Thyroiditis

From WebHealth

[edit] Thyroiditis

This inflammatory thyroid disease has been first described in pregnant women who develop this in the postpartum period in about 8%. The natural course of the disease is a thyroid enlargement where the blood tests show hyperthyroidism. This lasts for a period of several weeks and is then followed by a period of normal thyroid function.

Some patients stay stable, but others get the late complication, which consists of hypothyroidism. We know from biopsy studies that Hashimoto's thyroiditis is an autoimmune disease where lymphocytes invade the thyroid gland.

There are several forms of thyroiditis, but Hashimoto's thyroiditis is the most common form of it.

The postpartum thyroiditis is usually more silent and disappears faster. Hashimoto's thyroiditis has a ratio of 8:1 with regard to occurrence in women versus men. It is more frequent in the older generation and particularly in elderly women. It is often only diagnosed when hypothyroidism occurs. Thyroid autoimmune disease is associated with other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren's syndrome and pernicious anemia. Diabetes mellitus, adrenal insufficiency and hypoparathyroidism are also associated with Hashimoto's thyroiditis. Later in life these patients have an increased frequency of thyroid cancers, particularly the papillary thyroid cancer and thyroid lymphoma.

Hashimoto's thyroiditis (=Hashimoto's disease)

This condition is associated with other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren's syndrome and pernicious anemia. Diabetes mellitus, adrenal insufficiency and hypoparathyroidism are also associated with Hashimoto's thyroiditis.

Thyroiditis symptoms:

Usually patients complain about a painless enlargement of the thyroid gland or in males that they have difficulties to button up the collar of their shirt. A small percentage will experience pain with the swelling of the thyroid gland. The doctor finds a goiter on examination, which is a smooth or nodular enlargement of the thyroid gland just below the voice box. It often has a rubbery consistency to it.

Diagnostic tests:

In the beginning of the disease Hashimoto's thyroiditis patients have normal T4 and TSH tests, but very high thyroid peroxidase antibodies with occasional positive antithyroglobulin antibodies. Later, during the hypothyroid phase, the tests are accordingly (low T4, high TSH and decreased thyroid uptake test).

Treatment:

Treatment requires lifelong thyroid replacement therapy with thyroid hormone as the TSH level, which causes thyroid cancer, must be suppressed. Thyroid replacement decreases the goiter size and normalizes the hypothyroidism. At the same time the pituitary gland stops overpoducing TSH as the negative feedback loop shuts down TRH production in the hypothalamus and TSH production in the anterior pituitary gland (see introduction to this chapter). This will help thyroid cancer prevention later in life. For more info on Hashimoto's thyroiditis click here.

Home page

Hormones

Thyroid disease

References:

1. B. Sears: "The age-free zone". Regan Books, Harper Collins, 2000.

2. R.A. Vogel: Clin Cardiol 20(1997): 426-432.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 8: Thyroid disorders.

4. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 7:Pituitary disorders.

5. J Levron et al.: Fertil Steril 2000 Nov;74(5):925-929.

6. AJ Patwardhan et. al.: Neurology 2000 Jun 27;54(12):2218-2223.

7. ME Flett et al.: Br J Surg 1999 Oct;86(10):1280-1283.

8. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 261: Congenital anomalies.

9. AC Hackney : Curr Pharm Des 2001 Mar;7(4):261-273.

10. JA Tash et al. : Urology 2000 Oct 1;56(4):669.

11. D Prandstraller et al.: Pediatr Cardiol 1999 Mar-Apr;20(2):108-112.

12. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

13. J Bain: Can Fam Physician 2001 Jan;47:91-97.

14. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

15. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier