de Quervain's thyroiditis
- Granulomatous or subacute thyroiditis
- Due to viral infection
- Often follows a upper respiratory tract infection
- Presents with painful swelling of one or both thyroid lobes
- Usually associated with malaise and fever
- Patients often have clinical features of mild hyperthyroidism
- Free T4 and ESR is usually raised
- Usually a self-limiting illness with spontaneous recovery
- A few patients develop mild hypothyroidism
- Symptomatic improvement can occur with the use of NSAID
- Steroids may speed resolution in those with severe symptoms
Hashimoto's thyroiditis
- lymphomatous thyroiditis
- Due to autoimmune disease
- Produces diffuse swelling of thyroid gland
- Histologically the thyroid is infiltrated with lymphocytes and plasma cells
- May progress to secondary lymphoid nodule formation and stromal fibrosis
- Serum anti-thyroglobulin and anti-microsomal antibodies are raised
- Patients eventually become hypothyroid
- Thyroxine replacement therapy suppresses TSH and reduces size of gland
- Surgery is rarely required
- Long-term the risk of thyroid lymphoma is increased
Riedel's thyroiditis
- Also known as acute fibrous thyroiditis
- Rare but important as it often clinically mimics malignancy
- Produces a diffuse inflammatory infiltrate throughout the thyroid gland
- May extend beyond capsule into adjacent structures
- Clinically is associated with sclerosing cholangitis, retroperitoneal and mediastinal fibrosis
- Surgery is rarely required
- May require division of isthmus to decompress trachea
Acute suppurative thyroiditis
- Bacterial or fungal infection
- Produces acutely inflamed thyroid gland
- Diagnosis is confirmed by fine-needle aspiration cytology
- Treatment is by parenteral antibiotics
Bibliography
Farwell A P, Braverman L E. Inflammatory thyroid disorders. Otolaryngol Clin North Am
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Pasieka J L. Hashimoto's disease and thyroid lymphoma: role of the surgeon. World J Surg
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Slatosky J, Shipton B, Wahba H. Thyroiditis: differential diagnosis and
management. Am Fam Physician 2000; 61: 1047-1054.
Weetman A P. Thyroiditis. Curr Pract Surg 1992; 4: 118 - 122. |