Related articles: Subacute thyroiditis
Definition
Subacute thyroiditis is a transient inflammatory disease affecting the thyroid gland.
Often, the history is positive for a previous viral infection of the upper respiratory tract. Possible etiological agents are adenovirus, coxsackie, echovirus, measles virus, mumps and flu. Subacute thyroiditis is more frequent in women and often has a seasonal pattern, with greater frequency in the summer-autumn period.
In most cases, subacute thyroiditis tends to heal without leaving disease outcomes.
Most common symptoms and signs *
- Asthenia
- Increase in the ESR
- Chills
- Cachexia
- palpitations
- Dysphagia
- Neck pain
- Pain associated with chewing
- Temperature
- Heat intolerance
- Mass or swelling in the neck
- Nervousness
- Knot in the throat
- Weight loss
- Drowsiness
- Sweating
Further indications
Subacute thyroiditis occurs with pain in the anterior region of the neck, at the thyroid, and mild or moderate fever.
The pain in the neck moves characteristically from one side to the other or can be established in a single point, often radiating to the corner of the jaw up to the ear, simulating an acute pharyngitis or otitis; typically, this manifestation increases in intensity with swallowing and head rotation.
In the early stages of the disease, an increased release of preformed thyroid hormones and contained in the colloid of the follicles that have been damaged by the inflammatory process is frequent. This causes symptoms similar to those of hyperthyroidism, such as anxiety, insomnia, palpitations, fatigue, irritability and weight loss. In a second time, before the thyroid functions normalize, on the other hand, a transient hypothyroidism may occur due to the depletion of thyroxine (T4) and triiodothyronine (T3) reserves. Compared to other thyroid diseases, in the subacute thyroiditis asthenia and the general debilitating state are more pronounced.
The diagnosis is based on the clinical and functional evaluation of the thyroid (TSH and free T4 dosage and radioiodine thyroid uptake). Patients are initially thyrotoxic, with low levels of TSH (thyroid-stimulating hormone) and high levels of free T4; sometimes, then, they become transiently hypothyroid, with high TSH and low T4 free. Subacute thyroiditis is also accompanied by a high sedimentation rate of erythrocytes (ESR), an expression of the systemic inflammatory state. On physical examination, an asymmetrically enlarged thyroid is detected, hardened and painful on palpation.
When the diagnosis is uncertain, fine needle aspiration is useful. The histological examination shows a characteristic infiltrate of plasma cells, histiocytes and multinucleated giant cells, with a disruption of the follicular structure.
The treatment of subacute thyroiditis aims to reduce the inflammatory state and consists in the administration of NSAIDs, sometimes associated with corticosteroids and / or? -Blocks taken for a short period. Subacute thyroiditis usually resolves spontaneously within a few months; on some occasions, the process recurs and can cause permanent hypothyroidism, if the follicular destruction is very extensive.
