Pathology of thyroiditis

2021-01-27 12:00 AM

The case caused by bacteria often causes infection syndrome, at the thyroid manifested as an abscess with hot, red, swollen, painful, pain can spread to the ears, occipital, jaw.

Outline

Thyroiditis is a group of diseases that damage the thyroid gland that can be caused by an infection or an inflammatory process that occurs on the normal thyroid. The subclinical clinical scene, progressing differently depending on the cause of the disease. Fibrocystic thyroiditis can be very severe, lymphadenitis often leads to hypothyroidism, and subacute thyroiditis always heals.

Types of thyroiditis

Acute thyroiditis

Uncommon disease, occurs due to infection of the thyroid gland, with bacteria such as: Staphylococcus aureus, streptococcus, E. coli, anaerobic bacteria, salmonella ... sometimes with BK, with fungi such as actinomyces, individual with parasites like Echinococcus.

Clinical:

The case caused by bacteria often causes infection syndrome, at the thyroid manifested as an abscess with hot, red, swollen, painful, pain can spread to the ears, occipital, jaw.

Subclinical:

Blood count has increased leukocytes, multinuclear predominate. Thyroid ultrasound shows a hypoechoic gene. Thyroid scans show regions that do not capture iodin. Puncture detecting pus. T3, T4, TSH are normal, no antibodies are present.

Subacute thyroiditis

Caused by viruses such as mumps virus, Coxsacki, ECHO, adenovirus. The disease usually occurs in people with HLA BW 35.

Clinical:

Usually have previous flu symptoms. Diagnosis is based on symptoms of pain from spreading thyroid, enlarged thyroid, initially, one side then spread to the whole thyroid, the palpable density of thyroid gland, pain, the lymph node is not large. The whole body has a mild fever, muscle pain, and weakness. There are half of the cases with manifestations of thyrotoxicosis.

Subclinical:

Laboratory inflammatory syndrome, with increased VS, normal or slightly increased streptococcus. Radiation shows reduced or distracting iodin. Normal or slightly elevated thyroid hormone (released by damaged thyroid tissue). Normal or low TSH. There is no antibody.

Evolution:

Usually recover spontaneously after 6 weeks, sometimes longer. There have also been cases of transient hypothyroidism.

Painless thyroiditis

Quite often, especially in postpartum women (5-7% of pregnancies).

Clinical:

Firm, painless goitre. Signs of moderate thyrotoxicosis, without bulging eyes.

Subclinical:

VS normal or slightly increased. Antithyroid antibodies present with low titration. Thyroid hormone increases, TSH decreases. Thyroid scans do not capture iodine.

Evolution:

Heals spontaneously after 2-4 months, rarely more slowly. Transient hypothyroidism is quite common. It is possible to recur thyrotoxicosis long after that. Goitre can persist for a long time.

Note: Painless thyroiditis is very similar to subacute thyroiditis, the only difference in pain symptoms, another difference is that the silent thyroiditis is autoimmune. Iodine abuse can cause a similar manifestation, differentiating from the normal urinary iodine in the silent thyroiditis.

Lymphatic thyroiditis (Hashimoto)

An autoimmune disease, in subjects belonging to the HLA B8 DR3 group. Thyroid infiltrates with lymphocytes and cytoplasm, with thyroid follicles being destroyed in addition to hyperplastic thyroid follicles. Chronic progression can lead to hypothyroidism.

Clinical:

Large diffuse goitre, firm density, clear limit, painless, not large nearby lymph nodes. Hypothyroidism, sometimes quickly leading to hypothyroidism (hypothyroidism in adults + large goitre = Hashimoto). Sometimes manifestations of transient thyrotoxicosis.

Subclinical:

Presence of antibodies to thyroglobulin, antibodies to thyroid microsomes, antibodies to peroxidase. Normal or low count of thyroid hormone with increased TSH. Very rare but it is possible that T3, T4 increase with TSH decrease in thyrotoxic phase. Thyroid scintigraphy has a heterogeneous speckled pattern. VS normal or slightly increased.

Evolution:

Very variable, sometimes there exists the goitre, sometimes leading to hypothyroidism with atrophic thyroid.

Note:

The presence of anti-thyroid antibodies not only Hashimoto but also in Basedow disease.

A large incidence of hypothyroidism in adults with atrophy of the thyroid gland has a cause of Hashimoto's thyroiditis for which the onset is ignored.

Hashimoto can coordinate with other diseases such as adrenal insufficiency, ovary, diabetes. Or vitiligo, Biermer; or Basedow-type eye damage (rare).

Fibrous thyroiditis (Riedel)

The disease is rare, of unknown cause, progressing seriously.

Clinical:

The goitre is rocky, initially localized, and then spreads to the entire thyroid gland. The fibrosis spreads to the muscles in the neck, neighbouring organs causing a feeling of tightness in the neck, difficulty swallowing, difficulty breathing. The disease can coordinate fibrosis after peritoneum, mediastinum, after the eye socket, tear glands.

Subclinical:

T3, T4, TSH are normal, VS is normal, the radioactive iodine concentration is reduced.

Evolution:

Death is inevitable, the only treatment is surgery, but the possibility of surgery is very limited.