Lecture on Thyroiditis

Introduction

• The topic of thyroiditis is complex and has evolved over the years.
• Past materials may not cover current approaches or relevant information.
• Important to focus on key types of thyroiditis relevant for exams like Step 2 and Step 3.

General Overview

• Thyroiditis: A group of inflammatory thyroid disorders with shared features but different characteristics.
• Common feature: Enlargement or goiter of the thyroid gland, though not always detectable.
• Phases of Thyroiditis:
  • Hyperthyroid phase due to hormone release.
  • Euthyroid phase as levels normalize.
  • Hypothyroid phase due to gland damage.
  • Return to euthyroid state.
• Can cause compressive symptoms: dyspnea, dysphagia, voice changes.

Diagnostic Approach

• Physical exam may reveal goiter or nodules; nodules need cancer evaluation.
• More common in women than men, except one form.
• Most accurate test: biopsy, though not often necessary.
• Radioactive Iodine Uptake Test (RAIU): Useful for visualizing thyroid activity.

Types of Thyroiditis

1. Subacute Thyroiditis (De Quervain's)

• Cause: Likely post-viral, granulomatous.
• Symptoms: Painful thyroid, tender to touch.
• Phases: Hyperthyroid, euthyroid, hypothyroid.
• Diagnosis: Elevated sedimentation rate, TSH levels.
• Treatment: NSAIDs for pain, possible prednisone for inflammation.

2. Hashimoto's Thyroiditis

• Symptoms: Painless goiter, often presents with hypothyroid symptoms.
• Diagnosis: TSH test, corroborated by anti-TPO or thyroglobulin antibodies.
• Treatment: Levothyroxine, monitor TSH.
• Note: Check for nodules due to cancer risk.

3. Riedel's Thyroiditis

• Symptoms: Painless, fibrotic goiter causing compressive symptoms.
• Diagnosis: Surgical biopsy.
• Treatment: Tamoxifen, prednisone, possible surgery.

4. Acute Lymphocytic/Postpartum Thyroiditis

• Symptoms: Small, painless goiter.
• Phases: Hyperthyroid, euthyroid, hypothyroid.
• Prevalence: Common post-delivery.
• Treatment: Symptomatic for thyrotoxicosis.

5. Drug-Induced Thyroiditis

• Causes: Drugs like amiodarone, lithium, interferon-alpha.
• Diagnosis: Based on history and symptoms.

6. Suppurative Thyroiditis

• Cause: Bacterial or fungal infection.
• Symptoms: Painful, potentially febrile.
• Treatment: Antibiotics like penicillin or ampicillin.

Important Diagnostic Tips

• Painful Thyroiditis: Likely subacute or suppurative.
• Dysphagia/Dyspnea: Consider Riedel's.
• Symptomatic Treatment: Propranolol for hyperthyroid symptoms; levothyroxine for hypothyroidism.
• RAIU Scan: Differentiates types based on iodine uptake.
• Thyroid Nodules: FNA for potential malignancy.

Conclusion

• Understanding different forms of thyroiditis and their management is crucial.
• Key diagnostics include physical exams, lab tests, and RAIU scans.
• Appropriate treatment varies by type and symptom severity.