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What Is Thyroiditis?

Inflammation of the Thyroid Gland

Thyroiditis is an inflammation (not an infection) of the thyroid gland. Several types of thyroiditis exist, and the treatment is different for each.

 

Hashimoto's Thyroiditis 
Hashimoto's thyroiditis, also called autoimmune or chronic lymphocytic thyroiditis, is the most common type of thyroiditis. It is named after the Japanese physician, Hakaru Hashimoto, who first described it in 1912.

Hashimoto's thyroiditis is the most common cause of hypothyroidism. Learn more about the basics of hypothyroidism in our hypothyroidism slideshow.

The thyroid gland is always enlarged in Hashimoto's thyroiditis, although only one side may be enlarged enough to feel. During the course of this disease, the cells of the thyroid become inefficient in converting iodine into thyroid hormone and "compensate" by enlarging (for a review of this process see our thyroid function page).

The radioactive iodine uptake may be paradoxically high while the patient is hypothyroid because the gland retains the ability to take-up or "trap" iodine even after it has lost its ability to produce thyroid hormone.

As the disease progresses, the TSH (thyroid stimulating hormone) increases since the pituitary is trying to induce the thyroid to make more hormone, the T4 (a different thyroid hormone) falls since the thyroid can't make it, and the patient becomes  hypothyroid. This sequence of events can occur over a relatively short span of a few weeks or may take several years.

  • Treatment should begin with thyroid hormone replacement. This prevents or corrects the hypothyroidism, and it also generally keeps the gland from getting larger.
  • In most cases, the thyroid gland will decrease in size once thyroid hormone replacement is started.
  • Thyroid antibodies are present in 95% of patients with Hashimoto's thyroiditis and serve as a useful "marker" in identifying the disease without thyroid biopsy or surgery.
  • Thyroid antibodies may remain for years after the disease has been adequately treated and the patient is on thyroid hormone replacement.

Thyroid Conditions Related to Thyroiditis

De Quervain's Thyroiditis 
De Quervain's thyroiditis (also called subacute or granulomatous thyroiditis) was first described in 1904 and is much less common than Hashimoto's thyroiditis. The thyroid gland generally swells rapidly and is very painful and tender.

The gland discharges thyroid hormone into the blood and the patients become hyperthyroid; however, the gland quits taking up iodine (radioactive iodine uptake is very low), and the hyperthyroidism generally resolves over the next several weeks.

  • Patients frequently become ill with fever and prefer to be in bed.
  • Thyroid antibodies are not present in the blood, but the sedimentation rate (which measures inflammation) is very high.
  • Although this type of thyroiditis resembles an infection within the thyroid gland, no infectious agent has ever been identified, and antibiotics are of no use.
  • Treatment is usually bed rest and aspirin to reduce inflammation.
  • Occasionally cortisone (steroids, which reduce inflammation) and thyroid hormone (to "rest" the thyroid gland) may be used in prolonged cases.
  • Nearly all patients recover, and the thyroid gland returns to normal after several weeks or months.
  • A few patients will become hypothyroid once the inflammation settles down and therefore will need to stay on thyroid hormone replacement indefinitely.
  • Recurrences are uncommon.

Silent Thyroiditis
Silent thyroiditis is the third and least common type of thyroiditis. It was not recognized until the 1970s, although it probably existed and was treated as Graves' disease before that.

This type of thyroiditis resembles a combination of Hashimoto's thyroiditis and De Quervain's thyroiditis. The blood thyroid test is high and the radioactive iodine uptake is low (like De Quervain's thyroiditis), but there is no pain and needle biopsy resembles Hashimoto's thyroiditis. The majority of patients have been young women following pregnancy.

The disease usually needs no treatment, and 80% of patients show complete recovery and return of the thyroid gland to normal after 3 months. Symptoms are similar to Graves' disease except milder. The thyroid gland is only slightly enlarged and exophthalmos (development of "bug eyes") does not occur.

Treatment is usually bed rest with beta blockers to control palpitations (drugs to prevent rapid heart rates). Radioactive iodine, surgery, or antithyroid medication is never needed. A few patients have become permanently hypothyroid and needed to be placed on thyroid hormone.

Acute Thyroiditis
To date, this condition is underreported but is estimated to occur quite commonly, particularly following surgery in the neck. One of the most common reasons that someone might experience thyroiditis is following surgery in the neck or involving the thyroid gland. Having any surgery carries some risk, and in the case of parathyroid surgery, a common result is transient or temporary post-operative thyroiditis.1

For patients who are diagnosed with hyperparathyroidism,  and the cause is determined to require surgery to remove the parathyroid glands, there is a risk that you might develop thyroiditis. This type of thyroid inflammation occurs in response to vigorous movement of the thyroid gland during surgery in the neck or when parathyroid glands have been removed.

If you are going to have parathyroid surgery, you should ask about thyroiditis if you haven't already been told it is a possibility. This form of thyroiditis may be asymptomatic, meaning you may experience any symptoms and so won't even realize that you have thyroiditis. For others, an inflamed thyroid may produce symptoms such as tremors, anxiety, and maybe a racing heart. If you experience these feelings, you should call your doctor immediately. 

For those who develop dost-surgical thyroiditis, treatment is easily managed with medication for one to three months to help reduce the inflammation and restore the thyroid to healthy functioning.

Rarely, however, there is a slight risk that this acute thyroiditis may develop into thyrotoxicosis, which will require specific medical management.

Thyroiditis, Other
An inflamed thyroid may occur in response to a viral infection (viral thyroiditis) or a bacterial infection (bacterial thyroiditis), following radiation, or in response to certain medications.  Your doctor will determine the cause of your thyroiditis and will then treat the condition as needed.

 

 

 

 

Continue Reading
Hyperthyroidism Overview

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