{"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) Overview Pathology and Pathogenesis Clinical Features Laboratory Findings Phases Management<\/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","post-wrapper","thrv_wrapper"],"_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}]}}