Home Diseases Inflammation of the thyroid gland (thyroiditis): cause, course

Inflammation of the thyroid gland (thyroiditis): cause, course

by Josephine Andrews
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Inflammation of the thyroid gland (thyroiditis) is rare. Usually an autoimmune disease is behind it, such as Hashimoto’s thyroiditis. But bacteria, viruses, certain medications and injuries are also among the possible causes of thyroid inflammation. There are acute, subacute and chronic forms of thyroiditis. Here you can read everything you need to know about the signs, causes and treatment of thyroiditis.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

E05 E06 E03

Thyroiditis: description

With thyroiditis , the thyroid tissue becomes inflamed. This inflammation of the thyroid gland can have various causes. This results in a whole series of independent clinical pictures. They can appear suddenly (acute), within weeks (subacute), or slowly and for a long time (chronic).

According to their course, they can be divided into three groups:

  • Acute thyroiditis : suppurative thyroiditis (due to bacteria), nonsuppurative thyroiditis (after injury, radiation or radioiodine therapy )
  • Subacute thyroiditis : de Quervain’s thyroiditis (after viral infection), silent thyroiditis
  • Chronic thyroiditis : Hashimoto’s thyroiditis, Graves’ disease, post-partum thyroiditis, drug-induced thyroiditis, etc.

Hashimoto’s thyroiditis

In Hashimoto’s thyroiditis, the body’s immune system attacks the thyroid gland . You can read more about this in the article Hashimoto’s thyroiditis .

Basedow’s disease

The immune system is also the trigger for Graves’ disease. It causes an overactive thyroid function. More on this under Morbus-Basedow .

Thyroiditis: Symptoms

The symptoms that occur depend on the type of thyroid inflammation:

Acute thyroiditis: symptoms

Acute forms of thyroid inflammation (purulent thyroiditis, non-purulent thyroiditis) cause severe pain , bulging swelling , reddening and overheating ( hyperthermia ) in the area of ​​the thyroid gland. In addition, the lymph nodes are swollen and the patients suffer from difficulty swallowing and a high fever.

Subacute thyroiditis: symptoms

In contrast to acute thyroiditis, subacute inflammation of the thyroid gland begins insidiously . With thyroiditis de Quervain , pain occurs in the area of ​​the thyroid gland, which can radiate to the jaw , ears, the whole head or the chest area. Patients feel tired and weak, have difficulty swallowing and often also headaches, muscle aches and fever.

A subacute inflammation of the thyroid gland can also be almost symptom-free. Doctors then speak of silent or silent thyroiditis . The patients are not in pain. However, the inflammation of the thyroid gland can cause the organ to become overactive (hyperthyroidism), which leads to symptoms such as loss of appetite, weight loss, nervousness, restlessness, a constant feeling of warmth and a lack of concentration. These usually last for a few weeks and are followed by hypothyroidism with mild symptoms. Thyroid function then usually returns to normal.

Chronic thyroiditis: symptoms

Postpartum thyroiditis , which is inflammation of the thyroid gland after childbirth, is usually painless . It often initially triggers a slight hyperfunction of the thyroid gland with mostly mild symptoms such as inner restlessness, palpitations and fatigue. After about two to eight weeks, it goes into hypofunction, which lasts about as long. Sometimes at the beginning of the postpartum inflammation of the thyroid there is an underactive thyroid gland and only then does it become overactive.

Drug-induced inflammation of the thyroid gland as a result of interferon therapy manifests itself in two-thirds of all cases as an underactive thyroid gland (hypothyroidism); one third of patients develop hyperfunction (hyperthyroidism). Occasionally, the overfunction is replaced by an underfunction. The severity of possible symptoms depends on the extent of the functional disorder: in the case of hypothyroidism, for example, fatigue, listlessness, weight gain , dry skin and depressive moods can occur. Hyperactivity, on the other hand, can cause symptoms such as restlessness, palpitations, hypersensitivity to heat, sleep disorders and weight loss.

The drug amiodarone can also cause thyroid inflammation. With a corresponding predisposition, amiodarone can initiate the development of both Graves’ disease and Hashimoto’s thyroiditis. In addition, prolonged use of amiodarone can trigger mild hyperthyroidism, which usually causes no symptoms However, the hyperfunction can later turn into a subfunction.

Thyroiditis: causes and risk factors

Depending on the cause and course, physicians distinguish between different forms of thyroid inflammation. In most cases, thyroid inflammation develops as part of an autoimmune disease. But there are many other reasons why the thyroid can be inflamed. These include bacteria or viruses , injuries, certain medications and radiation therapy . Known examples are:

Acute bacterial thyroiditis (suppurative thyroiditis)

This purulent inflammation of the thyroid gland is caused by bacteria, which have usually reached the thyroid gland via the bloodstream. They often come from a bacterial infection in the ear, nose or throat area. Acute thyroiditis is very rare.

Thyroiditis after radioiodine, radiation therapy or trauma (nonsuppurative thyroiditis)

When tumors in the neck region (such as lymphoma) are treated with radiation therapy, the nearby thyroid gland can also receive the radiation. In about one percent of cases, thyroid inflammation develops as a result. High-dose radioiodine therapy – a nuclear medicine therapy for various thyroid diseases – and trauma can also result in inflammation of the thyroid gland. In all cases it is an acute thyroiditis, but without pus formation (in contrast to acute bacterial thyroiditis).

Subacute thyroiditis de Quervain

This form of thyroiditis often develops two to three weeks after an upper respiratory tract infection. The addition “subacute” means that the disease begins and progresses more slowly than acute thyroiditis. The cause of the disease is unclear, but it often occurs after a viral infection of the respiratory tract. Some patients are also likely to have a genetic predisposition.

In women, subacute de Quervain thyroiditis is three to six times more common than in men; Children very rarely get it. Incidentally, it is named after the Swiss surgeon Fritz de Quervain. He first described this form of thyroid inflammation in 1904.

Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is the best-known form of autoimmune thyroiditis. For unknown reasons, the body produces antibodies against its own thyroid gland, which leads to chronic inflammation of the thyroid gland.

Post partum thyroiditis (postpartum thyroiditis)

This form of thyroid inflammation can develop within the first year after childbirth. About six percent of new mothers are affected. Women with type 1 diabetes have a particularly high risk; a quarter of pregnant women with this pre-existing condition develop post-partum thyroiditis.

The disease is now considered a variant of Hashimoto’s thyroiditis. In both forms, thyroid autoantibodies are usually found in the patient’s blood. Experts suspect that post-partum thyroiditis is an abnormal variant of autoimmune thyroid inflammation: During pregnancy, immune processes – and thus also autoimmune processes – are suppressed. In the weeks after birth , the immune system recovers and can even become overactive. This overactive thyroid can turn into an underactive one after two to eight weeks and then heal or persist.

Silent thyroiditis

In the case of silent thyroiditis, the immune system attacks the thyroid gland. About half of the patients have autoantibodies in their blood, but at low levels. The inflammation is mild and usually heals on its own.

Drug-Related Thyroiditis

Certain medications can trigger overactive or underactive autoimmune thyroiditis. These include interferon (for hepatitis C ), interleukin-2, lithium, thalidomide , lenalidomide, and amiodarone (for abnormal heart rhythms).

Thyroiditis: investigations and diagnosis

To clarify an inflammation of the thyroid gland, the doctor will first have a detailed discussion with the patient in order to collect the medical history ( anamnesis ). An important point here revolves around the symptoms that occur. They can provide the doctor with valuable information about the type of thyroid inflammation. History information such as a possible sore throat, radiation therapy, drug therapy, or injury can also be revealing.

This is followed by a physical examination and the taking of a blood sample . The latter can quickly confirm the suspicion of an inflammation of the thyroid gland – namely when inflammation values ​​(C-reactive protein, blood sedimentation rate) are increased. The amount of white blood cells is also determined: it is increased in acute thyroiditis, but not in subacute thyroiditis.

The thyroid hormone levels are also measured. This is how the doctor can determine whether the thyroid gland is overactive or underactive. You can read more about this in the article Thyroid values .

An important imaging procedure when thyroid inflammation is suspected is ultrasound (sonography). If the thyroid gland is inflamed, it will appear dark on ultrasound and have a loose structure (a healthy thyroid gland will appear more uniform). In Hashimoto’s thyroiditis, the thyroid gland is smaller than normal.

For a more detailed examination, the doctor takes a tissue sample from the thyroid gland using a fine-needle biopsy . In the case of subacute Quervain thyroiditis, the typical Langhans’ giant cells can be seen under the microscope.

If necessary, further examinations are carried out, for example an antibody determination in suspected autoimmune thyroid inflammation (such as Hashimoto’s thyroiditis) or a scintigram.

Thyroiditis: treatment

Acute purulent (bacterial) inflammation of the thyroid gland is treated with antibiotics. Cooling pads (e.g. an ice tie) relieve the pain. Drugs such as acetylsalicylic acid or diclofenac also have a pain-relieving and anti-inflammatory effect. If an abscess has formed in the thyroid gland as a result of the inflammation, the pus contained in it must be removed by means of a puncture or an operation.

Acute non-purulent inflammation of the thyroid gland (e.g. after radiation therapy) usually heals on its own. When patients are in pain, they are given anti-inflammatory drugs.

Subacute de Quervain thyroiditis also usually heals spontaneously. Anti- inflammatory drugs (such as acetylsalicylic acid) and, in severe cases, cortisone (such as prednisolone ) may be given.

Postpartum thyroiditis is usually mild and usually does not require treatment. If the inflammation has led to hypothyroidism, thyroid hormones are used. Beta blockers can be given for temporary hyperfunction.

In the case of drug-related thyroid inflammation, the therapy depends on the dysfunction that occurs: Thyroid hormones are given in the case of hypofunction. Depending on the severity, hyperfunction is treated with a low-iodine diet, surgical removal of the thyroid gland or radioiodine therapy. If amiodarone has caused the thyroid inflammation, the drug is discontinued if possible.

You can read more about the treatment of Hashimoto’s thyroiditis and Graves ‘ disease in the respective articles.

Inflammation of the thyroid gland: course of the disease and prognosis

Acute thyroid inflammation heals completely with proper treatment. However, if the inflammation has severely destroyed the thyroid tissue, hypothyroidism can occur temporarily or permanently.

Subacute de Quervain thyroiditis resolves spontaneously in about 80 percent of cases, within three to six months. Hypothyroidism, which then requires the administration of thyroid hormones, develops very rarely.

Silent thyroiditis usually heals spontaneously.

Post-partum thyroiditis also usually heals without consequences. In some patients, however, the hypofunction of the thyroid persists and must be compensated for with thyroid hormones. After about six months, the drug can be discontinued on a trial basis. For most women, thyroid function returns to normal within a year of giving birth.

In about ten percent of cases of post-partum thyroiditis, however, chronic thyroid inflammation develops, more precisely Hashimoto’s thyroiditis. The risk of goiter (goiter) in the thyroid also increases after post-partum thyroiditis. Those affected should therefore have their thyroid levels checked regularly by a doctor. In addition, it is very likely that postpartum thyroiditis will recur after another pregnancy.

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