Thyroiditis refers to inflammation of the thyroid gland. It can be caused by negativities at any stage, such as cells in the thyroid glands, colloid tissue, enzymes, production or release of hormones. These negativities may be congenital due to genetic origin, or they may occur due to internal or external causes. There may even be infections or non-infectious causes. Medications or other chemicals can also cause it. Many of these diseases have been evaluated in our detailed articles.
Thyroiditis can also be grouped according to whether it is painful or painless. Cases of painful thyroiditis are usually acute thyroiditis, radiation thyroiditis, or subacute thyroiditis caused by infections. Painless thyroiditis, on the other hand, can usually be seen in drug-induced, autoimmune or postpartum thyroiditis.
Thyroiditis is generally divided into 3 classes:
- acute thyroiditis
- subacute thyroiditis
- chronic thyroiditis
What is acute thyroiditis?
They are acute painful thyroiditis, usually due to infections of the thyroid gland or radiation.
Although acute thyroiditis caused by infections is rare, it is usually caused by bacteria or fungi such as streptococci or staphylococci. A painful, tender and swollen thyroid gland occurs in the neck. When infection is suspected, infection tests and investigations can be performed together with ultrasonography. Even blood cultures or fine needle aspiration can be done. Thyroid function tests are usually normal in cases of acute painful thyroiditis caused by infection. Rarely, however, hypo- or hyperthyroidism may be present. It can be treated with appropriate antibiotic therapy and painkillers. In some advanced cases, surgical drainage of infected material may be required.
Thyroiditis caused by infections should be treated quickly. Otherwise, it may cause abscesses or septicemia.
Radiation is the most common cause of non-infectious acute painful thyroiditis. It can develop in people who receive radiation therapy to the neck area for various reasons. Especially in people who receive radiation therapy for tumors in the neck region, receive radioactive iodine therapy for the suppression of Graves’ disease, receive radiation therapy for the treatment of thyroid cancers, or are exposed to high-dose radiation for any reason, severe pain in the thyroid region may develop, usually in the second week of treatment. It is a very rare condition. In severe cases, painkillers and steroid therapy may be required. It is important to follow up the thyroid function tests of patients with radiation-induced thyroiditis.
Subacute thyroiditis
Subacute thyroiditis is generally thought to be due to viral infections. It is also referred to as De Quervain’s thyroiditis or granulomatous thyroiditis. Mumps is thought to be caused by viruses such as coxsackie A, B, echovirus, and adenoviruses. Moderate thyroid enlargement may be seen. Granulomas and fibromas are slightly more prominent in the thyroid gland.
Subacute thyroiditis is more common in summer and in women. Usually fever, unilateral or bilateral pain in the neck may develop. Signs of infection can be detected in the blood. It can be seen that antibodies against viruses increase. Increase in thyroid hormones and symptoms of hyperthyroidism can also be seen in the patient. In advanced cases, if the disease becomes severe, regression in thyroid hormones and hypothyroidism clinic may develop.
Subacute thyroiditis usually gets better on its own. The recovery period may take several weeks or several months. Symptomatic treatment is given for pain. In advanced cases, steroid support may be required in addition to painkillers. Beta-blockers may sometimes be given due to tachycardia in patients who develop hyperthyroidism. In addition, additional treatments may be required depending on the patient’s symptoms and clinic.
Chronic thyroiditis
Chronic thyroiditis is the most common thyroiditis causing hypothyroidism and goiter. They are usually painless. It can have many causes and forms. Hashimoto’s thyroiditis, autoimmune thyroiditis, postpartum thyroiditis, iatrogenic thyroiditis, Riedel’s thyroiditis and drug-induced thyroiditis are the main ones. Each form requires detailed evaluation and treatment. Thyroiditis may also develop due to drugs such as amiadaron or lithium.
Each of the chronic thyroiditis cases may have different clinical symptoms and differences in thyroid hormones. Detailed history of the patients, drug use, familial diseases, other accompanying diseases, and conduction tests together with a detailed examination may be useful for diagnosis. In some cases, thyroid ultrasonography, thyroid scintigraphy, thyroid hormone levels and antibody tests may be required. Even fine needle aspiration biopsy may be required to differentiate malignancies.
Although most of the thyroiditis is generally treatable and shows a calm process, the side effects of long-term hormonal changes can cause undesirable pictures.
Continuing hypothyroidism for a long time in cases of thyroiditis that suppresses thyroid hormones can cause an emergency and vital condition called myxedema coma, especially in elderly patients.
In some cases of thyroiditis, excessive elevation of thyroid hormones can cause an urgent and vital picture, also called thyroid storm, if long-term hyperthyroidism develops.
Infectious thyroiditis cases can turn into vital conditions such as abscess or sepsis if their treatment is delayed in the future.
There is also a risk that some thyroiditis, such as Hashimoto’s thyroiditis, will develop into thyroid cancers if they last for a long time.
For these reasons, patients with suspected thyroiditis should be evaluated in detail, followed regularly by an endocrinologist, and the process should be followed up.