Beginning >> Diseases >> Endocrine >> Thyroiditis

Endocrinology

Thyroiditis

The thyroiditis is a generalizing name of inflammatory diseases of a thyroid gland.
On an etiology, a pathogeny and a clinical current allocate several types of this disease. After poll, survey of the patient and diagnostic tests doctors classify type of an inflammation and appoint the corresponding treatment.


Histologic classification

Synonyms

Chronic lymphocytic

Chronic lymphocytic thyroiditis, Hashimoto's thyroiditis, autoimmune chronic

Subacute lymphocytic

Subacute lymphocytic thyroiditis: (1) postnatal thyroiditis and (2) sporadic painless thyroiditis

Subacute granulematozny

Subacute thyroiditis granulematozny, de Querven's thyroiditis

Acute microbic inflammatory

Purulent thyroiditis, acute thyroiditis

 Chronic invasive fibrous

Ridel's craw, Ridel's thyroiditis

Chronic lymphocytic thyroiditis.

Hashimoto's thyroiditis – the most widespread inflammatory disease of a thyroid gland, besides - a basic reason of a gipoterioz and a craw (including children's sporadic) around the world.

Epidemiology.

Hashimoto's thyroiditis makes 95 percent of all cases of a thyroiditis, occurs, as a rule, at women between 30 and 50 years of life. The incidence promptly grew in industrialized countries, increase is connected with artificially increased content of iodine in a diet.
Hashimoto's illness is genetically caused, other autoimmune diseases, such as are connected with it: malignant anemia, pseudorheumatism, diabetes mellitus, Shegren's syndrome and system lupus erythematosus. In many respects the induction of a disease happens because of consumption of iodine in the pharmacological doses much exceeding physiological throughout the long period.

Clinic.

In spite of the fact that Hashimoto's thyroiditis, as a rule, proceeds asymptomatically, some patients can have complaints to intensity or weight in a neck. Pain and sensitivity of a thyroid gland arises seldom. Symptoms of a hypothyroidism are diagnosed for 20% of patients. Physical inspection usually reveals atypical forms of a craw. Rare, but serious complication of a chronic autoimmune thyroiditis is the lymphoma of a thyroid gland.
The final forecast is put after blood analyses on the level of specific antibodies, namely – on the basis of high credits of the circulating antibodies to peroxidase of a thyroid gland and thyreoglobulin. All other diagnostic methods of a maloinformativna at this disease. At a nodular form for an exception of malignant new growths thinly needle aspiration biopsy with the subsequent histologic research of a bioptat is carried out.

Treatment.

Because of insignificance of manifestations of a thyroiditis many patients do not need treatment. At the expressed hypothyroidism replaceable hormonal therapy is shown by thyroxine drugs (T 4). It is carried out also for patients with the TTG level within norm to reduce the size of a thyroid gland and to prevent development of an explicit hypothyroidism in group of high risk.
Due to the risk of development of a hypothyroidism patients with Hashimoto's illness need an annual assessment of function of a thyroid gland.

Subacute lymphocytic form of a thyroiditis.

The Subacute Lymphocytic Thyroiditis (SLT) is subdivided into two groups: puerperal thyroiditis and sporadic painless thyroiditis.
PLT in a puerperal period is shown as the expressed thyrotoxicosis, usually develops within several months after the delivery and 1-2 months last. Then recovery with normalization of level of thyritropic hormones or transition to a hypothyroidism is possible. Patients with the first episode of puerperal PLT have high risk of recurrence at the subsequent pregnancies.
The sporadic painless thyroiditis begins with an insignificant hyperthyroidism with the subsequent hypothyroidism, at the final stage comes to an euthyroid state.

Epidemiology.

The subacute lymphocytic thyroiditis makes from 29 to 50% of all cases of a thyroiditis and arises most often at women between 30 and 50 years of life. Family history of autoimmune diseases of a thyroid gland occurs at 50% of patients with a puerperal form of a thyroiditis. Weight of manifestations of a hypothyroidism directly correlates with the level of antibodies to microsomal fraction of tirotsit (antimicrosomal antibody, the ANTI-MAGICIAN). At early durations of gestation the caption 1:1,600 indicates high risk of development of a puerperal hypothyroidism. Approximately at 6% of patients the disease passes into a chronic form.

Clinic.

Patients usually arrive with acute symptoms of a thyrotoxicosis: tachycardia, heartbeat, intolerance of a heat, nervousness and loss of weight. The small painless craw is present at 50% of the diseased. Level of T4 and T3 hormones is originally increased (with disproportionate increase in T4 to T3).

Treatment.

At this disease acute symptoms of a hyperthyroidism are removed by means of beta-blockers. The anti-thyroid drugs suppressing production of hormones of a thyroid gland are not shown. Replacement therapy by hormones of a thyroid gland at a hypothyroidism is recommended at the long or serious course of a disease. If the phase of a hypothyroidism lasts longer, than six months, it is possible to diagnose chronic decrease in hormonal activity of a thyroid gland.

Subacute granulematozny form of a thyroiditis.

The subacute thyroiditis granulematozny is always followed by symptoms of morbidity of a thyroid gland. The inflammation of a thyroid gland is caused by a viral infection, as a rule, to a disease the upper respiratory tract infection precedes. Numerous etiological agents can be involved, including - a virus of epidemic parotitis, the ESNO-virus, Koksaki's virus, Epstein-Burra's virus, flu and adenovirus.

Epidemiology.

Women get sick by 3-8 times more often than men, age of patients – from 30 to 50 years. Tends to seasonality of manifestations, most often arises in the flying and in the fall.

Diagnosis.

The first symptoms of a disease - acute pains in front part of a neck. Pain can amplify at turn of the head or swallowing, to irradiate in a jaw, an ear or a thorax. There can be hypermetabolism symptoms, SOE indicator is always considerably raised. At a palpation hypersensitivity or nodular formations of a thyroid gland is defined. The thyrotoxicosis is present at 50% of patients at an acute phase. In blood serum concentration of T4 is disproportionately increased in comparison with the T3 level, the TTG level is considerably reduced or is not defined. Indicators of thyreoglobulin (TG) are always higher than norm. Level of absorption of a radioiodine is considerably reduced, less than 2% in 24 hours are frequent.

Clinic.

The disease proceeds 4-6 months and includes four phases:

  1. Three-six weeks or longer last. Is followed by pains in a thyroid gland, in certain cases - thyrotoxicosis symptoms.
  2. Transitional. Proceeds asymptomatically.
  3. Decrease in hormonal activity of a thyroid gland which can last several weeks or months or to pass into a chronic form (5% of cases).
  4. The recovery period during which functions of a thyroid gland are normalized.

Treatment.

The symptomatic treatment is recommended by beta-blockers. Non-steroidal anti-inflammatory drugs are effective for reduction of inflammatory manifestations at easy forms. At severe forms Prednisolonum (from 20 to 40 mg a day) within 2-4 weeks is appointed. At 3-20% of patients recurrence of a disease after Prednisolonum cancellation is possible.

Microbic inflammatory thyroiditis.

The microbic inflammatory thyroiditis meets seldom, usually women have 20-40 years. Most often is caused by gram-positive bacteria, usually golden staphylococcus. Infection is preceded by chronic diseases of a thyroid gland (most often a nodal craw).
The main clinical signs – pain and sensitivity of front part of a neck, tachycardia, a leukocytosis and the raised SOE. Also fever, pharyngitis, pain when swallowing is observed and a skin erythema. Fine-needle aspiration allows to make a material intake for the subsequent crops and definition of the infectious agent.
Antibacterial therapy is shown. At patients with abscesses it is necessary to carry out surgical drainage or removal of one of shares of gland (lobectomy). For relief of symptoms heat, rest and purpose of antiinflammatory drugs is recommended.

Invasive fibrous thyroiditis.

This extremely rare disease is considered a final stage of a thyroiditis of Hashimoto. Average age of patients – 48 years, 83% of all cases are registered among women. At a palpation the ligneous structures which are densely soldered to surrounding fabrics in the form of tyazhy are defined. Symptoms vary and depend on extent of penetration of fibrous fabrics into structures of a neck (skeletal muscles, a gullet, a trachea). An asthma, a dysphagy, sometimes noisy goose breathing (stridor) can be observed. Always there is a hypothyroidism. 
Because of similarity between a fibrous thyroiditis and a cancer of a thyroid gland diagnosis has to be carried out with use of an open biopsy. The main treatment – surgical, is carried out a wedge-shaped resection of an isthmus of a thyroid gland.

 
"Syndrome of polycystic ovaries   Hunter syndrome"