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.
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.References
- Lazarus JH. Silent thyroiditis and subacute thyroiditis. In: The thyroid: A fundamental and clinical text, 7th, Braverman LE, Utiger RD (Eds), Lippincott-Raven, Philadelphia 1996. p.577.
- Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003; 348:2646.
- Kon YC, DeGroot LJ. Painful Hashimoto's thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. J Clin Endocrinol Metab 2003; 88:2667.
- Paes JE, Burman KD, Cohen J, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid 2010; 20:247.
- McLaughlin SA, Smith SL, Meek SE. Acute suppurative thyroiditis caused by Pasteurella multocida and associated with thyrotoxicosis. Thyroid 2006; 16:307.
- McAninch EA, Xu C, Lagari VS, Kim BW. Coccidiomycosis thyroiditis in an immunocompromised host post-transplant: case report and literature review. J Clin Endocrinol Metab 2014; 99:1537.
- Raman L, Murray J, Banka R. Primary tuberculosis of the thyroid gland: an unexpected cause of thyrotoxicosis. BMJ Case Rep 2014; 2014.
- Guttler R, Singer PA, Axline SG, et al. Pneumocystis carinii thyroiditis. Report of three cases and review of the literature. Arch Intern Med 1993; 153:393.
- Kobayashi A, Kuma K, Matsuzuka F, et al. Thyrotoxicosis after needle aspiration of thyroid cyst. J Clin Endocrinol Metab 1992; 75:21.
- Leckie RG, Buckner AB, Bornemann M. Seat belt-related thyroiditis documented with thyroid Tc-99m pertechnetate scans. Clin Nucl Med 1992; 17:859.
- Stang MT, Yim JH, Challinor SM, et al. Hyperthyroidism after parathyroid exploration. Surgery 2005; 138:1058.
- Mai VQ, Glister BC, Clyde PW, Shakir KM. Palpation thyroiditis causing new-onset atrial fibrillation. Thyroid 2008; 18:571.
- Espiritu RP, Dean DS. Parathyroidectomy-induced thyroiditis. Endocr Pract 2010; 16:656.
- Carella C, Mazziotti G, Amato G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: pathophysiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004; 89:3656.
- Schwartzentruber DJ, White DE, Zweig MH, et al. Thyroid dysfunction associated with immunotherapy for patients with cancer. Cancer 1991; 68:2384.
- Vialettes B, Guillerand MA, Viens P, et al. Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies. Acta Endocrinol (Copenh) 1993; 129:31.
- Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf) 2001; 55:501.
- Mannavola D, Coco P, Vannucchi G, et al. A novel tyrosine-kinase selective inhibitor, sunitinib, induces transient hypothyroidism by blocking iodine uptake. J Clin Endocrinol Metab 2007; 92:3531.
- Heufelder AE, Goellner JR, Bahn RS, et al. Tissue eosinophilia and eosinophil degranulation in Riedel's invasive fibrous thyroiditis. J Clin Endocrinol Metab 1996; 81:977.
- 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