Thyroiditis: Difference between revisions

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<br style="clear:left" />''<small>(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies. (*)[[TSH]] may be decreased transiently in the [[thyrotoxicosis]]. (**)TPOAb may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''</small>
<br style="clear:left" />''(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; [[Thyroid peroxidase]] antibodies. (*)[[TSH]] may be decreased transiently in the [[thyrotoxicosis]]. (**)TPOAb may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''


==Treatment==
==Treatment==
===Treatment of Hashimoto's thyroiditis===
The drugs used in the treatment of Hashimoto's thyroiditis are:<ref name="pmid24434360">{{cite journal |vauthors=Caturegli P, De Remigis A, Rose NR |title=Hashimoto thyroiditis: clinical and diagnostic criteria |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=391–7 |year=2014 |pmid=24434360 |doi=10.1016/j.autrev.2014.01.007 |url=}}</ref><ref name="pmid25266247">{{cite journal |vauthors=Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM |title=Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement |journal=Thyroid |volume=24 |issue=12 |pages=1670–751 |year=2014 |pmid=25266247 |pmc=4267409 |doi=10.1089/thy.2014.0028 |url=}}</ref>
The drugs used in the treatment of Hashimoto's thyroiditis are:<ref name="pmid24434360">{{cite journal |vauthors=Caturegli P, De Remigis A, Rose NR |title=Hashimoto thyroiditis: clinical and diagnostic criteria |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=391–7 |year=2014 |pmid=24434360 |doi=10.1016/j.autrev.2014.01.007 |url=}}</ref><ref name="pmid25266247">{{cite journal |vauthors=Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM |title=Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement |journal=Thyroid |volume=24 |issue=12 |pages=1670–751 |year=2014 |pmid=25266247 |pmc=4267409 |doi=10.1089/thy.2014.0028 |url=}}</ref>
#[[Levothyroxine]]:
#[[Levothyroxine]]:
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#*Dietary [[selenium]] supplementation is considered to be protective against the [[autoimmune diseases]] of the [[thyroid]].
#*Dietary [[selenium]] supplementation is considered to be protective against the [[autoimmune diseases]] of the [[thyroid]].


====Drug Regimen for Hashimoto's thyroiditis====
Drug Regimen:
*[[Levothyroxine (oral)|Synthetic levothyroxine]] (L-[[T4]]) 1.6–1.8 μg/kg of body weight per day orally.
*[[Levothyroxine (oral)|Synthetic levothyroxine]] (L-[[T4]]) 1.6–1.8 μg/kg of body weight per day orally.
===Treatment of de Quervain's thyroiditis thyroiditis===
The drugs used in the treatment of [[de Quervain's thyroiditis]] are:<ref name="pmid20886353">{{cite journal |vauthors=Engkakul P, Mahachoklertwattana P, Poomthavorn P |title=Eponym : de Quervain thyroiditis |journal=Eur. J. Pediatr. |volume=170 |issue=4 |pages=427–31 |year=2011 |pmid=20886353 |doi=10.1007/s00431-010-1306-4 |url=}}</ref><ref name="pmid3427792">{{cite journal |vauthors=Yamamoto M, Saito S, Sakurada T, Fukazawa H, Yoshida K, Kaise K, Kaise N, Nomura T, Itagaki Y, Yonemitsu K |title=Effect of prednisolone and salicylate on serum thyroglobulin level in patients with subacute thyroiditis |journal=Clin. Endocrinol. (Oxf) |volume=27 |issue=3 |pages=339–44 |year=1987 |pmid=3427792 |doi= |url=}}</ref><ref name="pmid8257868">{{cite journal |vauthors=Volpé R |title=The management of subacute (DeQuervain's) thyroiditis |journal=Thyroid |volume=3 |issue=3 |pages=253–5 |year=1993 |pmid=8257868 |doi= |url=}}</ref><ref name="pmid6144501">{{cite journal |vauthors=Feely J, Peden N |title=Use of beta-adrenoceptor blocking drugs in hyperthyroidism |journal=Drugs |volume=27 |issue=5 |pages=425–46 |year=1984 |pmid=6144501 |doi= |url=}}</ref>
====Drug Regimens for de Quervain's thyroiditis====
* '''For pain'''
**Preferred regimen (1): [[Naproxen]]: 500 to 1000 mg per day in two divided doses
**Preferred regimen (2): [[Ibuprofen]]: 1200 to 3200 mg per day in three or four divided doses
* '''For severe condition'''
**Preferred regimen (1): [[Prednisone]]: 40 mg per day orally
* '''For hypothyroidism'''
*Preferred regimen (1): [[Levothyroxine (oral)|Synthetic levothyroxine]] (L-T4): 1.6–1.8 μg/kg per day orally
* '''For thyrotoxic symptoms'''
**Preferred regimen (1): [[atenolol]]: 25-200mg per day orally
**Preferred regimen (2): [[metoprolol]]: 25-200mg per day orally
===Treatment of silent thyroiditis===
The drugs used in the treatment of silent thyroiditis are:<ref name="pmid22443972">{{cite journal |vauthors=Samuels MH |title=Subacute, silent, and postpartum thyroiditis |journal=Med. Clin. North Am. |volume=96 |issue=2 |pages=223–33 |year=2012 |pmid=22443972 |doi=10.1016/j.mcna.2012.01.003 |url=}}</ref><ref name="pmid7630839">{{cite journal |vauthors=Schubert MF, Kountz DS |title=Thyroiditis. A disease with many faces |journal=Postgrad Med |volume=98 |issue=2 |pages=101–3, 107–8, 112 |year=1995 |pmid=7630839 |doi= |url=}}</ref><ref name="pmid1987447">{{cite journal |vauthors=Singer PA |title=Thyroiditis. Acute, subacute, and chronic |journal=Med. Clin. North Am. |volume=75 |issue=1 |pages=61–77 |year=1991 |pmid=1987447 |doi= |url=}}</ref>
====Drug Regimen for silent thyroidits====
* '''For thyrotoxic symptoms'''
**Preferred regimen (1): [[atenolol]]: 25-200mg per day orally
**Preferred regimen (2): [[metoprolol]]: 25-200mg per day orally
* '''For hypothyroidism'''
*Preferred regimen (1): [[Levothyroxine (oral)|Synthetic levothyroxine]] (L-T4): 1.6–1.8 μg/kg per day orally
===Treatment of Riedel's thyroidtis===
*Pharmacologic medical therapies for Riedel's thyroiditis include [[corticosteroids]] and [[tamoxifen]].<ref name="pmid8120524">{{cite journal |vauthors=Zimmermann-Belsing T, Feldt-Rasmussen U |title=Riedel's thyroiditis: an autoimmune or primary fibrotic disease? |journal=J. Intern. Med. |volume=235 |issue=3 |pages=271–4 |year=1994 |pmid=8120524 |doi= |url=}}</ref><ref name="pmid9497955">{{cite journal |vauthors=Vaidya B, Harris PE, Barrett P, Kendall-Taylor P |title=Corticosteroid therapy in Riedel's thyroiditis |journal=Postgrad Med J |volume=73 |issue=866 |pages=817–9 |year=1997 |pmid=9497955 |pmc=2431527 |doi= |url=}}</ref><ref name="pmid263470">{{cite journal |vauthors=Chopra D, Wool MS, Crosson A, Sawin CT |title=Riedel's struma associated with subacute thyroiditis, hypothyroidism, and hypoparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=46 |issue=6 |pages=869–71 |year=1978 |pmid=263470 |doi=10.1210/jcem-46-6-869 |url=}}</ref><ref name="pmid7560814">{{cite journal |vauthors=Bagnasco M, Passalacqua G, Pronzato C, Albano M, Torre G, Scordamaglia A |title=Fibrous invasive (Riedel's) thyroiditis with critical response to steroid treatment |journal=J. Endocrinol. Invest. |volume=18 |issue=4 |pages=305–7 |year=1995 |pmid=7560814 |doi=10.1007/BF03347818 |url=}}</ref><ref name="pmid5694137">{{cite journal |vauthors=Thomson JA, Jackson IM, Duguid WP |title=The effect of steroid therapy on Riedel's thyroiditis |journal=Scott Med J |volume=13 |issue=1 |pages=13–6 |year=1968 |pmid=5694137 |doi=10.1177/003693306801300103 |url=}}</ref><ref name="pmid12698518">{{cite journal |author=Dabelic N, Jukic T, Labar Z, Novosel SA, Matesa N, Kusic Z |title=Riedel's thyroiditis treated with tamoxifen |journal=Croat. Med. J. |volume=44 |issue=2 |pages=239–41 |year=2003|pmid=12698518 |doi= |url=http://www.cmj.hr/2003/44/2/12698518.pdf|format=PDF}}</ref>
*[[Mycophenolate sodium|Mycophenolate mofetil]] is also used in combination with [[corticosteroids]].<ref name="pmid20067381">{{cite journal |vauthors=Levy JM, Hasney CP, Friedlander PL, Kandil E, Occhipinti EA, Kahn MJ |title=Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis |journal=Thyroid |volume=20 |issue=1 |pages=105–7 |year=2010 |pmid=20067381 |doi=10.1089/thy.2009.0324 |url=}}</ref><ref name="pmid21568724">{{cite journal |vauthors=Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V |title=Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008 |journal=Thyroid |volume=21 |issue=7 |pages=765–72 |year=2011 |pmid=21568724 |doi=10.1089/thy.2010.0453 |url=}}</ref>
====Drug Regimens for Riedel's thyroidtis====
The effectiveness of therapy and dosages for Riedel's thyroiditis have not yet been assessed completely. As a result, the exact dosage regimens and duration of therapy cannot be defined. The current recommendations are based on the clinical manifestations, associated conditions, and the response to treatment.
* Preferred regimen (1): [[Prednisone]] 15-60mg PO q24h for 6 months to 2 years   
* Preferred regimen (2): [[Prednisone]] 500 mg PO q24h for 6 months to 2 years
* Alternative regimen (1): [[Tamoxifen]] 10-20 mg PO q24h for 6 months to 2 years
* Alternative regimen (1): [[Mycophenolate sodium|Mycophenolate mofetil]] 1 g PO q12h for 6 months to 2 years


==Related Chapters==
==Related Chapters==

Revision as of 17:26, 3 October 2017

Thyroiditis Microchapters

Patient Information

Overview

Classification

Hashimoto's thyroiditis
Riedel's thyroiditis
De quervain thyroiditis
Suppurative thyroiditis
Postpartum thyroiditis

Differentiating Thyroiditis from Other Diseases

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2], Usama Talib, BSc, MD [3]

Overview

Thyroiditis refers to an inflammation of the thyroid gland.


Classification

Differentiating Thyroiditis from Other Diseases

Various forms of thyroiditis can be differentiated from each other on the basis of pathological and laboratory findings:

Conditions Causes Age at onset Pathological findings Diagnostic approach
Hashimoto's thyroiditis
  • Autoimmune
  • All ages, peak at 30-50
  • Lymphocytic infiltration
  • Germinal centers
  • Fibrosis (in some variants)
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
  • Giant cells
  • Granulomas
Silent thyroiditis
  • Autoimmune
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Postpartum thyroiditis
  • Autoimmune
  • Childbearing age
  • Lymphocytic infiltration
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Suppurative thyroiditis
  • Infection
  • Children, 20-40
  • Abscess formation

Diagnosis

Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU† Thyroglobin TRH TPOAb^
Primary hypothyroidism Autoimmune (Hashimoto's thyroiditis) - - ↑* ↓ Normal/↓ Normal/↓ Normal/↑ Normal Present (high titer)
Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Infectious thyroiditis + + Normal Normal Normal Normal Normal Normal Absent
Transient hypothyroidism Subacute (de Quervain's) thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal Low/absent
Postpartum thyroiditis +/- +/- ↑/↓ ↓/↑ Normal ↓ ↑ Normal/↑ Present (high titer)
Silent thyroiditis - - ↑/↓ ↓/↑ Normal ↓ ↑ Normal Present (high titer)
Others Drug-induced - - ↑/↓ ↓/↑ Normal ↓ Normal/↑ Normal Absent**
  • History of hyperthyroidism
  • History of trauma
  • History of drug use, surgery, or radiation
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - ↑ Normal Normal Normal Normal Normal Normal/↑
  • Asymptomatic


(†)T3RU; Triiodothyronine Resin uptake. (^)TPOAb; Thyroid peroxidase antibodies. (*)TSH may be decreased transiently in the thyrotoxicosis. (**)TPOAb may be present in drug-induced hypo/hyperthyroidism such as Interferon-alpha, interleukin-2, and lithium.

Treatment

The drugs used in the treatment of Hashimoto's thyroiditis are:[7][8]

  1. Levothyroxine:
    • lifelong synthetic levothyroxine (L-T4) is used to treat the hypothyroidism in Hashimoto's disease.
    • Main goals of levothyroxine replacement therapy are:
      • Resolution of the hypothyroid symptoms and signs including biological and physiologic markers of hypothyroidism
      • Normalization of serum thyrotropin with improvement in thyroid hormone concentrations
      • To avoid overtreatment (iatrogenic thyrotoxicosis)
    • Side effects include atrial fibrillation and osteoporosis
  2. Corticosteroids:
    • A short course of glucocorticoids can be used in the treatment of IgG4-related variant of Hashimoto's thyroiditis.
  3. Selenium:

Drug Regimen:

Related Chapters

References

  1. ↑ Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  2. ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  3. ↑ "Thyroiditis — NEJM".
  4. ↑ Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.
  5. ↑ Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
  6. ↑ De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J. "Clinical Strategies in the Testing of Thyroid Function". PMID 25905413.
  7. ↑ Caturegli P, De Remigis A, Rose NR (2014). "Hashimoto thyroiditis: clinical and diagnostic criteria". Autoimmun Rev. 13 (4–5): 391–7. doi:10.1016/j.autrev.2014.01.007. PMID 24434360.
  8. ↑ Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM (2014). "Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement". Thyroid. 24 (12): 1670–751. doi:10.1089/thy.2014.0028. PMC 4267409. PMID 25266247.



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