Overview of thyroiditis
- Kenneth D Burman, MD
Kenneth D Burman, MD
- Chief, Endocrine Section
- Medstar Washington Hospital Center, Washington, DC
- Professor, Department of Medicine
- Georgetown University Medical Center
The term thyroiditis encompasses a diverse group of disorders characterized by some form of thyroid inflammation (table 1). They include conditions that cause acute illness with severe thyroid pain (eg, subacute thyroiditis and infectious thyroiditis) and conditions in which there is no clinically evident inflammation and the illness is manifested primarily by thyroid dysfunction or goiter (eg, painless thyroiditis and fibrous [Riedel's] thyroiditis) [1,2].
This topic review provides an overview of the different types of thyroiditis. These disorders can be categorized in several ways: according to their known or suspected etiology, their pathology, or their clinical features. The approach we use is to categorize thyroiditis according to whether it is associated with thyroid pain and tenderness because the presence or absence of those findings dominates the major diagnostic considerations (table 1). The diagnosis and management of several of the individual disorders, ie, subacute thyroiditis (or subacute granulomatous thyroiditis), painless thyroiditis, and postpartum thyroiditis, are discussed in more detail elsewhere, as is chronic autoimmune thyroiditis (Hashimoto's thyroiditis). (See "Subacute thyroiditis" and "Painless thyroiditis" and "Pathogenesis of Hashimoto's thyroiditis (chronic autoimmune thyroiditis)" and "Postpartum thyroiditis".)
There is some controversy concerning the nomenclature used to categorize the different forms of thyroiditis. However, most thyroidologists use the term subacute thyroiditis to apply to a specific disease called subacute granulomatous thyroiditis. Infectious thyroiditis is also called suppurative thyroiditis, and painless thyroiditis is also known as silent thyroiditis and lymphocytic thyroiditis with spontaneously resolving hyperthyroidism.
THYROIDITIS WITH THYROID PAIN AND TENDERNESS
Causes of this pattern of thyroiditis include subacute, infectious, traumatic, and radiation thyroiditis. Painful Hashimoto's thyroiditis is very rare and, in some circumstances, has been treated surgically .
Subacute thyroiditis — In the hyperthyroid phase, subacute thyroiditis (subacute granulomatous thyroiditis) is characterized by neck pain; a tender, diffuse goiter; and elevated thyroxine (T4) and/or triiodothyronine (T3). The classic pattern of changes in thyroid function in patients with subacute is hyperthyroidism, followed by hypothyroidism, and then recovery (figure 1). Hyperthyroidism, when it occurs, is due to damage to thyroid follicular cells and breakdown of stored thyroglobulin, leading to unregulated release of T4 and T3. Since ongoing synthesis of the thyroid hormones is inhibited due to thyroid-stimulating hormone (TSH) suppression and thyroid radioiodine uptake is low during the hyperthyroid phase (in contrast to Graves' hyperthyroidism), the hyperthyroidism lasts only until the stores of T4 and T3 are depleted, usually two to six weeks. Hypothyroidism is also usually transient but can occasionally be permanent.
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- THYROIDITIS WITH THYROID PAIN AND TENDERNESS
- Subacute thyroiditis
- Infectious thyroiditis
- Radiation thyroiditis
- Palpation or trauma-induced thyroiditis
- THYROIDITIS WITHOUT PAIN AND TENDERNESS
- Painless thyroiditis
- Postpartum thyroiditis
- Drug-induced thyroiditis
- - Interferon alfa
- - Interleukin-2
- - Amiodarone
- - Lithium
- - Kinase inhibitors
- - Checkpoint inhibitor immunotherapy
- Fibrous thyroiditis
- INFORMATION FOR PATIENTS