Thyroiditis includes a group of individual disorders causing inflammation of the thyroid gland.
Thyroiditis is caused by an attack on the thyroid either by antibodies or any kind of infection, causing inflammation and damage to the thyroid cells. Thyroiditis is often an autoimmune disease and mostly caused by attack of antibodies. But the reason why certain people make thyroid antibodies is unknown. However, one of the risk factor is family history.
Thyroiditis can also be caused by an infection, such as a virus or bacteria, which works in the same way as antibodies to cause inflammation in the gland. Drugs such as interferon and amiodarone, can also damage thyroid cells and cause thyroiditis.
The cause of thyroiditis again depends on type of thyroiditis. Anti-thyroid antibodies and autoimmune disease is the cause for Hashimoto's thyroidits as well as Post partum thyroiditis, Silent thyroiditis or Painless thyroiditis.Viral infection is the cause for Subacute thyroiditis where as bacterial infection for acute thyroiditis. Any infectious organism can cause acute thyroiditis. Drugs such as amiodarone, lithium, interferons, cytokines are responsile for causing Drug induced thyroiditis. Radiation induced thyroiditis is caused by the treatment with radioactive iodine for hyperthyroidism or external beam radiation therapy for certain cancers.
Treatment can be done depending on the clinical features of the patient which in turn depends on the type of thyroiditis.
To reduce the symptoms of palpitations, shakes and tremors, Beta blockers can be helpful. Since the thyrotoxic phase is temporary, the dose should be adjusted when symptoms improve.
Since the thyroid is not overactive in this condition, any kind of antithyroid medications are not used for the thyrotoxic phase. For Post partum thyroiditis, Subacute thyroiditis and Silent thyroiditis or Painless thyroiditis, this is a part of the treatment. Occasionally this treatment is required for Radiation induced and Hashimoto's thyroidits. The period of treatment depends on the duration of transient phase.
For Hashimoto's thyroiditis treatment is initiated with thyroid hormone replacement for hypothyroidism. This prevents or corrects the hypothyroidism, and it also generally keeps the gland from getting larger or help shrink. In most cases, the thyroid gland will decrease in size once thyroid hormone replacement is started. Thyroid antibodies are present in all most all of patients with Hashimoto's thyroiditis and these may remain for years after the disease has been treated. Antibodies are the marker in identifying the disease without thyroid biopsy or surgery.
With the hypothyroid phase of subacute, painless and post-partum thyroiditis, thyroid hormone therapy is required if the patients are symptomatic. The therapy may be not be necessary if the hypothyroidism in these disorders is mild and the patient has few symptoms. Once the thyroid hormone therapy is begun in patients with subacute, painless and post-partum thyroiditis, the treatment should be continued for approximately 6-12 months. Later tapering the dose will let you know if it is required permanently.
Mild anti-inflamatory medications such as aspirin or ibuprofen is used to manage the pain associated with subacute thyroiditis.Occasionally, the pain can be severe and require steroid therapy with prednisone.
Thyroid antibodies are not present in the blood, but the sedimentation rate which measures inflammation is very high. Antibiotics are not helpful as infectious agent are not found.
Bed rest is recommended to reduce inflammation. Usually all patients recover, and the thyroid gland returns to normal after several weeks or months. However, a very few patients will become hypothyroid once the inflammation settles down and therefore will need to stay on thyroid hormone replacement for a long period.