7 Types and Diagnosis of Thyroiditis | Endocrinology


What is thyroiditis?

The thyroid gland is butterfly-shaped (weighing 15-20 grams) located in front of the lower neck between Adam’s apple and the breastbone. It produces hormones that regulate the metabolism of the thyroid. Metabolism is the rate at which your body processes things (how fast it burns food for energy and heat). Thyroiditis is an inflammation or inflammation of the thyroid gland and leads to either high or low thyroid hormone production.

Thyroiditis has three stages:

  • Thyrotoxic phase: Thyrotoxicosis means that the thyroid is inflamed and releasing too many hormones.
  • Hypothyroid phase: After a few weeks or months of overactive thyroid hormones, there may not be enough thyroid hormones to release the thyroid. This can lead to a lack of thyroid hormones or hypothyroidism.
  • Euthyroid stage: In the third euthyroid stage, thyroid hormone levels are normal. This stage can come temporarily after the thyrotoxic phase before moving to the hypothyroid stage or it can come finally after the thyroid gland can recover from inflammation and maintain normal hormone levels.

Types of thyroiditis

  1. Hashimoto’s thyroiditis: An autoimmune disease caused by antithyroid antibodies. It is the most common form of thyroiditis and is five times more common in women than in men. Hashimoto’s thyroiditis usually leads to hypothyroidism and requires replacement therapy with thyroid hormone replacement therapy.
  2. Silent thyroiditis or painless thyroiditis: Another autoimmune disease caused by antithyroid antibodies. It is also common in women and is the most common cause of Hashimoto’s thyroiditis.
  3. Postpartum thyroiditis: An autoimmune condition caused by antithyroid antibodies sometimes occurs immediately after a woman gives birth.
  4. Radiation-Induced Thyroiditis: A condition caused by external radiation or radioactive iodine that is used to treat hyperthyroidism as a medical treatment for some cancers.
  5. Subacute thyroiditis or Quervain thyroiditis: A common traumatic condition caused by a virus
  6. Acute thyroiditis or separating thyroiditis: A rare condition caused by infection or bacterial
  7. Drug-induced thyroiditis: A condition caused by the use of drugs such as amiodarone, interferon, lithium, and cytokines. It occurs only in a small number of patients using objectionable medications, so it is not common in the general population.

Thyroiditis causes

  • Thyrotoxic phase: The thyroid is inflamed and releases a lot of hormones.
  • Hypothyroid phase: After a few weeks or months, thyroid hormone is released excessively and can lead to hypothyroidism when you don’t have enough left.
  • Euthyroid stage: At this stage, thyroid levels are normal. It occurs between or at the end of the first two stages after the inflammation has subsided.

Symptoms of thyroiditis

Common symptoms are fatigue, swelling at the base of the neck, and sometimes some pain in the front of the throat. However, other symptoms vary depending on whether your thyroid is inactive (hypothyroidism) or hyperthyroidism (hyperthyroidism).

Symptoms of hypothyroidism can include:

  • Fatigue
  • Depression
  • Weight gain
  • Dry Skin
  • Constipation
  • Muscle pains
  • Cold impatience

Symptoms of hyperthyroidism can include:

  • Anxiety and irritability
  • Weight Loss
  • Insomnia
  • Heart palpitations
  • Muscular weakness
  • Impatient to heat

The thyroid can be attacked by various agents. These attacks cause inflammation and damage to thyroid cells, which can lead to thyroiditis. Some of the agents that cause thyroiditis are antibodies (the most common cause), medications, radiation, and organisms (viruses and bacteria). The conditions that attack the body are autoimmune diseases. Thyroiditis is an autoimmune (antibody-mediated) disease.

Some people are not sure why they make thyroid antibodies. Thyroid disease is known to run in families. Thyroiditis can be caused by an infection or a side effect of some medications.

Risk factors for thyroiditis

These factors contribute to the risk of Hashimoto’s disease:

  • Gender: Women are more likely to get Hashimoto’s disease.
  • Years: Hashimoto’s disease can occur at any age, but usually in middle age.
  • Family History: If other members of your family have thyroid or other autoimmune diseases, you are at a higher risk for Hashimoto’s disease.
  • Other autoimmune diseases: Having another autoimmune disease, such as rheumatoid arthritis, type 1 diabetes, or lupus, increases your risk of getting Hashimoto’s disease.
  • Radiation exposure: People exposed to high levels of environmental radiation are at increased risk for Hashimoto’s disease.

Thyroiditis diagnosis

Your doctor may do one or more of these tests.

  • Blood test: Thyroid hormones circulate in your blood, and their levels can help your doctor diagnose a specific type of thyroiditis.
  • Radioactive iodine intake test (RAIU): Since iodine builds up in the thyroid gland, a doctor or nurse will give you radioactive iodine as a pill or liquid. During the next 24 hours, your doctor will check at various points how much iodine your thyroid has absorbed.
  • Thyroid scan: Receive an injection of radioactive iodine. You lie face down on the table with your head tilted back and your neck exposed. Your doctor will use a device to take pictures of your thyroid.
  • Erythrocyte sedimentation rate (ESR or sedimentation rate): This test measures inflammation to see how fast red blood cells fall. A high ESR means you have subacute thyroiditis.
  • Ultrasound: An ultrasound of your thyroid shows a nodule or growth, a change in blood flow, and the shape or density of the gland.

Treatment of thyroiditis

The observation and use of action medications may be involved in the treatment of Hashimoto’s disease. If there is no evidence of a hormone deficiency, and your thyroid is working normally, your doctor may prescribe a wait-and-watch procedure. If you need medication, you will need it for the rest of your life.

Synthetic hormones

If Hashimoto’s disease causes thyroid hormone deficiency, you may need thyroid hormone replacement therapy. It usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others). Synthetic levothyroxine is similar to thyroxine, which is a natural version of this hormone produced by the thyroid gland. Oral medications restore proper hormone levels and reverse all symptoms of hypothyroidism.

Monitor the dose

To determine the optimal dose of levothyroxine initially, your doctor will usually monitor your TSH level six to eight weeks after treatment and after any dose changes. Once you have determined the dose that normalizes your thyroid tests, your doctor may check your TSH level every 12 months so that the dose you need can vary. High amounts of thyroid hormone can accelerate bone loss, which can make osteoporosis worse or increase your risk for the disease. Excessive treatment with levothyroxine can also cause heart rhythm disorders (arrhythmia).

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with smaller doses and gradually increase the dose. The establishment of the progressive hormone allows you to adapt to the increase in your cardiac metabolism.

Levothyroxine has virtually no side effects and is relatively inexpensive when used in proper doses. If you change brands, tell your doctor to make sure you are still getting the correct dose. Also, do not skip doses or stop taking the medicine. If you do, the signs and symptoms will gradually return.

Effects of other substances

Certain medicines, drugs, and certain foods can affect your ability to absorb levothyroxine. However, taking levothyroxine four hours before or after other actions can solve the problem. Talk to your doctor if you take large amounts of soy products or a high fibre diet or any of the following:

  • Iron supplements, including multivitamins that contain iron
  • Cholestyramine (private), a medicine used to lower cholesterol levels in the blood.
  • Aluminum hydroxide, which is found in some antacids.
  • Sucralfate, an ulcer drug
  • Calcium supplements

Do you need a combination of hormones?

Levothyroxine is a synthetic form of natural T-4. T-4 becomes T-3 in the body. While most people are only successfully treated with levothyroxine, some people do not feel completely normal on levothyroxine.

The researchers looked at whether it might be beneficial to adjust standard treatment for hypothyroidism to replace some T-4 with small amounts of T-3. However, most studies have concluded that the inclusion of T-3 has no more benefit than treatment with T-4 alone.

There is some evidence that T-3 may be beneficial for certain subtypes, such as people who have had their thyroid surgically removed (thyroidectomy). Investigations are ongoing.

T-3 can be given alone as liothyronine (cytomegaly) or in combination with T-4. Taking a combination of T-4 and T-3 produces higher than normal T-3 levels, especially immediately after taking the medication. It causes a rapid heart rate, anxiety, and trouble sleeping.

But, for those who haven’t had enough relief from T-4 alone, it’s a long time to see if the combination of adding liothyronine to standard levothyroxine treatment can help you over a three to six-month trial.

The standard treatment for Hashimoto’s disease is levothyroxine, a synthetic form of thyroxine (T-4). However, an extract containing thyroid hormone is obtained from the thyroid gland of pigs. These products, for example, thyroid arm or, containing levothyroxine and triiodothyronine (T-3).

  • Doctors have many concerns about thyroid hormone extract, such as Armor Thyroid,
  • The balance of T-4 and T-3 in animals is not the same as in humans.
  • The exact amount of T-4 and T-3 in each batch of natural extract product can vary, leading to unpredictable levels of these hormones in the blood.

Complications of thyroiditis

If left untreated, an active thyroid gland (hypothyroidism) caused by Hashimoto’s disease can lead to several health problems:

  • Preserve: The gland expands as the thyroid is constantly stimulated to release more hormones, a condition called a goiter. Hypothyroidism is one of the most common causes of a goiter. It is usually not uncomfortable, but a large goiter can affect your appearance and interfere with swallowing or breathing.
  • Heart problems: Hashimoto’s disease may be associated with an increased risk of heart disease because it occurs in people with high concentrations of lipoprotein cholesterol (LDL), the “bad” cholesterol, and the thyroid gland (hypothyroidism). If left untreated, hypothyroidism can lead to an enlarged heart and heart failure.
  • Mental health problems: Depression can occur early in Hashimoto’s disease and get worse over time. Hashimoto’s disease causes a decrease in sexual desire (libido) in both men and women and leads to a decrease in mental functioning.
  • Myxedema: This rare malignant condition develops due to chronic severe hypothyroidism as a result of untreated Hashimoto’s disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness.

Myxedema can trigger a coma by exposing your body to colds, narcotics, infections, or other stress. Myxedema requires immediate emergency medical treatment.

  • Birth defects: Babies born to women with untreated hypothyroidism due to Hashimoto’s disease are more likely to have birth defects than babies born to healthy mothers. Doctors have known for a long time that these children are more likely to have intellectual and developmental problems. There may be a link between hypothyroidism and birth defects, such as a cleft palate.

Hypothyroidism is also linked to heart, brain, and kidney problems during pregnancy and childhood. If you are thinking of getting pregnant or are in the early stages of pregnancy, monitor your thyroid level.

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