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Thyroiditis

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Thyroiditis

  1. 1. Ahmed Adel Fouad Abdelhakeem
  2. 2.  Thyroiditis is a general term that refers to “inflammation of the thyroid gland”.  Thyroiditis includes a group of individual disorders that all cause thyroidal inflammation and, as a result, causes many different clinical presentations.
  3. 3. Hashimoto’s thyroiditis Radiation induced Thyroiditis Drug-induced thyroiditis Subacute thyroiditis Acute/Infectious thyroiditis
  4. 4.  The  This most common cause of thyroiditis. form of thyroid disease may also be referred to as chronic lymphocytic thyroiditis.
  5. 5.  It is characterized by: Gradual thyroid failure because of autoimmune destruction of the thyroid gland.  The name Hashimoto thyroiditis is derived from the 1912 report by Hashimoto describing patients with goiter and intense lymphocytic infiltration of the thyroid (struma lymphomatosa)
  6. 6.  it is primarily a disease of older women.  can occur in children “ nonendemic goiter”  The concordance rate in monozygotic twins is 30% to 60%.  Several chromosomal abnormalities have been associated with thyroid autoimmunity.
  7. 7.  There are reports that polymorphisms in the HLA locus, specifically the HLA-DR3 and HLADR5 alleles, are linked to Hashimoto thyroiditis, but the association is weak.  genome wide linkage analyses in families with Hashimoto thyroiditis have provided evidence for several susceptibility loci, such as on chromosomes 6p and 12q, that may harbor genes predisposing to this disorder.
  8. 8.  Hashimoto thyroiditis is an autoimmune disease in which the immune system reacts against a variety of thyroid antigens.  There is progressive depletion of thyroid epithelial cells (thyrocytes), which are gradually replaced by mononuclear cell infiltration and fibrosis.
  9. 9.  The thyroid is often diffusely enlarged.  The capsule is intact.  the gland is well demarcated from adjacent structures.  The cut surface is pale, yellow-tan, firm, and somewhat nodular.
  10. 10. many of the symptoms associated with thyroid hormone deficiency.  Fatigue  Drowsiness  Difficulty with learning  Dry, brittle hair and nails  Dry, itchy skin  Puffy face  Constipation.  Weight gain  Heavy menstrual flow  Increased frequency of miscarriages  Increased sensitivity to many medications. 
  11. 11.  is a self-limited thyroid condition.  associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function.  responsible for 15-20% of patients presenting with thyrotoxicosis.  and 10% of patients presenting with hypothyroidism.
  12. 12. Subacute granulomatous, subacute painful, or “de Quervain thyroiditis”. Lymphocytic thyroiditis (also known as subacute painless thyroiditis). Subacute postpartum thyroiditis.
  13. 13. Subacute granulomatous thyroiditis  Self limited disease  CAUSE: Possible viral cause.  CLINICAL FEATURES: Enlarged Gland, Tender thyrotoxicosis followed by hypothyroidism.
  14. 14.   Infiltration of chronic inflammatory cells. Foreign Body giant cells “ Giant Cell Thyroiditis “
  15. 15.  Self limited disease  CAUSE: Anti-thyroid antibodies, autoimmune disease  CLINICAL FEATURES: Thyrotoxicosis followed by hypothyroidism.
  16. 16.  Non-Specific lymphoid infiltration of thyroid parenchyma.  No germinal center formation.
  17. 17.  This is the type of thyroiditis that may occur in women after they give birth.  2 Phases:  Over Active Phase.  Under Active Phase.  Then, return to Normal state.
  18. 18.  Within the first one to four months after delivery.  This phase can be characterized by : 1. 2. 3. 4. 5. 6. slight enlargement of the thyroid . Anxiety. Restlessness. Insomnia. weight loss. difficulty concentrating.
  19. 19.  blood tests to measure :  increased levels of thyroid hormone in the bloodstream .  the abnormal antibodies, anti-microsomal and antithyroglobulin antibodies.
  20. 20. A fine needle aspiration biopsy of the thyroid gland during this phase would reveal inflammatory cells attacking the thyroid gland.
  21. 21.  During this hyperthyroid phase, treatment is usually not recommended because this phase usually lasts for a short period of time, about 2 to 4 months.  However, if the symptoms are extreme, beta blockers may be used to slow the heart rate and decrease nervousness.
  22. 22.  occurs 3 to 8 months postpartum.  This phase can be characterized by: 1. 2. 3. 4. 5. slight enlargement of the thyroid gland. weight gain. Fatigue. lack of energy . depression.
  23. 23.  thyroid hormone medication for about six months.  After this time, the medication is stopped to determine whether or not the thyroid has recovered its normal function.  If so, the medication may be stopped permanently, otherwise the medication must be resumed because of permanent injury to the thyroid gland.
  24. 24.  cute suppurative thyroiditis is quite rare in modern times.  Cause: It is caused by a bacterial infection in the thyroid which causes pus to collect and form an abscess within the thyroid gland. The bacterial infection may be carried in the bloodstream from anywhere in the body or it may come from the throat itself.
  25. 25.  thyroidal pain.  systemic illness.  painless enlargement of the thyroid.  hypothyroidism.  The symptoms usually resolve once the infection resolves.  In the few instances where it still occurs, antibiotics and surgery to drain the pus can result in complete cure.
  26. 26.  CAUSE: Drugs include: amiodarone, lithium, interferons, cytokines.  CLINICAL FEATURES: Either thyrotoxicosis or hypothyroidism.  DURATION AND RESOLUTION: Often continues as long as the drug is taken.
  27. 27.  CAUSE: 1. 2. Follows treatment with radioactive iodine for hyperthyroidism external beam radiation therapy for certain cancers. CLINICAL FEATURES: 1. Occasionally thyrotoxicosis 2. more frequently hypothyroidism.
  28. 28.  Treatment depends on the type of thyroiditis and the clinical presentation. Thyrotoxicosis Hypothyroidism Thyroidal pain
  29. 29.  Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful.
  30. 30.  thyroid hormone replacement.
  31. 31.  anti-inflamatory medications such as aspirin .  steroid therapy with prednisone.

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