Thyroiditis

Thyroiditis

1. Thyroiditis Ratheesh.R SLMGNC

2. Introduction Thyroiditis is the medical term for inflammation (swelling) of the thyroid gland, which can either cause abnormally high or low levels of thyroid hormones in the blood. The thyroid gland is a butterfly-shaped gland found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism. They affect processes such as heart rate and body temperature, and help convert food into energy to keep the body going. Harrisons principles of internal medicine 18 th edition, Dan L. Longo, Anthony S. Fauci , Mc graw hill medical publications, pp 2927-2950.

3. Definition Thyroiditis  is an inflammation (not an infection) of the thyroid  gland.

4. Types Hashimoto's thyroiditis  (the most common) De Quervain's or subacute thyroiditis   Post-partum thyroiditis  (triggered after giving birth) Silent or painless thyroiditis   Drug-induced thyroiditis Radiation-induced thyroiditis   Acute or infectious thyroiditis  

5. Cont…. Hashimoto's thyroiditis : Hashimoto's thyroiditis is an autoimmune condition. This means your immune system mistakenly attacks your thyroid gland, causing it to gradually swell and become damaged. De Quervain's ( subacute ) thyroiditis : De Quervain's thyroiditis (sometimes called subacute thyroiditis ) is a painful swelling of the thyroid gland that is thought to be triggered by a viral infection, such as mumps or the flu.

6. Cont…. Post-partum thyroiditis :   Like Hashimoto's thyroiditis , post-partum thyroiditis is an autoimmune condition, but it only happens in women who have recently given birth. In post-partum thyroiditis , the immune system attacks your thyroid gland within around six months of giving birth, causing a temporary rise in thyroid hormone levels ( thyrotoxicosis ).

7. Cont…. Silent (painless) thyroiditis :   Silent thyroiditis is very similar to post-partum thyroiditis . It is also an autoimmune condition, but is not related to giving birth and can occur in both men and women. Drug-induced thyroiditis :   Thyroiditis can also be triggered by medications including interferon,  amiodarone , lithium and a class of drugs to treat certain cancers (which include sunitinib ), if these medicines damage the thyroid gland.

8. Cont…. Radiation-induced thyroiditis :   Radioactive iodine treatment for an overactive thyroid gland or radiotherapy for certain cancers can also damage the thyroid gland, leading to symptoms of an overactive thyroid gland or symptoms of an underactive thyroid gland. Acute or infectious thyroiditis :   Acute or infectious thyroiditis is usually triggered by a bacterial infection. It is rare and is associated with either a weakened immune system or, in children, with a problem in the development of the thyroid.

9. Causes Auto immune destruction Genetic Pre-Disposition Viral invasion Respiratory infection Streptococcus pyogenic Staphylococcus aureus Fungi invasion

10. Pathophysiology Due to any factors Enlargement of the thyroid gland caused by infiltration of lymphocyte Destruction of the parenchyma of thyroid caused by autoimmune deficiency Hypothyroidism, if untreated

11. Clinical Features Fatigue Drowsiness Difficulty with learning Dry, brittle hair and nails Dry, itchy skin Puffy face Constipation. Heavy menstrual flow Malaise Chills Thyroid tenderness Nervousness Increased sensitivity to many medications. Swelling Dysphagia Dysphonia Anterior neck pain Fever , Sore throat Irritability Low BMR Enlargement of thyroid gland

12. Special investigations TSH Thyroid auto antibodies test Histology- diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles from follicular hyperplasia. - Damage to the follicular basement membrane. -Atrophy of the thyroid parenchyma

13. Cont…. Blood tests to measure…. increased levels of thyroid hormone in the bloodstream . the abnormal antibodies, anti- microsomal and antithyroglobulin antibodies.

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

15. Treatment Anti microbial medication Fluid Replacement Antibiotic therapy parenterally Anti-inflammatory agents Analgesics Mild Sedative Steroids drugs may be (pain, fever and malaise) Beta adrenergic blocking(Reduce thyrotoxicisis )

16. Treatment: 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.

17. Treatment 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.

18. Special Treatment Treatment depends on the type of thyroiditis and the clinical presentation.

19. Thyrotoxicosis Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful.

20. Hypothyroidism Thyroid hormone replacement.

21. Thyroidal pain Anti- inflamatory medications such as aspirin . Steroid therapy with prednisone.

22. Surgery Surgical incision and Drainage may be needed, if any abscess is present. Surgical resection Goitre, if tracheal compression, cough or hoarseness occur. Fine Needle biopsy is done.

23. Complications Airway obstruction Dysphonia Hoarseness - Due to recurrent laryngeal involvement Hypothyroidism Hypo para thyroidism Dysphagia Stridor - Due to tracheal compression

24. Nursing Diagnosis Pain r/t inflammation of thyroid gland. Anxiety r/t Enlargement of neck/thyroid gland. Risk for Ineffective Airway Clearance related to obstruction of the trachea, swelling, bleeding and laryngeal spasm. Impaired Verbal Communication related to vocal cord injury / damage to the larynx, tissue edema, pain, discomfort.