Thyroiditis

Question 1

define thyroiditis?

Answer 1

inflammation of thyroid gland

1) Increased thryoid hormone synthesis: Hyperthyroidism
2) increased release of stored thyroid hormones: thyroiditis-> hypothyroidism

Question 2

what is a typical presentation of riedel’s thyroiditis?

Answer 2

iron hard/ woody /craggy painless lump

no lymphadenopathy-> Associated with psc

Question 3

what is Hashinmoto’s thyroiditis?

Answer 3

an autoimmune condition. The most common cause of hypothyroidism in the UK.

Question 4

what are the different types of thyroiditis?

Answer 4

Hashimoto’s thyroiditis - an autoimmune condition

Other types of thyroiditis:

de Quervain’s thyroiditis

Postpartum thyroiditis

Drug-induced thyroiditis

Acute or infectious thyroiditis

Riedel’sthyroiditis

Question 5

what is De Quervain’s Thyroiditis

Answer 5

• Post-viral infection
• Transient hyperthyroidism-> hypo -> euthyroid
• Painful goitre, fever,↑ESR

Question 6

what is riedels thyroiditis?

Answer 6

dense fibrosis that replaces normal thyroid parenchyma – thyroid becomes very hard and may be described as being woody

pts will usually be euthyroid however some may become hypothyroid- this may extend beyond the gland, causing dysphagia and tracheal compression. The diagnosis is confirmed histologically following biopsy

Question 7

outline the pathogenesis of Hashimoto’s thyroiditis?

Answer 7

agressive destruction of thyroid cells by immune system

environmental triggers-> smoking, infection

Question 8

summarise the epidemiology of thyroiditis?

Answer 8

True incidence is UNKNOWN

15-20 x more common in WOMEN

Usually occurs in 30-50 yrs

Question 9

what are the presenting symptoms of thyroiditis?

Answer 9

Symptoms of hypothyroidism

• Fatigue
• Constipation
• Dry skin
• Weight gain
• Cold intolerance
• Menstrual irregularities
• Depression
• Hair loss

Symptoms caused by rapid enlargement of the thyroid gland

• Dyspnoea
• Dysphagia
• Tenderness

Question 10

what are the appropriate investigations for thyroiditis?

Answer 10

TSH- raised

antibodies for Hashinmoto’s

• Anti-TPO antibodies
• Anti-thyroglobulin antibodies
• AMA

Thyroid ultrasound

Radionucleotide isotope scanning ( usually low)

Histology: diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles

Question 11

outline a management plan for thyroiditis?

Answer 11

Thyroid hormone replacement -oral levothyroxine sodium

Titrate dose based on patient’s needs

Surgical

• Considered if large goitre that is causing symptoms-> compression of surrounding structures or if there is a malignant nodule
• Pts with goitre who are euthyroid but have compressive symptoms may need subtotal thyroidectomy
• Thyroid carcinomas would have a total thyroidectomy

Question 12

what are the possible complications of thyroiditis?

Answer 12

• Thyroid hormone over-replacement –> bone loss + tachycardia
• Hyperlipidaemia
• Hashimoto’s encephalopathy
• Myxoedema coma

Question 13

summarise the prognosis of patients with thyroiditis?

Answer 13

GOOD PROGNOSIS with early diagnosis and levothyroxine replacement