What is thyroiditis?

Thyroiditis means inflammation of thyroid gland ( a butterfly shaped endocrine gland located in the neck). This can result from some viral infections, antibodies, some drugs, radiation etc. Due to any such reason, inflammation of thyroid gland occurs and this leads to the release of all of the preformed stored thyroid hormone into the blood circulation resulting in thyrotoxic symptoms. Subsequently due to destruction of the follicles thyroid hormone synthesis ceases and hypothyroidism results.

What is the role of thyroid hormone?

Thyroid hormone helps in using energy, keep the body warm and maintaining the working of brain, heart, muscle and other organs in order. Both excess (called as thyrotoxicosis) and deficiency of thyroid hormone ( called as hypothyroidism) may be harmful and cause problems.

What are the types of thyroiditis?

1. Subacute thyroiditis (De quervain’s thyroiditis)- Occurs due to some viral infection. Predominant feature is thyroidal pain. Initially there isa thyrotoxic phase (lasting 1-3months), followed by normalization of thyroid profile and later hypothyroid phase ( lasting 6-12months). Most patients recover in 12-18months. They may require thyroid hormone replacement.

2. Silent thyroiditis (painless and postpartum thyroiditis)- Postpartum thyroiditis occurs within 6 months of delivery of a baby. Painless thyroiditis can occur at any time in both men and women. It goes through same phases of thyrotoxicosis initially and hypothyroidism later. Most patients recover in 12-18months.

3. Hashimoto’s thyroiditis– It is an autoimmune disease. Anti-thyroid antibodies form and cause slow destruction of thyroid gland. Rarely these patients also may have symptoms of thyrotoxicosis. Usually they develop permanent hypothyroidism.

4. Drug induced thyroiditis– Can result from drugs like lithium, interferon, amiodarone, cytokines. Thyrotoxic phase is usually short lived and is followed by hypothyroidism. Disease resolves with discontinuation of the offending drug.

5. Radiation induced thyroiditis– Occurs due to radiation therapy given for cancers or radioactive iodine therapy given for hyperthyroidism. These patients may develop thyrotoxic symptoms initially, but more commonly they present with hypothyroidism, usually permanent.

6. Acute suppurative thyroiditis– Caused by infectious agents, mostly bacterial. Patients present with thyroidal pain, generalized illness and mild hypothyroidism.

What are the symptoms of thyroiditis?

There are three phases of thyroiditis

a. Thyrotoxic phase– During thyrotoxic phase patients present with anxiety, insomnia, palpitations (fast heart rate), weight loss, fatigue, irritability and increased stool frequency. Thyroidal pain is present in subacute and acute suppurative thyroiditis. Duration of thyrotoxic phase varies in different types of thyroiditis. It is 1-3months in subacute and silent thyroiditis, shorter in radiation and drug induced thyroiditis and may be absent in hashimoto’s and acute suppurative thyroiditis.

b. Normal – Thyrotoxic symptoms settle and thyroid profile may show a normal result. Generally lasts 1-3months after thyrotoxic phase.

c. Hypothyroid phase– Typical symptoms include weight gain, fatigue, dry skin, constipation, depression and poor exercise tolerance. It generally lasts 9-12months.

How do you diagnose thyroiditis?

1. History taking and physical examination by your doctor
2. Blood tests for thyroid profile with or without antibodies depending on the type of thyroiditis.
3. You may also require radioactive iodine uptake scan to rule out other causes of thyrotoxicoxis- low uptake will confirm the diagnosis of thyroiditis.
4. Sometimes, Ultrasound neck and fine needle aspiration cytology (FNAC) may be required if goiter/ thyroid nodule is present.

What is the treatment of thyroiditis?

1. Thyrotoxic phase– If you are having adrenergic symptoms ( like tremors, anxiety, palpitations, tachycardia), then your doctor may give you beta blockers for few days. Antithyroid drugs are not required.

2. Thyroidal pain– Pain associated with subacute thyroiditis responds to anti-inflammatory drugs that is non-steroidal anti-inflammatory drugs. Rarely you may require a short course of steroids if symptoms are severe.

3. Hypothyroid phase– Depending upon your history, findings and thyroid profile, your doctor may put you on thyroid hormone replacement. It is usually required in hashimoto’s thyroiditis, but in other forms it is required only if you fulfill certain conditions like you are symptomatic for hypothyroidism, planning pregnancy, have goiter, positive antibodies etc. If started, it will generally be required for 6-12months and then tapered. But if you have permanent hypothyroidism ( you will come to know after tapering off the medicine), then life long treatment is required.

What is the outcome of thyroiditis?

1. Most cases of hashimoto’s and radiation induced thyroiditis have permanent hypothyroidism.
2. About 5% cases of subacute thyroiditis and 20% cases of silent and postpartum thyroiditis also land up in permanent hypothyroidism.
3. Drug induced thyroiditis recovers after stopping the offending drug.
4. Acute suppurative thyroiditis recovers after treating the infection.