Thyroiditis
Thyroiditis: Excerpt from Handbook of Diseases
Inflammation of the thyroid gland occurs as autoimmune thyroiditis (long-term 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’s 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 ster-oids 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.
Special considerations
❑ Before treatment, obtain a patient history to identify underlying diseases that may cause thyroiditis, such as tuberculosis or a recent viral infection.
❑ Check vital signs, and examine the patient’s neck for unusual swelling, enlargement, or redness. Provide a liquid diet if the patient has difficulty swallowing, especially when due to fibrosis. If the neck is swollen, measure and record the circumference daily to monitor progressive enlargement.
❑ In suppurative thyroiditis, administer antibiotics, and report and record elevations in temperature.
❑ Instruct the patient to watch for and report signs of hypothyroidism (lethargy, restlessness, sensitivity to cold, forgetfulness, dry skin) — especially if he has Hashimoto’s thyroiditis, which often causes hypothyroidism.
❑ Check for signs of thyrotoxicosis (nervousness, tremor, weakness), which often occur in subacute thyroiditis.
❑ After thyroidectomy, check vital signs every 15 to 30 minutes until the patient’s condition stabilizes. Stay alert for signs of tetany secondary to accidental parathyroid injury during surgery. Keep 10% calcium gluconate available for I.M. use if needed.
❑ Assess dressings frequently for excessive bleeding. Watch for signs of airway obstruction, such as difficulty talking or increased swallowing; keep tracheotomy equipment handy.
❑ Explain to the patient that lifelong thyroid hormone replacement therapy is necessary if permanent hypothyroidism occurs. (Many patients will have transient hypothyroidism as the gland recovers from subacute thyroiditis.) Tell the patient to watch for signs of an overdose, such as nervousness and palpitations.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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