This document discusses different types of thyroiditis, which refers to inflammation of the thyroid gland. It describes the main causes and clinical presentations of several thyroiditis disorders, including Hashimoto's thyroiditis, radiation-induced thyroiditis, drug-induced thyroiditis, subacute thyroiditis, acute/infectious thyroiditis, and postpartum thyroiditis. Treatment depends on the type of thyroiditis and symptoms, and may include beta blockers, thyroid hormone replacement, anti-inflammatory medications, or steroids.

1. Ahmed Adel Fouad Abdelhakeem

3.  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.

5. Hashimoto’s
thyroiditis
Radiation
induced
Thyroiditis
Drug-induced
thyroiditis
Subacute
thyroiditis
Acute/Infectious
thyroiditis

7.  The
 This
most common cause of thyroiditis.
form of thyroid disease may also be
referred to as chronic lymphocytic
thyroiditis.

8.  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)

9.  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.

10.  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.

12.  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.

15.  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.

19. 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.


20.  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.

21. Subacute granulomatous,
subacute painful, or “de
Quervain thyroiditis”.
Lymphocytic thyroiditis
(also known as subacute
painless thyroiditis).
Subacute postpartum
thyroiditis.

22. Subacute granulomatous thyroiditis
 Self
limited disease
 CAUSE:
Possible viral cause.
 CLINICAL
FEATURES:
Enlarged Gland, Tender
thyrotoxicosis followed by hypothyroidism.

23. 

Infiltration of chronic inflammatory cells.
Foreign Body giant cells “ Giant Cell Thyroiditis “

24.  Self
limited disease
 CAUSE:
Anti-thyroid antibodies, autoimmune disease
 CLINICAL
FEATURES:
Thyrotoxicosis followed by hypothyroidism.

25. 
Non-Specific lymphoid infiltration of thyroid parenchyma.

No germinal center formation.

27.  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.

28.  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.

29.  blood
tests to measure :
 increased levels of thyroid hormone in the
bloodstream .
 the abnormal antibodies, anti-microsomal
and antithyroglobulin antibodies.

30. A
fine needle aspiration biopsy of the thyroid
gland during this phase would reveal
inflammatory cells attacking the thyroid
gland.

31.  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.

32.  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.

33.  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.

34.  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.

35.  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.

36.  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.

37.  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.

39.  Treatment
depends on the type of thyroiditis
and the clinical presentation.
Thyrotoxicosis
Hypothyroidism
Thyroidal pain

40.  Beta
blockers to decrease palpitations and
reduce shakes and tremors may be helpful.

41.  thyroid
hormone replacement.

42.  anti-inflamatory
medications such as aspirin .
 steroid therapy with prednisone.