Thyroiditis is an inflammation (not an
infection) of the thyroid gland. Several types
thyroiditis exist and the treatment is
different for each. Below is the three most
common of the different thyroiditis types.
Hashimoto's Thyroiditis (also called autoimmune
or chronic lymphocytic thyroiditis) is the most
common type of thyroiditis. It is named after
the Japanese physician, Hakaru Hashimoto, that
first described it in 1912. The thyroid gland is
always enlarged, although only one side may be
enlarged enough to feel. During the course of
this disease, the cells of the thyroid becomes
inefficient in converting iodine into thyroid
hormone and "compensates" by enlarging (for a
review of this process see our function page).
The radioactive iodine uptake may be
paradoxically high while the patient is
hypothyroid because the gland retains the
ability to take-up or "trap" iodine even after
it has lost its ability to produce thyroid
hormone. As the disease progresses, the TSH
increases since the pituitary is trying to
induce the thyroid to make more hormone, the T4
falls since the thyroid can't make it, and the
patient becomes hypothyroid. The sequence of
events can occur over a relatively short span of
a few weeks or may take several years.
Treatment is to start thyroid hormone
replacement. This prevents or corrects the
hypothyroidism and it also generally keeps
the gland from getting larger.
most cases the thyroid gland will decrease
in size once thyroid hormone replacement is
Thyroid antibodies are present in 95% of
patients with Hashimoto's Thyroiditis and
serve as a useful "marker" in identifying
the disease without thyroid biopsy or
Thyroid antibodies may remain for years
after the disease has been adequately
treated and the patient is on thyroid
Quervain's Thyroiditis (also called subacute or
granulomatous thyroiditis) was first described
in 1904 and is much less common than Hashimoto's
Thyroiditis. The thyroid gland generally swells
rapidly and is very painful and tender. The
gland discharges thyroid hormone into the blood
and the patients become hyperthyroid; however
the gland quits taking up iodine (radioactive
iodine uptake is very low) and the
hyperthyroidism generally resolves over the next
Patients frequently become ill with fever
and prefer to be in bed.
Thyroid antibodies are not present in the
blood, but the sedimentation rate, which
measures inflammation, is very high.
Although this type of thyroiditis resembles
an infection within the thyroid gland, no
infectious agent has ever been identified
and antibiotics are of no use.
Treatment is usually bed rest and aspirin to
Occasionally cortisone (steroids) (to reduce
inflammation) and thyroid hormone (to "rest"
the thyroid gland) may be used in prolonged
Nearly all patients recover and the thyroid
gland returns to normal after several weeks
few patients will become hypothyroid once
the inflammation settles down and therefore
will need to stay on thyroid hormone
Recurrences are uncommon.
Silent Thyroiditis is the
third and least common type of thyroiditis. It
was not recognized until the 1970's although it
probably existed and was treated as Graves'
Disease before that. This type of thyroiditis
resembles in part Hashimoto's Thyroiditis and in
part De Quervain's Thyroiditis. The blood
thyroid test are high and the radioactive iodine
uptake is low (like De Quervain's Thyroiditis),
but there is no pain and needle biopsy resembles
Hashimoto's Thyroiditis. The majority of
patients have been young women following
pregnancy. The disease usually needs no
treatment and 80% of patients show complete
recovery and return of the thyroid gland to
normal after three months. Symptoms are similar
to Graves' Disease except milder. The thyroid
gland is only slightly enlarged and exophthalmos
(development of "bug eyes") does not occur.
Treatment is usually bed rest with beta blockers
to control palpitations (drugs to prevent rapid
heart rates). Radioactive iodine, surgery, or
antithyroid medication is never needed. A few
patients have become permanently hypothyroid and
needed to be placed on thyroid hormone.
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