Name
PREGNANCY
DESCRIPTION
DETAIL
CAUSES : 1. ACUTE * BACTERIAL INFECTION : STAPHYLOCOCCUS , STREPTOCOCCUS & ENTEROBACTER, TUBERCULAR, SYPHILITIC * FUNGAL INFECTION - ASPERGILLUS , CANDIDA , COCCIDIOIDES , HISTOPLASMA, PNEUMOCYSTIS * RADIATION THYRODITIS AFTER TREATMENT * DRUG INDUCED - AMIODARONE ( CAN BE SUBACUTE OR CHRONIC ), INTERFERON ALPHA, INTERFERON BETA, INTERLEUKIN-2 2. SUBACUTE * VIRAL ( OR GRANULOMATOUS ) THYROIDITIS * SILENT THYROIDITIS ( INCLUDING POST PARTUM THYROIDITIS ) * MYCOBACTERIAL INFECTION 3. CHRONIC * AUTOIMMUNITY : FOCAL THYROIDITIS , HASHIMOTO THYROIDITIS , ATROPHIC THYROIDITIS( PRIMARY MYXEDEMA), JUVENILE, POSTPARTUM * RIEDELS THYROIDITIS * PARASITIC THYROIDITIS - ECHINOCOCCOSIS , STRONGYLOIDIASIS, CYSTICERCOSIS * TRAUMATIC : AFTER PALPATION* IN DESTRUCTION INDUCED THYRODITIS- RAIU IS LOW & IT IS HIGH IN GRAVES DISEASE & TOXIC NODULAR GOITER * TPO ANTIBODIES - ALWAYS ELEVATED * THROGLOBULIN ANTIBODIES - LESS FREQUENTLY ELEVATED * THYROGLOBULIN LEVELS - MARKEDLY HIGH IN MOST OF CASES
TYPENOTES
Medical Care Adequate analgesia is the unique focus of therapy in subacute granulomatous thyroiditis. In some patients, no therapy is required. In most cases, pain relief is essential. Traditionally, clinicians have used nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with mild cases, reserving corticosteroids for severe disease. Most NSAIDs are comparable in pain relief efficacy. Many authorities believe that corticosteroids are the mainstay of therapy. Prednisolone administered in doses from 30-60 mg per day for a week and then tapered rapidly and withdrawn over 4 weeks is a commonly recommended regimen. Corticosteroids are highly effective, and relief of pain is quick and dramatic. If pain and tenderness do not disappear within 72 hours of the onset of therapy, question the diagnosis of SAT. In 10% of patients, relapse may occur during tapering of steroids, necessitating reinstitution of higher doses and continuation of steroids for another month. For this reason, some physicians try to avoid steroids, reserving them for patients whose symptoms cannot be controlled with NSAIDs. In most instances, symptoms of thyrotoxicosis also are alleviated with glucocorticoids, and no additional therapy is required. Thyrotoxicosis usually is mild, and efforts to reduce serum concentrations of thyroid hormones usually are unnecessary. Beta-blockers may be used if symptoms of adrenergic stimulation are troublesome. Propranolol has the theoretical advantage of inhibiting conversion of T4 to T3 at higher doses. Beta1 selective agents (metoprolol or atenolol) have more convenient dosing and are better tolerated. Thionamides are not indicated because the mechanism of thyrotoxicosis is leakage of hormone from damaged thyroid follicles. In addition, the thyrotoxic symptoms are not responsive to thionamides. When thyrotoxic symptoms are severe or if the patient cannot tolerate beta-blockers, use of ipodate or iopanoic acid, potent blockers of conversion of T4 to T3, has been suggested. At a dose of 500 mg once daily, these drugs rapidly normalize T3 levels and ameliorate the hyperthyroid symptoms. The hypothyroid phase does not require treatment; however, if the patient is symptomatic, levothyroxine may be initiated with successful discontinuation after an arbitrary time of approximately 6 months. Consultations Consultation with an endocrinologist may be beneficial.
RELATED DISEASE
Not Available Disease
Disease
Remarks
THYROIDITIS
INCREASED CHANCES OF ABORTION, PREECLAMPSIA, PRETERM DELIVERY, CHF, PLACENTAL ABRUPTION, POSTPARTUM HGE, THYROID STORM, IUGR, LOW BIRTH WT, CONGENITAL ANOMALIES, POOR NEUROPSYCHOLOGICAL DEVELOPMENT
DISEASE
INVESTIGATION
THYROGLOBULIN, THYROID ANTIBODIES, T3, T4, TSH, FNAC, COMPLETE BLOOD COUNT, ANTI-THYROID PEROXIDASE ANTIBODIES TEST(TPO), THYROID SCAN, MRI, CT SCAN, ULTRA SOUND EXAM, RADIOACTIVE IODINE UPTAKE TEST