Inflammations belong to the rather rare diseases of the thyroid gland. Behind the term “thyroiditis” is an inhomogeneous group of different clinical pictures. However, they have one thing in common: a diffuse or focal inflammatory reaction of the thyroid tissue to an inflammatory stimulus. Thyroiditis can be classified according to its cause, its clinical course, or its histology, that is, the microscopic image of the thyroid tissue.
When does thyroiditis develop?
Acute thyroiditis is usually caused by bacteria that have spread through the bloodstream or lymphatic system. Less commonly, it develops from other infections (tuberculosis, syphilis, fungi), as a result of radiation or certain medications, or from an autoimmune reaction or injury. Subacute thyroiditis (de Quervain) is probably triggered by viruses, for example from a measles or mumps infection. The post-pregnancy form triggered by autoimmune processes (postpartum thyroiditis) is also usually subacute. Chronic thyroiditis is almost always caused by an autoimmune disease in which the defense system mistakenly produces antibodies against the body’s own tissue. Depending on which antibodies and cells can be found in the tissue, different forms of this autoimmune thyroiditis are distinguished. The best known are Hashimoto’s thyroiditis and Riedel’s stroma. Rarely, drugs or other diseases such as AIDS are the cause.
Symptoms of acute thyroiditis.
Symptoms vary depending on the form of thyroiditis. In the acute form, there is usually a renewed rise in fever with sweating and swelling of the thyroid gland, which usually increases quite rapidly, after an infection in the throat, nose or ear area. The pain may radiate to the ear and jaw region, while the swelling is often confined to one area. The skin over this is reddened. Sufferers often feel very ill and have difficulty swallowing.
Symptoms of subacute thyroiditis.
The symptoms of the subacute form can range from no symptoms to severe courses like those of acute thyroiditis. Acute tenderness, which may radiate, is typical. The thyroid gland is only moderately enlarged. Sometimes hyperthyroidism occurs transiently.
Symptoms of chronic thyroiditis.
The chronic forms are usually accompanied by a painless enlargement of the thyroid gland. Especially at the beginning, those affected usually have no symptoms at all, which is why the disease is rarely recognized in its early stages. Later, some forms may cause pressure on the airways and neck vessels. When the tissue is destroyed by the progressive inflammatory process, hypothyroidism results with corresponding symptoms. These include:
- Sensitivity to cold
- Pulse slowing
- Cool, dry skin
- Thin, shaggy hair
- Sluggishness
- Depression
How is the diagnosis made?
First, the doctor will take the medical history. He will palpate the thyroid gland and examine its size and condition with ultrasound, possibly taking a tissue sample. Blood tests are important – depending on the suspected disease, they will look for hormone changes, antibodies or signs of inflammation. Metabolic activity and function of the thyroid gland can be assessed by scintigraphy by checking the accumulation of iodine in the thyroid gland. During scintigraphy, the patient receives an injection of a radioactively labeled substance into a vein. If the thyroid gland is hypothyroid, it absorbs little to no of the substance, while if it is hyperthyroid, some areas of the thyroid gland absorb excessive amounts.
What are the treatment options?
Depending on the cause, antibiotics and anti-inflammatories and/or pain medications may be prescribed. If the inflammation is acute, the patient should be on bed rest. Cold neck compresses help with the pain. In some cases, cortisone is indicated; in others, no treatment is necessary – the inflammation recedes on its own after a few weeks. If there is hypothyroidism, this is compensated for with thyroid medication.
