{"id":4422361,"date":"2025-01-11T15:06:43","date_gmt":"2025-01-11T21:06:43","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/thyroiditis\/"},"modified":"2025-01-12T18:45:42","modified_gmt":"2025-01-13T00:45:42","slug":"thyroiditis","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/thyroiditis\/","title":{"rendered":"Thyroiditis"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">CHRONIC LYMPHOCYTIC (HASHIMOTO) THYROIDITIS<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Overview and Epidemiology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Most common cause of primary hypothyroidism<\/strong> in iodine-replete regions.<\/li>\n\n\n\n<li><strong>Autoimmune<\/strong> in nature, characterized by antibodies against thyroid antigens (e.g., thyroid peroxidase, thyroglobulin).<\/li>\n\n\n\n<li><strong>Female : Male ratio<\/strong> is about <strong>8 : 1<\/strong>.<\/li>\n\n\n\n<li><strong>Genetic Predisposition<\/strong>: Often associated with other endocrine autoimmune disorders.<\/li>\n\n\n\n<li><strong>Onset<\/strong>: Usually becomes clinically evident between <strong>20 and 40 years<\/strong> of age.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pathology<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Histologic Features<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Diffuse lymphocytic infiltration<\/strong> (T and B cells).<\/li>\n\n\n\n<li>Destruction of thyroid follicles.<\/li>\n\n\n\n<li>Formation of <strong>lymphoid germinal centers<\/strong>.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/myendoconsult.com\/learn\/endocrinology-physical-exam\/\" data-wpil-monitor-id=\"131\">Physical Exam<\/a><\/strong>\n<ul class=\"wp-block-list\">\n<li>Asymptomatic, <strong>firm, symmetric <a href=\"https:\/\/myendoconsult.com\/learn\/topics\/goiters\/\" data-wpil-monitor-id=\"132\">goiter<\/a><\/strong> (borders scalloped, pseudopodia, bosselated surface).<\/li>\n\n\n\n<li>Often discovered incidentally or when hypothyroid symptoms appear.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Course<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Progression<\/strong> from subclinical to overt hypothyroidism over time (gradual loss of thyroid function).<\/li>\n\n\n\n<li><strong>Serologic Findings<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Elevated <strong>thyroid peroxidase (TPO)<\/strong> and <strong>thyroglobulin<\/strong> antibodies.<\/li>\n\n\n\n<li>Primary hypothyroidism \u2192 elevated <strong>TSH<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1579\" height=\"982\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Hashimotos-thyroiditis-high-power-compressed.jpg\" alt=\"Hashimoto\u2019s thyroiditis characterized by dense lymphoplasmacytic infiltrate and Hurthle cell metaplasia Large areas of thyroid parenchyma are replaced by inflammatory infiltrate\" class=\"wp-image-4416296\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Hashimotos-thyroiditis-high-power-compressed.jpg 1579w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Hashimotos-thyroiditis-high-power-compressed-300x187.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Hashimotos-thyroiditis-high-power-compressed-768x478.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Hashimotos-thyroiditis-high-power-compressed-1536x955.jpg 1536w\" sizes=\"auto, (max-width: 1579px) 100vw, 1579px\" \/><figcaption class=\"wp-element-caption\">Hashimoto\u2019s thyroiditis characterized by dense lymphoplasmacytic infiltrate and Hurthle cell metaplasia\nLarge areas of thyroid parenchyma are replaced by inflammatory infiltrate\n<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Levothyroxine replacement<\/strong> to correct hypothyroidism.<\/li>\n\n\n\n<li><strong>Thyroid biopsy<\/strong> usually unnecessary (diagnosis based on antibody tests + TSH).<\/li>\n\n\n\n<li><strong>Surgery<\/strong> only indicated for specific reasons, e.g., a large symptomatic goiter.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">FIBROUS (RIEDEL) THYROIDITIS<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Overview<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Rare<\/strong>, primarily affects males.<\/li>\n\n\n\n<li><strong>Chronic proliferative fibrosing process<\/strong> involving the thyroid gland, potentially extending to trachea, esophagus, fasciae, muscles.<\/li>\n\n\n\n<li>May be part of a <strong>systemic fibrosing disorder<\/strong> (e.g., also retroperitoneal or mediastinal fibrosis).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pathology<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Microscopic Features<\/strong>\n<ul class=\"wp-block-list\">\n<li>Marked <strong>diffuse fibrosis<\/strong> with infiltration by macrophages and eosinophils.<\/li>\n\n\n\n<li>Remnant thyroid acini compressed by dense fibrous stroma.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Gross Appearance<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>\u201cWoodlike,\u201d stony-hard<\/strong> thyroid texture.<\/li>\n\n\n\n<li>Gland often enlarged asymmetrically, firmly adherent to adjacent structures (but not skin).<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Features<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Neck pressure, tightness<\/strong>, dysphagia, hoarseness.<\/li>\n\n\n\n<li>May have elevated thyroid autoantibodies (TPO, thyroglobulin), but often <strong>euthyroid<\/strong>.<\/li>\n\n\n\n<li><strong>TSH<\/strong> may be normal or slightly abnormal.<\/li>\n\n\n\n<li>Diagnosis confirmed by <strong>thyroid biopsy<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medical Therapy<\/strong>: Glucocorticoids or tamoxifen can halt or reverse fibrotic progression in some cases.<\/li>\n\n\n\n<li><strong>Surgery<\/strong>: May be required for symptomatic tracheal compression.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">SUBACUTE THYROIDITIS (DE QUERVAIN THYROIDITIS)<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Overview<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Also called <strong>subacute granulomatous thyroiditis, acute nonsuppurative thyroiditis<\/strong>.<\/li>\n\n\n\n<li><strong>Abrupt onset<\/strong> of hyperthyroid symptoms (fever, fatigue, myalgias), with a <strong>very tender<\/strong> thyroid enlargement.<\/li>\n\n\n\n<li><strong>Five times<\/strong> more frequent in women.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pathology and Pathogenesis<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Likely Viral-Related<\/strong>\n<ul class=\"wp-block-list\">\n<li>Many have a recent history of upper respiratory infection.<\/li>\n\n\n\n<li>Viral insult \u2192 follicular damage \u2192 release of stored T4\/T3 \u2192 transient hyperthyroidism, later hypothyroid phase.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Histology<\/strong>\n<ul class=\"wp-block-list\">\n<li>Inflammatory reaction with lymphocytes, neutrophils, necrosis of <a href=\"https:\/\/myendoconsult.com\/learn\/normal-thyroid-follicular-cells\/\" data-wpil-monitor-id=\"133\">follicular cells<\/a>.<\/li>\n\n\n\n<li>Disruption of thyroid follicles.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Features<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Thyroid gland is <strong>painful, tender<\/strong> (sometimes severely).<\/li>\n\n\n\n<li>Enlargement often <strong>asymmetric<\/strong>, 1.5\u20132\u00d7 normal size.<\/li>\n\n\n\n<li>Pain can radiate to jaw\/ears; dysphagia may occur.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Laboratory Findings<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Elevated<\/strong> free T4, total T3, and thyroglobulin.<\/li>\n\n\n\n<li><strong>Suppressed<\/strong> TSH.<\/li>\n\n\n\n<li><strong>Low<\/strong> <a href=\"https:\/\/myendoconsult.com\/learn\/radioactive-iodine-uptake-and-scan\/\" data-wpil-monitor-id=\"134\">radioactive iodine uptake<\/a> (typically &lt;2%) because the inflamed gland cannot concentrate iodine.<\/li>\n\n\n\n<li><strong>Elevated ESR<\/strong> (&gt;50 mm\/h), possible leukocytosis.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Phases<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Hyperthyroid Phase<\/strong>: 2\u20138 weeks of high T3\/T4 release from damaged follicles.<\/li>\n\n\n\n<li><strong>Hypothyroid Phase<\/strong>: Post-inflammation, as stored hormone is depleted before regeneration.<\/li>\n\n\n\n<li><strong>Recovery<\/strong>: Normal function usually returns eventually.<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Pain Control<\/strong>\n<ul class=\"wp-block-list\">\n<li>NSAIDs or short-course glucocorticoids (2\u20138 weeks).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Symptomatic Relief<\/strong>\n<ul class=\"wp-block-list\">\n<li>\u03b2-blockers for tremor, palpitations, anxiety.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Hypothyroid Phase<\/strong>\n<ul class=\"wp-block-list\">\n<li>Levothyroxine if clinically symptomatic, usually for 6\u20138 weeks.<\/li>\n\n\n\n<li>Normal thyroid function typically resumes.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>CHRONIC LYMPHOCYTIC (HASHIMOTO) THYROIDITIS Overview and Epidemiology Pathology Clinical Course Management FIBROUS (RIEDEL) THYROIDITIS Overview Pathology Clinical Features Management SUBACUTE THYROIDITIS (DE QUERVAIN THYROIDITIS)&hellip;<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[683],"class_list":["post-4422361","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-thyroid-gland"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422361","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":4,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422361\/revisions"}],"predecessor-version":[{"id":4422839,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422361\/revisions\/4422839"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422361"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422361"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}