symptoms

The Post-partum thyroiditis, ie a thyroid inflammation occurring in the puerperium, initially triggers a slight hyperfunction of the thyroid gland with usually mild symptoms such as inner agitation, palpitations and fatigue. She goes into a subfunction after about six to eight months. Sometimes, at the beginning of postpartum thyroiditis, hypofunction also occurs, and only then does it become hyperfunctioning.

A drug-induced thyroiditis as a result of interferon therapy, in two-thirds of all cases there is an underactive thyroid (hypothyroidism); One third of patients develop hyperfunction (hyperthyroidism). Occasionally the overfunction is replaced by a subfunction. The severity of possible symptoms depends on the extent of the dysfunction: Hypothyroidism can cause tiredness, listlessness, weight gain, dry skin and depressed mood. On the other hand, hyperfunction may cause symptoms such as inner agitation, palpitations, hypersensitivity to heat, sleep disorders, and weight loss.

Also, the drug drug amiodarone can cause thyroiditis. If properly predisposed, amiodarone may initiate the disease development of both Graves’ disease and Hashimoto’s thyroiditis. In addition, the prolonged use of amiodarone may cause mild hyperthyroidism, which usually causes no discomfort. The overfunction can later turn into a subfunction.

Thyroiditis: causes and risk factors

Depending on the cause and course differentiate doctors different forms of thyroiditis. Well-known examples are:

Acute Bacterial Thyroiditis (Purulent Thyroiditis)

This purulent thyroiditis is caused by bacteria, which have mostly reached the thyroid via the bloodstream. Often they come from a bacterial infection in the neck, nose or ear area. Acute thyroiditis is very rare.

Thyroiditis after radioiodine, radiotherapy or trauma (non-lateral thyroiditis)

When tumors in the cervical region (such as lymphomas) are treated by radiation therapy, the neighboring thyroid gland can also receive the radiation. In about one percent of cases develops in the episode of thyroiditis. Also a high-dose radioiodine therapy – a nuclear medicine therapy method for various thyroid diseases – as well as trauma can lead to an inflammation of the thyroid gland. In all cases it is an acute thyroiditis, but without pus formation (in contrast to acute bacterial thyroiditis).

Subacute thyroiditis de Quervain

This virus-induced form of thyroid inflammation often develops two to three weeks after an upper respiratory infection. The term “subacute” means that the disease begins more slowly and progresses than the acute thyroiditis. In women, sub-acute thyroiditis de Quervain is three to six times more likely to be affected than in men; Children rarely get sick of it. Incidentally, the namesake is the Swiss surgeon Fritz de Quervain. He first described this form of thyroiditis in 1904.

Hashimoto’s Thyreoidits

Hashimoto’s thyroiditis is the most common form of autoimmune thyroiditis. The body forms antibodies against its own thyroid gland for unknown reasons, which causes a chronic inflammation of the thyroid gland.

Post-partum thyroiditis (postpartum thyroiditis)

This form of thyroiditis develops in women six to 24 weeks after delivery. Affected are about four percent of new mothers. Experts suspect that postpartum thyroiditis is an abnormal variant of autoimmune thyroiditis: During pregnancy, immune processes – and thus autoimmune processes – are suppressed. In the weeks after birth, the immune system recovers and can even become overactive. This overactive thyroid gland may become hypersensitive after six to nine months and then heal or persist.

Drug-related thyroiditis

Certain medications can cause autoimmune thyroiditis with over- or under-functioning. These include interferon (in hepatitis C) and amiodarone (in cardiac arrhythmia).

Thyroiditis: examinations and diagnosis

To clarify a thyroid inflammation, the doctor will first conduct a detailed conversation with the patient to raise the medical history (anamnesis). An important point here is about emerging symptoms. They can provide the doctor with valuable information on the type of thyroiditis. Even information from the past, such as a possible strep throat, radiotherapy, drug therapy or injury can be enlightening.

This is followed by a physical examination and the taking of a blood sample. The latter can quickly confirm the suspicion of inflammation of the thyroid – namely, when inflammation levels (C-reactive protein, erythrocyte sedimentation rate) are increased. The amount of white blood cells is also determined: it is elevated in acute thyroiditis, but not in subacute thyroiditis. Also measured are thyroid hormone levels.

An important imaging technique for suspected thyroiditis is ultrasound (sonography). When the thyroid gland is inflamed, it appears dark on ultrasound and has a loose structure (a healthy thyroid appears more uniform). In Hashimoto’s thyroiditis, the thyroid gland is smaller than normal.

For a more detailed examination, the doctor uses fine needle biopsy to take a tissue sample from the thyroid gland. In a subacute thyroiditis of Quervain, for example, the typical Langhans giant cells can be detected under the microscope.

If necessary, further investigations are carried out, for example an antibody determination in case of suspected autoimmune thyroiditis (such as Hashimoto’s thyroiditis).

Thyroiditis: treatment

A Acute purulent (bacterial) thyroiditis is treated with antibiotics. Cooling pads (for example, an ice tie) relieve the pain. Also analgesic and anti-inflammatory drugs such as acetylsalicylic acid or diclofenac. If an abscess has formed in the thyroid gland as a result of the inflammation, the pus contained must be removed by puncture or surgery.

At a acute non-sided thyroiditis (For example, after radiotherapy) patients receive anti-inflammatory agents.

A subacute thyroiditis de Quervain usually heals spontaneously. There may be anti-inflammatory drugs (such as acetylsalicylic acid) and, in severe cases, additional cortisone (such as prednisolone).

Has a postpartum thyroiditis led to hypothyroidism, thyroid hormones are used. In case of a temporary overfunction betablocker can be given.

At a drug-induced thyroiditis the therapy depends on the dysfunction occurring: Underactive thyroid hormones are given. Depending on the severity, hyperfunction is treated with a low-iodine diet, surgical removal of the thyroid or radioiodine therapy. If amiodarone causes thyroiditis, the drug will be discontinued if possible.

Thyroiditis: disease course and prognosis

Acute thyroiditis heals completely when properly treated. However, if the inflammation has severely damaged the thyroid tissue, there may be temporary or permanent hypothyroidism.

A subacute thyroiditis de Quervain spontaneously heals in about 80 percent of cases, within three to six months. Very rarely develops a hypothyroidism, which then requires the administration of thyroid hormones.

Silent thyroiditis usually heals spontaneously.

Postpartum thyroiditis usually heals without consequences. In some patients, however, the hypofunction of the thyroid remains and must be compensated with thyroid hormones. After about half a year, the drug can be discontinued on a trial basis. Because in most women, the thyroid function normalizes within a year after birth again. In about ten percent of cases of postpartum thyroiditis, however, a chronic develops thyroiditis, more precisely: a Hashimoto’s thyroiditis.