ABSTRACT
Thyroiditis is a general term for inflammation of the thyroid gland. The most common forms of thyroiditis encountered by family physicians include Hashimoto, postpartum, and subacute. Most forms of thyroiditis result in a triphasic disease pattern of thyroid dysfunction. Patients will have an initial phase of hyperthyroidism (thyrotoxicosis) attributed to the release of preformed thyroid hormone from damaged thyroid cells. This is followed by hypothyroidism, when the thyroid stores are depleted, and then eventual restoration of normal thyroid function. Some patients may develop permanent hypothyroidism. Hashimoto thyroiditis is an autoimmune disorder that presents with or without signs or symptoms of hypothyroidism, often with a painless goiter, and is associated with elevated thyroid peroxidase antibodies. Patients with Hashimoto thyroiditis and overt hypothyroidism are generally treated with lifelong thyroid hormone therapy. Postpartum thyroiditis occurs within one year of delivery, miscarriage, or medical abortion. Subacute thyroiditis is a self-limited inflammatory disease characterized by anterior neck pain. Treatment of subacute thyroiditis should focus on symptoms. In the hyperthyroid phase, beta blockers can treat adrenergic symptoms. In the hypothyroid phase, treatment is generally not necessary but may be used in patients with signs and symptoms of hypothyroidism or permanent hypothyroidism. Nonsteroidal anti-inflammatory drugs and corticosteroids are indicated for the treatment of thyroid pain. Certain drugs may induce thyroiditis, such as amiodarone, immune checkpoint inhibitors, interleukin-2, interferon-alfa, lithium, and tyrosine kinase inhibitors. In all cases of thyroiditis, surveillance and clinical follow-up are recommended to monitor for changes in thyroid function.
Subject(s)
Thyroiditis/diagnosis , Thyroiditis/therapy , Hashimoto Disease/diagnosis , Hashimoto Disease/physiopathology , Hashimoto Disease/therapy , Humans , Thyroiditis/physiopathologySubject(s)
Communicable Diseases/diagnosis , Communicable Diseases/therapy , Emergency Service, Hospital , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Thyroiditis/diagnosis , Thyroiditis/therapy , Anti-Bacterial Agents/therapeutic use , Child , Diagnosis, Differential , Diagnostic Imaging , Early Diagnosis , Humans , Intensive Care Units, Pediatric , Patient Admission/statistics & numerical data , Pediatric Emergency MedicineABSTRACT
Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in the management of the patients. Painful thyroiditis includes acute thyroiditis of infectious origin and subacute thyroiditis. The first one can be treated by antibiotics or antifungals depending on the germ found. The second one will be treated with non-steroidal anti-inflammatory drugs or corticosteroids. In cases of Hashimoto's thyroiditis with overt hypothyroidism, replacement therapy with L-thyroxine will be adapted to the TSH level. As amiodarone treatment provides dysthyroidism, the thyroid status should be monitored regularly. Hypothyroidism will be treated using thyroid replacement therapy. Hyperthyroidism imposes a stop of amiodarone when it is possible. Treatment with synthetic antithyroid drugs (propyl-thio-uracil) or corticosteroids could be used whether there is an underlying thyroid disease or not. Immunotherapies with anti-PD-1/PDL1 or anti-CTLA-4 can also provide dysthyroidism. A monitoring of the thyroid assessment needs to be done in these patients, even if there are no clinical signs, which are not very specific in this context. The treatment of hypothyroidism will be based on thyroid replacement therapy according to the TSH level and the presence or absence of anti-TPO antibodies. Treatment of symptomatic hyperthyroidism may involve a prescription of beta-blockers, or synthetic antithyroid drugs in case of positive anti-TSH receptor antibodies. In all cases, it is desirable to contact an endocrinologist to confirm the diagnosis hypothesis and to decide on a suitable treatment.
Subject(s)
Thyroiditis , Acute Disease , Adult , Female , History, 21st Century , Humans , Iatrogenic Disease , Immunotherapy/adverse effects , Interferon-alpha/adverse effects , Iodine/toxicity , Male , Pregnancy , Puerperal Disorders/epidemiology , Puerperal Disorders/therapy , Thyroiditis/complications , Thyroiditis/epidemiology , Thyroiditis/therapy , Thyroiditis, Autoimmune/complications , Thyroiditis, Autoimmune/epidemiology , Thyroiditis, Autoimmune/therapyABSTRACT
Hyperthyroidism is caused by an increased synthesis of thyroid hormones or release of preformed thyroid hormones due to destruction of thyroid tissue, or there is an exogenous extrathyroidal source. The term thyroiditis describes a heterogeneous group of disorders, which result in destruction of thyroid tissue and release of preformed thyroid hormones. Although a less common condition, a thyroiditis remains an important differential diagnosis for thyrotoxicosis, and a symptomatic therapy is the cornerstone of treatment. Because of the classical triphasic clinical course a 'wait and see strategy' is reasonable, especially during the first and self-limited hyperthyroid phase. Usually a transient hypothyroid phase follows, before the euthyroid function is restored within a year. However, as permanent hypothyroidism may result, regular follow-up and in that case treatment with levothyroxine is mandatory.
Subject(s)
Hyperthyroidism/diagnosis , Thyroiditis/diagnosis , Thyrotoxicosis/diagnosis , Adrenergic beta-Antagonists/therapeutic use , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diagnosis, Differential , Female , Hashimoto Disease/diagnosis , Hashimoto Disease/etiology , Hashimoto Disease/therapy , Humans , Hyperthyroidism/etiology , Hyperthyroidism/therapy , Prednisolone/therapeutic use , Prognosis , Thyroiditis/etiology , Thyroiditis/therapy , Thyrotoxicosis/etiology , Thyrotoxicosis/therapy , Watchful WaitingABSTRACT
OBJECTIVE: To compare the clinical effects between ginger-partition moxibustion combined with glucocorticoid and simple oral glucocorticoid for thyreoitis at subacute stage. METHODS: Eighty-one patients were randomly divided into an observation group (41 cases) and a control group (40 cases). In the observation group, ginger-partition moxibustion and hormone were applied. Moxa cones were used at local ashi points, Zusanli (ST 36), Guanyuan (CV 4) and Qihai (CV 6), six cones every point, once every other day and three times a week. Besides, 24 mg methylprednisolone tablets were adopted orally every day, and in two weeks the dose was 16 mg/d, in four weeks 8 mg/d, in six weeks 4 mg/d; all the patients were observed for 8 week. In the control group, simple methylprednisolone was prescribed orally, and the dose, the usage and treatment time were the same as those in the observation group. Erythrocyte sedimentation rate (ESR), triiodothyronine (T3), thyroxin (T4) and ultra-sensitive thyroid stimulating hormone (TSH) before and after treatment were observed in the two groups, as well as fever, the pain of thyroid gland, the regression time of swelling and adverse reaction. RESULTS: The time of thyroid gland pain relieved of the observation group was earlier than that of the control group [(3.07 ± 0.78) days vs (3.62 ± 0.92) days, P < 0.05]. After treatment, T3, T4 and ESR were declined apparently (all P < 0.01), and TSH was obviously increased in the two groups (both P < 0.01). After 2-week treatment, ESR in the observation group was lower than that in the control group (P < 0.05). After 4-week treatment, T3, T4, TSH and ESR in the observation group were better than those in the control group (all P < 0.05). After 8 weeks, all indices in the observation group were superior to those in the control group, without statistical significance between the two groups (all P > 0.05). The effects of the observation group in 2 weeks, 4 weeks and 8 weeks were better than those in the control group (all P < 0.05). The cured course was shorter in the observation group than that in the control group (P < 0.05). The adverse reaction rate in the observation group was lower than that in the control group [4.9% (2/41) vs 22.5% (9/40), P < 0.05]. Three months later after treatment, the cured patients were followed. There was no recrudescence in the observation group and three patients caught the disease again in the control group, but there was no statistical significance between the two groups (P > 0.05). CONCLUSION: Ginger-partition moxibustion combined with glucocorticoid achieves better effect than simple oral glucocorticoid for thyreoitis at subacute stage, and the adverse reaction is less, which presents the clinical advantages of the integration of Chinese and western medicine.
Subject(s)
Glucocorticoids/administration & dosage , Moxibustion , Thyroiditis/therapy , Zingiber officinale/chemistry , Adult , Female , Humans , Male , Middle Aged , Thyroid Gland/drug effects , Thyroid Gland/metabolism , Thyroid Hormones/metabolism , Thyroiditis/drug therapy , Thyroiditis/pathology , Thyrotropin/metabolism , Young AdultABSTRACT
Tuberculosis (TB) of the thyroid gland, either in its primary or secondary form, is an extremely rare occurrence. It is infrequent even in countries with high incidence and prevalence of pulmonary and extrapulmonary TB. We report here a case of primary tuberculosis of thyroid presenting to us with sudden onset thyroid swelling since 20 days.
Subject(s)
Thyroid Diseases/microbiology , Tuberculosis/diagnosis , Antitubercular Agents/therapeutic use , Female , Humans , Middle Aged , Thyroid Diseases/diagnosis , Thyroid Diseases/therapy , Thyroidectomy , Thyroiditis/microbiology , Thyroiditis/therapy , Tuberculosis/therapyABSTRACT
BACKGROUND: Riedel's thyroiditis (RT) is a rare, fibroinflammatory condition which induces gradual thyroid gland destruction and adjacent soft-tissue fibrous infiltration. About one- seventh of RT cases are associated with hypoparathyroidism, necessitating long-term therapy for symptomatic hypocalcemia. The reversibility of the parathyroid hormone deficit has not been fully described. PATIENT FINDINGS: A 40-year-old woman with no prior history of thyroid disease presented with a six month history of progressive thyroid enlargement complicated by worsening dysphagia and positional dyspnea. Her past medical history was remarkable only for retroperitoneal fibrosis. Physical examination revealed a large, hard, non-mobile goiter. Thyroid indices while maintained on levothyroxine were normal, but marked asymptomatic hypocalcemia with an inappropriately normal parathyroid hormone level was noted. Thyroid imaging and fine needle aspiration were consistent with RT. Isthmectomy and subsequent serial corticosteroid and tamoxifen treatment led to rapid symptom improvement. Serum calcium and parathyroid hormone levels returned to the reference range within three months. SUMMARY: We describe a case of RT in which hypoparathyroidism resolved after treatment targeted the mechanical compression and the fibroinflammatory milieu of the patient's thyroidal disease. CONCLUSIONS: RT can be associated with hypoparathyroidism that is clinically silent at presentation. Mechanical decompression of the goiter and immunomodulatory therapy can reverse the fibrosclerotic process and lead to rapid recovery of parathyroid gland function, as in this patient. However, in most cases hypoparathyroidism is persistent and requires continued treatment to prevent symptomatic hypocalcemia.
Subject(s)
Hypoparathyroidism/therapy , Thyroiditis/therapy , Adult , Africa , Biopsy, Fine-Needle , Female , Goiter/pathology , Humans , Hypocalcemia/prevention & control , Hypocalcemia/therapy , Hypoparathyroidism/complications , Hypoparathyroidism/ethnology , Hypoparathyroidism/surgery , Inflammation , Parathyroid Glands/pathology , Parathyroid Hormone/blood , Thyroid Gland/pathology , Thyroid Gland/surgery , Thyroiditis/complications , Thyroiditis/ethnology , Thyroiditis/surgery , Thyroxine/therapeutic use , Treatment OutcomeABSTRACT
El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.
The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.
Subject(s)
Humans , Thyroiditis/diagnosis , Thyroiditis/etiology , Thyroiditis/therapy , Thyroiditis, Subacute/diagnosis , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/etiology , Thyroiditis, Suppurative/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Chronic Disease , Interferon-alpha/adverse effects , Lithium Compounds/adverse effects , Diagnosis, Differential , Glucocorticoids/therapeutic use , Goiter/complications , Amiodarone/adverse effectsABSTRACT
The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.
Subject(s)
Thyroiditis , Amiodarone/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Chronic Disease , Diagnosis, Differential , Glucocorticoids/therapeutic use , Goiter/complications , Humans , Interferon-alpha/adverse effects , Lithium Compounds/adverse effects , Thyroiditis/diagnosis , Thyroiditis/etiology , Thyroiditis/therapy , Thyroiditis, Subacute/diagnosis , Thyroiditis, Subacute/etiology , Thyroiditis, Subacute/therapy , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/etiology , Thyroiditis, Suppurative/therapyABSTRACT
PURPOSE: To report an unusual case of IgG4-related Mikulicz's disease associated with thyroiditis. CASE REPORT: We describe a 25-year-old Chinese man who presented with bilateral, painless swellings of the lachrymal glands, parotid glands, and thyroid nodules. The patient underwent left-sided dacryoadenectomy and the diagnosis of IgG4-related Mikulicz's disease was pathologically confirmed. The size of the right-sided lachrymal gland and parotid glands recovered fundamentally after one month of glucocorticoid therapy. CONCLUSION: IgG4-related Mikulicz's disease associated with thyroiditis should be considered in the differential diagnosis of bilateral swellings of lachrymal glands, salivary glands, and thyroid nodules. Surgical excision is recommended in order to treat the tumor and to ensure the pathological diagnosis. Glucocorticoid therapy should be considered in association with surgery after removal.
Subject(s)
Immunoglobulin G , Mikulicz' Disease/pathology , Thyroiditis/pathology , Adult , Autoimmune Diseases/immunology , Autoimmune Diseases/pathology , Diagnosis, Differential , Glucocorticoids/therapeutic use , Humans , Lacrimal Apparatus , Male , Mikulicz' Disease/immunology , Mikulicz' Disease/therapy , Salivary Glands , Thyroiditis/immunology , Thyroiditis/therapyABSTRACT
INTRODUCTION: Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. OBJECTIVE: This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. MATERIALS AND METHODS: After structuring clinical questions, search for evidence was made available in the literature, initially in the database MedLine, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. RESULTS: We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. CONCLUSIONS: The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. The treatment can be performed with antithyroid drugs, surgery or administration of radioactive iodine according to the etiology of thyrotoxicosis, local availability of methods and preferences of the attending physician and patient.
Subject(s)
Goiter/therapy , Hyperthyroidism , Thyroid Nodule/therapy , Thyroidectomy/standards , Adolescent , Adult , Child , Graves Disease/diagnosis , Graves Disease/therapy , Humans , Hyperthyroidism/diagnosis , Hyperthyroidism/therapy , Thyroiditis/therapy , Thyrotoxicosis/diagnosis , Thyrotoxicosis/therapyABSTRACT
INTRODUÇÃO: O hipertireoidismo é caracterizado pelo aumento da síntese e liberação dos hormônios tireoidianos pela glândula tireoide. A tireotoxicose refere-se à síndrome clínica decorrente do excesso de hormônios tireoidianos circulantes, secundário ao hipertireoidismo ou não. Este artigo descreve diretrizes baseadas em evidências clínicas para o manejo da tireotoxicose. OBJETIVO: O presente consenso, elaborado por especialistas brasileiros e patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia, visa abordar o manejo, diagnóstico e tratamento dos pacientes com tireotoxicose, de acordo com as evidências mais recentes da literatura e adequadas para a realidade clínica do país. MATERIAIS E MÉTODOS: Após estruturação das questões clínicas, foi realizada busca das evidências disponíveis na literatura, inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO - Lilacs. A força das evidências, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão. RESULTADOS: Foram definidas 13 questões sobre a abordagem clínica inicial visando ao diagnóstico e ao tratamento que resultaram em 53 recomendações, incluindo investigação etiológica, tratamento com drogas antitireoidianas, iodo radioativo e cirurgia. Foram abordados ainda o hipertireoidismo em crianças, adolescentes ou pacientes grávidas e o manejo do hipertireoidismo em pacientes com oftalmopatia de Graves e com outras causas diversas de tireotoxicose. CONCLUSÕES: O diagnóstico clínico do hipertireoidismo, geralmente, não oferece dificuldade e a confirmação diagnóstica deverá ser feita com as dosagens das concentrações séricas de TSH e hormônios tireoidianos. O tratamento pode ser realizado com drogas antitireoidianas, administração de radioiodoterapia ou cirurgia de acordo com a etiologia da tireotoxicose, as características clínicas, disponibilidade local de métodos e preferências do médico-assistente e paciente.
INTRODUCTION: Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. OBJECTIVE: This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. MATERIALS AND METHODS: After structuring clinical questions, search for evidence was made available in the literature, initially in the database MedLine, PubMed and Embase databases and subsequently in SciELO - Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. RESULTS: We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. CONCLUSIONS: The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. The treatment can be performed with antithyroid drugs, surgery or administration of radioactive iodine according to the etiology of thyrotoxicosis, local availability of methods and preferences of the attending physician and patient.
Subject(s)
Adolescent , Adult , Child , Humans , Goiter/therapy , Hyperthyroidism , Thyroid Nodule/therapy , Thyroidectomy/standards , Graves Disease/diagnosis , Graves Disease/therapy , Hyperthyroidism/diagnosis , Hyperthyroidism/therapy , Thyroiditis/therapy , Thyrotoxicosis/diagnosis , Thyrotoxicosis/therapyABSTRACT
Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.
Subject(s)
Carcinoma/complications , Hashimoto Disease/complications , Thyroid Neoplasms/complications , Thyroiditis, Suppurative/complications , Thyroiditis/complications , Anti-Bacterial Agents/therapeutic use , Biopsy , Carcinoma/diagnosis , Carcinoma/therapy , Carcinoma, Papillary , Female , Hashimoto Disease/diagnosis , Hashimoto Disease/therapy , Hormone Replacement Therapy , Humans , Lymph Node Excision , Middle Aged , Thyroid Cancer, Papillary , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/therapy , Thyroidectomy , Thyroiditis/diagnosis , Thyroiditis/therapy , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/therapy , Thyroxine/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Interferon-alpha (IFNα)-induced thyroid dysfunction occurs in up to 20% of patients undergoing therapy for hepatitis C. The diversity of thyroid disease presentations suggests that several different pathological mechanisms are involved, such as autoimmunity and direct toxicity. Elucidating the relationships between risk factors and disease phenotype provides insight into the mechanisms of disease pathophysiology. METHODS: We studied 869 euthyroid patients from the ACHIEVE 2/3 trial, a randomized international clinical trial comparing pegylated-IFNα2a weekly or albumin-IFNα2b every 2 weeks for up to 24 weeks in patients with hepatitis C, genotype 2 or 3, from 136 centers. The study population was 60% male and 55% white. Serum thyrotropin (TSH) and free thyroxine were measured before therapy, monthly during treatment from week 8, and at 4- and 12-week follow-up visits. RESULTS: Overall, 181 (20.8%) participants had at least one abnormal TSH during the study. Low TSH occurred in 71 (8.2%), of whom 30 (3.5%) had a suppressed TSH below 0.1 mU/L. Hypothyroidism occurred in 53 patients (6.1%), with peak TSH above 10 mU/L in 12 patients (1.4%). Fifty-seven patients had a biphasic thyroiditis (6.6%), with extreme values for the nadir and/or peak TSH in all but one. Medical therapy was given to one thyrotoxic patient, four hypothyroid patients, and 26 biphasic thyroiditis patients. Multivariate logistic regression analysis demonstrated that biphasic thyroiditis is associated with being female and higher pretreatment serum TSH, whereas being Asian or a current smoker decreased the risk of thyroiditis. Hypo- and hyperthyroidism are most strongly predicted by the pretreatment TSH. CONCLUSIONS: Biphasic thyroiditis accounted for the majority (58%) of clinically relevant IFNα-induced thyroid dysfunction. We confirmed our recent findings in a related cohort that female sex is a risk factor for thyroiditis but not hypothyroidism. Further, in this large multiethnic study, the risk of thyroiditis is dramatically increased, specifically for white women. Smoking was found to be protective of thyroiditis. These results support closer monitoring of women and those with a serum TSH at the extremes of the normal range during therapy so that prompt intervention can mitigate the consequences of thyroid dysfunction associated with IFNα treatment.
Subject(s)
Antiviral Agents/adverse effects , Hepatitis C/drug therapy , Hypothyroidism/chemically induced , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Racial Groups , Serum Albumin/adverse effects , Smoking/adverse effects , Thyroiditis/chemically induced , Thyrotropin/blood , Adult , Asia/epidemiology , Biomarkers/blood , Chi-Square Distribution , Europe/epidemiology , Female , Hepatitis C/blood , Hepatitis C/diagnosis , Hepatitis C/ethnology , Humans , Hypothyroidism/blood , Hypothyroidism/ethnology , Hypothyroidism/therapy , Logistic Models , Male , Middle Aged , Multivariate Analysis , North America/epidemiology , Odds Ratio , Recombinant Fusion Proteins/adverse effects , Recombinant Proteins/adverse effects , Risk Factors , Serum Albumin, Human , Sex Factors , South America/epidemiology , Thyroiditis/blood , Thyroiditis/ethnology , Thyroiditis/therapy , Thyroxine/blood , Time Factors , Treatment OutcomeABSTRACT
The diagnosis of thyroiditis encompasses a broad spectrum of thyroid disorders. Analysis of signs and symptoms, biochemical changes, neck ultrasound characteristics and radioactive iodine uptake values allows an accurate diagnosis. Recent studies of the whole genome have helped to identify many susceptibility genes for autoimmune thyroiditis. However, none of these genes contribute to a significant increase in risk of developing this thyroiditis. Clinical awareness of the characteristic presentations of exceptional thyroiditis (acute suppurative thyroiditis, Riedel's thyroiditis) is an important issue. Selenium administration seems to be beneficial for reducing the incidence of thyroiditis. Finally, certain drug-induced thyroiditis remains a therapeutic challenge for the physician.
Subject(s)
Thyroiditis , Diagnosis, Differential , Environment , Genetic Predisposition to Disease , Hashimoto Disease/diagnosis , Humans , Iatrogenic Disease/epidemiology , Risk Factors , Thyroiditis/diagnosis , Thyroiditis/epidemiology , Thyroiditis/etiology , Thyroiditis/therapy , Thyroiditis, Autoimmune/diagnosis , Thyroiditis, Suppurative/diagnosisABSTRACT
OBJECTIVE: Hepatitis C virus (HCV) infection is one of the major epidemics afflicting young people in both developed and developing countries. The most common endocrine disorder associated with this infection, especially in conjunction with interferon-α (IFN-α)-based therapy, is thyroid disease (TD). This review examines the development of TD before, during, and after the completion of treatment with combination IFN-α and ribavirin (RBV) for chronic HCV infection. We also summarize the current understanding of the natural history of the condition and propose management and follow-up guidelines. METHODS: PubMed was searched up to June 30, 2011 for English-language publications that contained the search terms "hepatitis C virus," "chronic hepatitis C," "HCV," "thyroid disease," "thyroiditis," "autoimmunity," "interferon-alpha," and "ribavirin." Additional publications were identified from the reference lists of identified papers. The included studies were original research publications and included combination IFN-α and RBV use in patients that developed TD. RESULTS: The prevalence of TD before combination IFN-α and RBV therapy ranges from 4.6 to 21.3%; during therapy, 1.1 to 21.3%; and after therapy, 6.7 to 21.3%. The most common TD is thyroiditis. Thyroid function testing (TFT) frequency and diagnostic criteria for various thyroid conditions are not standardized, and many of the existing studies are retrospective. CONCLUSION: Patients undergoing this therapy should be assessed with a standardized protocol to appropriately detect and manage developed TD. Based on the currently available literature, we recommend that patients receiving combination interferon-α and RBV therapy undergo monthly thyrotropin (TSH) level testing.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Ribavirin/therapeutic use , Thyroid Diseases/etiology , Antiviral Agents/adverse effects , Disease Susceptibility , Drug Monitoring , Drug Therapy, Combination/adverse effects , Evidence-Based Medicine , Hepatitis C, Chronic/immunology , Hepatitis C, Chronic/physiopathology , Humans , Interferon-alpha/adverse effects , Practice Guidelines as Topic , Ribavirin/adverse effects , Thyroid Diseases/chemically induced , Thyroid Diseases/immunology , Thyroid Diseases/therapy , Thyroid Gland/drug effects , Thyroid Gland/immunology , Thyroiditis/chemically induced , Thyroiditis/etiology , Thyroiditis/immunology , Thyroiditis/therapyABSTRACT
Riedel's thyroiditis, known as invasive fibrous thyroiditis, is a very rare form of chronic thyroiditis. It is hard to make the diagnosis without surgical biopsy. We present a case of Riedel's thyroiditis in a 52-year-old female with past history of Hashimoto's thyroiditis. She suffered from bilateral neck pain, which radiated to both lower jaws. The erythrocyte sedimentation rate was 125 mm/hour. Subacute thyroiditis superimposed on Hashimoto's thyroiditis was diagnosed and treated with steroid. However the response was poor and she had a history of severe peptic ulcer. To avoid inducing the peptic ulcer by steroid, she received bilateral subtotal thyroidectomy. During surgery, the thyroid had severe adhesion to surrounding soft tissue and the pathology showed Riedel's thyroiditis. The neck pain improved after thyroidectomy. Tamoxifen has been given for 8 months and the size of remnant thyroid decreased to 8 mm. We concluded that combined thyroidectomy and tamoxifen successfully cured a patient with Riedel's thyroiditis.