Thyroiditis

Inflammation of the thyroid
Hashimoto’s thyroiditis
- Also known as chronic lymphocytic thyroiditis
Subacute thyroiditis
- Also known as granulomatous thyroiditis, de Quervain’s thyroiditis and giant cell thyroiditis
- Thought to be caused by a virus.
Postpartum thyroiditis
- Believed to be autoimmune
- Occurs in 7.2% of women post delivery
Riedel thyroiditis
- Invasive fibrous, woody, ligneous are all terms used to describe this
  typically as part of a systemic fibrosis
- Rarest form of thyroiditis

Hashimoto’s Thyroiditis

Also known as chronic lymphocytic thyroiditis
Most have symptoms of hypothyroidism but some will have symptoms of hyperthyroidism
Patients have a high rate of other autoimmune disease
- Sjogren’s
- Myasthenia gravis
- Celiac disease
- Addison’s disease

Also known as granulomatous thyroiditis, de Quervain’s thyroiditis and giant cell thyroiditis
Thought to be caused by a virus.
50% will have thyrotoxicosis followed by hypothyroid followed by euthyroid

Hypothyroid or hyperthyroid symptoms occur in 4–7% of women in the first 6 months after delivery.
Painless

Blood work
- Thyroid stimulating hormone (TSH)
- T4
- Thyroid autoantibodies
- Sed rate
U/S used to distinguish thyroiditis from nodular goiter or possible malignancy
Radioiodine uptake scan may be helpful
Fine needle aspiration (FNA)

Most common about 80%- 90% of thyroid cancers
Females affected 3:1
Pts commonly between 30 and 60
Least aggressive thyroid malignancy, slow growing but will move to regional lymph nodes.
Childhood head and neck radiation increases lifelong risk
FNA, MRI, U/S
T4, TSH
Treatment consists of total thyroidectomy and radioactive iodine to ablate any remaining tissue.

10–15% of thyroid cancers
More aggressive than papillary cancer
May secrete enough T4 to cause thyroid storm
FNA, MRI, U/S
T4, TSH
Treatment consists of total thyroidectomy and radioactive iodine to ablate any remaining tissue.

3% of thyroid cancers
One third sporadic (nonfamilial), One third are familial one third are associated with MEN type 2
Typically early metastasis is present
Tumor secretes calcitonin
May secrete serotonin and prostaglandins causing flushing and diarrhea
FNA, MRI, U/S
T4, TSH
Treatment consists of total thyroidectomy and radioactive iodine to ablate any remaining tissue.

Only about 2% of thyroid cancers
Most aggressive thyroid cancer rapidly enlarging and early metastases to local and distant sites
Typically found in older patients
Typically single nodule – 5% of palpable nodules are malignant
Painless neck swelling
May have hyperthyroid symptoms due to excess T4 production including thyroid storm.
Metastatic disease found in the lung or bones
FNA, MRI, U/S
T4, TSH
Treatment consists of total thyroidectomy and radioactive iodine to ablate any remaining tissue.