Thyroiditis – also known as inflammation of the thyroid gland – is a disease of the thyroid gland and accounts for about one to three percent of all diseases of the organ. At about 80 percent, Hashimoto’s thyroiditis, a chronic thyroiditis, is the most common form of thyroiditis.
What is thyroiditis?
Thyroiditis is either a focal or diffusely distributed inflammation of the thyroid tissue. The course may be acute, subacute, or chronic. The various forms have completely different causes and thus each represents an independent clinical picture. A further subdivision of the disease is made into painless and painful thyroiditis.
Causes
Thyroiditis can have different causes. Some forms are triggered by infections with bacteria or viruses, while others are caused by injury to the organ or exposure to ionizing radiation. Likewise, autoimmune diseases can also be the cause of thyroiditis. In autoimmune diseases, cells of the immune system are directed not only against invading pathogens. In addition to the foreign bodies, the body’s own healthy cells are also attacked. Due to a wide variety of causes, the course of thyroiditis can also vary. The causes for the development of subacute thyroiditis, also called Quervain’s thyroiditis after Fritz de Quervain, are still unknown. However, it has been observed that this form of thyroiditis often occurs following airway infections.
Symptoms, complaints, and signs
In acute thyroiditis, severe difficulty swallowing presents within a few hours or days. Sick individuals experience hoarseness, coughing, and increasing pain, among other symptoms. In addition, a high fever develops, accompanied by chills, fatigue and other general symptoms. The thyroid gland swells and can often be palpated externally. If thyroiditis is treated early, further complications can usually be avoided. Drug therapy counteracts the above symptoms, which usually resolve within two to three days. Subacute thyroiditis presents over the course of two to three weeks. During this period, the thyroid gland swells severely and begins to ache. A general feeling of malaise as well as fever and difficulty swallowing are also present. The throat is usually very sensitive to pressure and the voice seems weakened or altered. In subacute thyroiditis, there is usually no swelling of the lymph nodes. However, mild hyperthyroidism may occur at the beginning of the disease, usually associated with restlessness, irritability, and physical discomfort. The subacute form also resolves quickly with appropriate treatment. Most patients are free of symptoms after three weeks at the latest.
Diagnosis and course
In acute thyroiditis, the enlarged thyroid gland can often be palpated. A blood test reveals elevated levels of white blood cells (leukocytes) and accelerated blood sedimentation, which can be understood as general indications of an inflammatory response in the body. In the next step, an ultrasound examination (sonography) is used to determine acute thyroiditis and to rule out other disease. Subacute thyroiditis shows only a slightly increased concentration of white blood cells in the blood count, but a significantly increased blood sedimentation. In many cases, thyroid antibodies are also found in the blood, although they are far below the levels of a chronic inflammation, such as those of Hashimoto’s thyroiditis. Often, the doctor can confirm the diagnosis only after a fine-needle biopsy, in which tissue is removed from the thyroid gland. If the thyroiditis is severe, examination of the removed tissue will show a severe reaction, often associated with nodule formation. Thyroiditis can take a different course, be painful or, as is often the case with chronic thyroiditis, be extremely painless. The disease can occur acutely or insidiously, almost unnoticed, so that a therapy must be individually designed depending on the type of thyroiditis.
Complications
Depending on its form, thyroiditis can cause various complications. First, thyroiditis results in enlargement of the thyroid gland, which is associated with severe pain, fever, and a general feeling of illness. In a severe course, the fever can develop into a life-threatening condition. In addition, restlessness, irritability and lack of sleep can occur as a result of the disease – a frequent trigger for accidents in everyday life. Thyroiditis caused by bacteria can lead to the development of abscesses in its course. The acute form often results in a proliferation of connective tissue into the actual glandular tissue. If this displaces the hormone-producing tissue, it may result in hypothyroidism. In the subacute form, scar tissue can form, which can also cause hypothyroidism. When thyroiditis is treated via hormone therapy, sleep problems, extreme malaise, and a decrease in sexual interest may occur. There is also an increased risk of osteoporosis and depression. In women, hormone therapy may cause menstrual irregularities. The use of antirheumatic drugs and other preparations may also be associated with side effects and allergic reactions.
When should you see a doctor?
Headache, muscle pain, difficulty swallowing, and fatigue are typical symptoms of thyroiditis. A visit to the doctor is recommended if symptoms persist for more than two to three days. If pain occurs in the thyroid area, it is best to consult a doctor immediately. Thyroiditis often occurs after trauma, radioiodine or radiation therapy, or bacterial infections of the throat, nose, and ears. The subacute form develops as a result of an upper respiratory tract infection. Those who belong to the risk groups must have the symptoms mentioned clarified quickly. People with immunodeficiency, the chronically ill, the elderly, pregnant women and children should see their family doctor if thyroiditis is suspected. Pregnant women may also develop postpartum thyroiditis six to 24 weeks after delivery, which manifests as repeated infections and must be treated promptly. If the symptoms occur after taking certain medications such as interferon or amiodarone, a change in medication is necessary. Thyroiditis is treated by an internist or a general practitioner. Chronic and severe symptoms should be clarified in a specialist clinic for thyroid diseases.
Treatment and therapy
Depending on the form of the disease, the course of thyroiditis varies. Acute as well as subacute thyroiditis respond well to therapy and often heal after a few weeks and after three to six months, respectively. In the case of chronic thyroiditis, the situation is different. In the long run, the destruction of the hormone-producing tissue is observed here, whereupon a therapy with the missing thyroid hormone is prescribed, starting with a low dose, which must be adjusted again and again and maintained for life. Thyroiditis must be treated according to the type of causative agent. Acute thyroiditis due to bacterial infection can be well treated with antibiotics. In case of a mild course, tablets are sufficient, but if it is a more severe form of thyroiditis, infusions are administered. In febrile illness, high fluid intake and strict bed rest are recommended. Until the symptoms subside, the neck can be cooled supportively. Subacute thyroiditis often takes a rather mild course. Anti-inflammatory drugs with a mild anesthetic effect are helpful here. In the case of more severe symptoms, cortisone brings relief the very next day. Chronic thyroiditis results in the gradual destruction of tissue, ultimately leaving behind a non-functioning thyroid gland. Therefore, for example, Hashimoto’s thyroiditis itself is not curable. However, thyroid hormone in the form of L-thyroxine must be substituted throughout life.
Prevention
Prevention of thyroiditis is possible only to the extent that care can be taken to treat bacterial and viral infections in a sustained manner.A disease that has not healed favors a secondary infection, which can promote or even cause thyroiditis.
Follow-up
In most cases, thyroiditis is not a disease in its own right. Other diseases often underlie the symptoms. Thyroiditis is often caused by autoimmune diseases. The physician adapts the follow-up care to the respective symptoms, their manifestation and the actual cause. In addition, it must be differentiated whether a chronic or an acute thyroiditis is present. The aim of follow-up care is to alleviate and heal the inflammation. If another disease is causing the symptoms, it will be corrected during follow-up. This sometimes requires a biopsy at the discretion of the specialist. The development of hyperthyroidism or hypothyroidism should also be prevented. The patient is given medication against secondary complaints such as fatigue. Painkillers are also prescribed. As part of the aftercare, the doctor checks the healing progress. A healed acute inflammation does not require any further aftercare. In the chronic form, the controls extend over months or even years. Regular blood tests provide information about the hormone production in the thyroid gland. Deviating hormone values are treated with appropriate medicine or require further examination. In the case of severe inflammation, foci of pus can form on the thyroid gland. They are punctured or surgically removed. The specialist finishes the follow-up when the healing is satisfactory. At this point, treatment is complete.
What you can do yourself
Patients with thyroiditis can strengthen their organism by perceiving various measures that will stabilize the immune system. In addition to a balanced and healthy diet, the intake of vitamins, as well as sufficient exercise, the avoidance of harmful substances is particularly important. Therefore, the consumption of alcohol, drugs, nicotine or non-prescribed medications should be completely refrained from. Sporting activities and an optimal oxygen supply support the body’s immune system. Optimal sleep hygiene, sufficient rest and recovery phases, and leisure activities tailored to the needs of the affected person promote well-being and strengthen the organism. If the disease progresses chronically, mental strengthening is particularly important for coping with the disease. Mental techniques can be used to reduce stressors. Cognitive training, yoga or meditation are only a few possibilities that are used in the context of self-help. They support the quality of life and contribute to a positive basic attitude. Care should be taken to ensure that an adequate amount of fluid is consumed daily. Therefore, fluid balance should be well monitored and adequately regulated. Since swallowing difficulties are common, ingested foods should be sufficiently ground in the mouth. The grinding action of the teeth should be utilized so that pieces of food that are too large are not transported into the esophagus.
