Thyroiditis: Symptoms and Treatment

Thyroiditis is a whole group of diseases that differ in the features of etiology and are united by a single common process, which is the inflammation of tissues in the thyroid gland. Thyroiditis, the symptoms of which are determined depending on the specific form of the course of this disease, can also develop into a struma, a disease in which the enlarged thyroid gland undergoes uniform inflammation.



General Description

As we have already noted, thyroiditis is a generalized disease of a group of inflammatory processes of various etiology, this, respectively, determines the presence of various clinical manifestations in them. Any of the forms of thyroiditis involves damage to the follicles of the thyroid gland under a pathomorphological pattern peculiar to each of these forms of the disease.

It is on the basis of pathomorphological features that the corresponding clinical classification of thyroiditis is formed, in which, among other things, the duration and severity of its course is taken into account. Based on this classification, the following forms of the disease are distinguished:


  • Thyroiditis acute;
  • Subacute thyroiditis:

    • Granulomatous subacute thyroiditis
    • Lymphocytic subacute thyroiditis.

  • Thyroiditis chronic:

    • Lymphocytic chronic thyroiditis
    • Fibrous chronic thyroiditis.

It is noteworthy that, in general, the history of the study of the disease under consideration, that is, directly thyroiditis, is on the order of several hundred years. In a sense, this causes confusion in the definition of its varieties, while the classification listed above is for each of the items the basis for past determinations, which thus become synonyms for these forms. In each of the forms considered below, with their inherent symptomatology, we will indicate the remaining definitions indicating the same variety of thyroiditis.

Acute thyroiditis

As synonyms defining this disease, the following are distinguished:


  1. acute purulent thyroiditis
  2. Thyroiditis is purulent;
  3. pyogenic thyroiditis;
  4. acute thyroiditis bacterial;
  5. A sharp string.

The directly acute form of thyroiditis can be manifested in focal or diffuse form, purulent or neogenic.

Acute purulent thyroiditis

The development of acute purulent thyroiditis occurs due to the hematogenous spread of the infectious process (in acute or chronic form). Such processes are provoked can be a number of diseases, including pneumonia, tonsillitis and others. As for non-swallowed acute thyroiditis, its development often results from injuries, radiation therapy, as well as a hemorrhage that occurred directly in the thyroid gland.

Thyroiditis of the thyroid gland, the symptoms of which in the form in question are manifested in particular in its densification, at a certain stage of development leads to the formation in this area of ​​an abscess (abscess). As a result, there is a disruption of the production of hormones in the area of ​​inflammation. Meanwhile, quite often the pathological process does not completely affect the gland or a large part of it, and therefore there are no hormonal disorders in the body.

Symptoms of acute thyroiditis

The onset of the disease is predominantly acute, accompanied by a sharp increase in temperature (at 40 degrees). In addition, there is a strong chill and an increase in heart rate (tachycardia). In the area in which the thyroid gland is located, patients notice strong pains that transmit to the tongue, ears, occipital region and to the lower jaw (pain irradiation).

Increased pain in these areas occurs when coughing and swallowing. In addition, there are also signs that indicate an intoxication of the body. In particular, they consist of severe weakness, headache, pain in the muscles and joints.

Predominantly the patient’s condition is characterized as severe, the palpation of the thyroid gland indicates a local increase in it, as well as a sharp soreness that occurs during palpation (palpation). Initially, the increase in this disease has a dense consistency, later purulent melting in combination with the formation of an abscess leads to its softening.

There is also an increase in cervical lymph nodes and their soreness in the process of probing. In some cases, as a complication of purulent thyroiditis is the breakthrough of pus through the thyroid gland to the organs located next to (trachea and esophagus, and also mediastinum). In the more rare cases, the infectious process can become generalized and its course is accompanied by the development of sepsis.

Complications

Completion of the acute form of thyroiditis can lead to the appearance of an abscess in the tissues of the thyroid gland, which later can break through. If this happens outside, then the situation is not so critical, it’s another matter if pus comes into the surrounding tissues or if it gets into the pericardial space.




Purulent inflammation in its progression in the neck tissue region can lead to certain damage to the vessels, as well as to the brain tissue and the purulent membranes of a purulent infection, moreover, the development of the disease can lead to infection of general blood (ie sepsis) . Thus, the treatment of acute thyroiditis should be done extremely carefully and, crucially, timely.

If acute thyroiditis is not treated, it will accordingly lead to damage to a significant area of ​​the tissue of the thyroid gland, which in turn provokes the development of its irreversible insufficiency.

In general, the duration of the acute form of thyroiditis is about 1-2 months. As a criterion indicating recovery, complete elimination of the actual phenomena of an infectious-inflammatory scale is determined (normalized blood test parameters, the temperature corresponds to normal indices, etc.). In the case of an abscess in the thyroid gland, it is possible for him to be opened, as we already pointed out, either to the mediastinum (mediastinitis) or to the trachea (which leads to diagnoses in the form of aspiration pneumonia and lung abscess). Statistics of the disease also indicate the occurrence of hypothyroidism as an outcome of acute purulent thyroiditis.

Acute nasal thyroiditis

The course of acute neonatal thyroiditis occurs by analogy with aseptic inflammation. Its symptoms are less pronounced than in the purulent form of the disease.

Subacute thyroiditis

The subacute form of thyroiditis can occur in the form of subacute granulomatous thyroiditis and in the form of subacute lymphocytic thyroiditis.

Subacute granulomatous thyroiditis

The granulomatous form of subacute thyroiditis is also known as:


  • thyroids de Cerven;
  • thyroiditis is viral;
  • Disease / goiter de Kerven.

The current form of thyroiditis is characterized by a flow with tenderness, noted in the thyroid gland, and this soreness is manifested in any case of the disease. It occurs on the background of the effects of a viral infection, mainly to those include infections of the upper respiratory tract. In addition, it is often involved in various etiologic agents, including the virus of the epidemic form of mumps, the Coxsackie virus, adenovirus, influenza virus and Epstein-Barr virus.

Predominantly the susceptibility to the disease is noted among women — they get sick up to 8 times more often than men. With regard to the age category of patients, there is a limit in the range of 30 to 50 years. There is also a seasonal manifestation of the disease — often all its manifestations occur during the summer / autumn.

Symptoms of subacute granulomatous thyroiditis

As the first symptoms of the disease, acute pain occurs in the anterior region of the neck. Strengthening them occurs when swallowing and turning the head, as in the case with the acute form of the disease, it is possible to irradiate the pain to the ear, jaw and chest. In addition, there may be a manifestation of symptoms, indicating hypermetabolism, blood tests indicate a significant increase in ESR. Palpation determines the increased sensitivity or the presence of nodular formations in the thyroid gland. An order of more than 50% of cases indicates the occurrence of thyrotoxicosis in patients.

The duration of the disease is on the order of up to 6 months, it consists of the following phases:


  1. Phase I (duration is up to 6 weeks). Actual manifestations in the form of pain in the thyroid gland, as well as symptoms of thyrotoxicosis (tachycardia, hypertension, dyspnea, protrusion of the eyeball, motor dysfunction, weight loss, hand tremors, nervousness, sleep disorders, irritability, too fast speech, weakness, menstrual irregularities Cycle in women, etc.).
  2. Phase II (transitional). Characterized by the absence of any symptomatology.
  3. Phase III (duration from several weeks to several months). There is a decrease in the hormonal activity characteristic of the thyroid gland, after which this disorder can develop into a chronic form.
  4. Phase IV (recovery). During this period, the functions inherent in the thyroid gland gradually come to normalization.

Subacute lymphocytic thyroiditis

This form is also known in the form of its definitions as:


  • thyroiditis is painless;
  • Silent thyroiditis
  • postpartum thyroiditis;
  • thyroid lymphocyte in spontaneously resolved thyrotoxicosis

Actually, one of the names represents one of two forms, into which subacute lymphocytic thyroiditis is divided. Thus, PLT can occur in the postpartum form and in sporadic, painless form.

PLT of the postpartum period is characterized by the severity of manifestations in general characteristic of thyrotoxicosis. As a rule, its development is observed within the next few months from the moment of birth, while the duration of the course of the disease is about 1-2 months. Recovery may occur when the level of indices of thyroid-stimulating hormones is normalized, but the transition of the disease to hypothyroidism is also possible. Patients who had the first episode of the disease subsequently experienced a high risk of recurrence after delivery in subsequent pregnancies.

As for the painless sporadic thyroiditis, its onset occurs in combination with minor manifestations of hypothyroidism with the subsequent onset of this disease and the transition to the euthyroid state at the final stage.

The manifestation of acute symptoms characteristic of thyrotoxicosis is typical for PLT (as we already noted when considering the granulomatous form of thyroiditis, this includes tachycardia, increased blood pressure, weight loss, nervousness, etc.). About 50% of patients face manifestation in the form of an increase in the thyroid gland. There is also an increase in the level of hormones (T3, T4) detected during the analyzes.

Chronic thyroiditis

Chronic thyroiditis can occur in two varieties, respectively, acting as a form of the disease as lymphocytic or fibrotic thyroiditis.

Chronic lymphocytic thyroiditis

Among the common names that define this disease, we can distinguish the following options:


  1. autoimmune thyroiditis
  2. non-nasal chronic thyroiditis
  3. thyroiditis / illness / goiter Hashimoto or Hashimoto
  4. lymphoma cell
  5. Lymphomatous thyroiditis.

The definition of an autoimmune thyroiditis of the thyroid gland is most often used, the symptoms of which are somewhat lower and we will consider it, first stopping at the peculiarities of this form of the disease as a whole.

So, chronic lymphocytic thyroiditis is, as you probably guessed from a generalized description of this group of diseases, an inflammation in the thyroid gland of an autoimmune nature. In particular, this implies the formation in the body of patient lymphocytes and antibodies that have a destructive effect on cells belonging to the thyroid gland.

Predominantly chronic thyroiditis of the autoimmune form is observed in patients aged 40-50 years, as was noted earlier, here also the incidence of women significantly exceeds the incidence of men, and almost 10 times. In this form, Hashimoto’s thyroiditis, the symptoms of which can be quite pronounced in the manifestations, occurs most often, and recently there has been a clear trend in the susceptibility of patients of the young age group, as well as children.

There is an opinion that this form of the disease is hereditary, meanwhile, the implementation of heredity as a predisposing factor to the appearance of the disease we are considering requires additional exposure to certain external factors of an unfavorable nature. These include, in particular, viral respiratory diseases and foci of chronic type in the areas of the tonsils and sinuses of the nose, tooth decay with caries, etc. That is, as the main and only factor to the appearance of the disease, heredity can not be considered.

It is noteworthy that the chronic autoimmune thyroiditis, the symptoms of which can arise and against the background of the effect of prolonged uncontrolled use of drugs in the composition with iodine, and also against the background of radiation exposure to the organism, is generally characterized by the complexity of the mechanism provoking immune aggression.

Now we will stop directly on the symptomatology of the disease. It should be noted that often autoimmune thyroiditis can occur without special manifestations. On the early signs of the disease can be said when there are unpleasant sensations in the thyroid gland, as well as when a coma is felt in the throat, which in particular occurs when swallowing. In addition, there is also a feeling of pressure, concentrated in the area of ​​the throat. There may be minor pain that occurs when probing the thyroid gland, in some cases, weakness and pain in the joints.

When hyperthyroidism occurs in patients with a significant release of hormones into the bloodstream as a result of damage to the cells of the affected area, symptoms such as increased blood pressure, sweating, and tachycardia appear. Often hyperthyroidism appears at the very beginning of the disease.

Autoimmune thyroiditis, the symptoms of which appear depending on the current clinical picture in conjunction with the size of the thyroid gland, is divided into the following forms:


  • Atrophic autoimmune thyroiditis. In this case, there is no enlargement of the thyroid gland. In general, this form is noted in most patients, usually in old age or among patients who were previously exposed to radiation exposure. The considered form of the disease mainly proceeds in combination with hypothyroidism (a decrease in thyroid functions).
  • Hypertrophic autoimmune thyroiditis. Here, on the contrary, there is always an increase in the thyroid gland, an increase occurs both along its entire volume (hypertrophic diffuse form) and in combination with Presence of nodules (nodular form). In addition, it is possible to combine a diffuse form with a nodular one. The onset of the disease in this form is often characterized by the manifestations of thyrotoxicosis, but mostly the functions of the thyroid gland are defined as normal or slightly decreased.

Chronic fibrosis thyroiditis

This form also has some versions of its definition, in particular this:


  1. thyroiditis / Strioma / goiter Riedel
  2. fibroid-invasive thyroiditis
  3. Woody thyroiditis.

This form of thyroiditis is, again, an inflammatory disease in which the thyroid gland undergoes destruction and the formation in it of a connective (fibrous) tissue in combination with compaction, in it arising and characteristic compression, produced on organs, thyroid glands surrounding. To date, this form of the disease is infrequent, which is explained by the breadth of antibiotic use. Women, as in other cases, fibrotic thyroiditis are more likely than men — about three times.

There is speculation that fibroid thyroiditis is in itself the final stage of the autoimmune form of thyroiditis, but there are certain challenges to this theory, because it is not proven. It is believed that fibrotic thyroiditis still occurs against the background of the transfer of a viral infection to patients.

As for the symptomatology, it can be seen that the condition of the patients as a whole remains within the norm with fibrotic thyroiditis. Manifestations of the disease are expressed in the violation of swallowing and in the sensation of a characteristic lump in the throat, formed when swallowing. In some cases, a dry cough appears, while the voice becomes rough. Later, violations of the respiratory system are attached, the voice acquires an ospoid, and in some cases disappears altogether.

The above symptoms are associated with lesions that occur against the background of inflammation in the organs surrounding the thyroid gland (trachea, vocal cords, esophagus). Progressing fibrous process can also capture parathyroid glands, this, in turn, manifests itself in the form of hypoparathyrosis and seizures.

Treatment of thyroiditis


  • Acute thyroiditis. In this case, the therapy is carried out using antibiotics, as well as drugs that focus on the treatment of concomitant symptoms. In addition, vitamins (groups B, C) are prescribed. The development of the abscess requires the need for surgical intervention.
  • Subacute thyroiditis. For the treatment of this form of the disease, therapy involves the use of hormonal drugs. Symptomatic of hyperthyroidism, respectively, requires the prescription of drugs for individual treatment in conjunction with this disease.
  • Chronic autoimmune thyroiditis. Here, treatment is usually focused on the use of medications, meanwhile, a significant increase in thyroid size requires surgery.




If you have any symptoms that correspond to any of the listed forms of thyroiditis, you need to contact the endocrinologist.