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thyroiditis

Thyroiditis: A Comprehensive Review

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

Medical Director, Journal of Current Clinical Care and www.healthplexus.net, Adjunct Clinical Lecturer, Departments of Medical Imaging and Family Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Thyroiditis encompasses a spectrum of inflammatory conditions affecting the thyroid gland, presenting significant diagnostic and therapeutic challenges for clinicians. This comprehensive review examines the major classifications, pathophysiology, clinical manifestations, and current diagnostic approaches to thyroiditis, with particular emphasis on ultrasonographic features. The article provides detailed treatment strategies for various forms of thyroiditis, ranging from conservative management to hormone replacement therapy, while emphasizing the importance of individualized treatment approaches based on disease type and severity. Understanding the diverse presentations and appropriate diagnostic pathways is crucial for optimal patient outcomes in thyroid disease management.
Key Words: thyroiditis, thyroid ultrasound, autoimmune thyroid disease, thyroid inflammation.
Thyroiditis presents in multiple forms (including Hashimoto’s, subacute, silent, postpartum, acute suppurative, and Riedel’s), with Hashimoto’s being the most common and characterized by autoimmune-mediated lymphocytic infiltration leading to progressive thyroid destruction.
The clinical presentation often follows a biphasic pattern: an early thyrotoxic phase (with symptoms like anxiety, palpitations, and heat intolerance) followed by a hypothyroid phase (characterized by fatigue, cold intolerance, and weight gain).
Diagnostic evaluation relies on a combination of laboratory testing (thyroid function tests, antibodies, inflammatory markers) and imaging, with ultrasound being the primary imaging modality due to its non-invasive nature and excellent visualization capabilities.
Each type of thyroiditis has distinct ultrasound characteristics - for example, Hashimoto’s shows a “Swiss cheese” appearance with multiple micronodules, while subacute thyroiditis presents with a “geographic” or “map-like” appearance of poorly defined hypoechoic areas.
Serial ultrasound measurements are valuable for monitoring disease progression and treatment response, but clinicians should be aware of its limitations, including operator dependency and variable appearance in different disease phases.
Treatment approaches should be tailored to the specific type of thyroiditis - while Hashimoto’s typically requires lifelong hormone replacement, subacute thyroiditis is often self-limiting and may only need symptomatic treatment with NSAIDs or corticosteroids.
The presence of enlarged cervical lymph nodes with preserved fatty hilum in Hashimoto’s thyroiditis is a normal finding and shouldn’t necessarily trigger concern, but long-term surveillance is important due to the small risk of thyroid lymphoma development in chronic cases.
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Related Terms: Radiology, thyroiditis, thyroid ultrasound, autoimmune thyroid disease, thyroid inflammation
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