Thyroiditis

What is Thyroiditis?

Thyroiditis refers to the "inflammation of thyroid gland" that is located on the front of the neck below the larynx.

The thyroid gland is responsible for producing thyroid hormones which are vital for normal body mechanisms.(1^✔)

What are the Types of Thyroiditis?

There are various forms of thyroiditis namely:

• Hashimoto's Thyroiditis named after Japanese physician Hakaru Hashimoto (1912), is the most common cause of hypothyroidism in the US and also known as autoimmune or chronic lymphocytic thyroiditis. It is commonest cause of hypothyroidism. In India, it is predominantly 5-10 times more in women than men and has a reported prevalence of 1-2% in women.(2^✔)
• Postpartum Thyroiditis causes temporary thyrotoxicosis, followed by temporary hypothyroidism. This is a common cause of thyroid problems after the baby is delivered.
• Silent Thyroiditis is the least common form of thyroiditis. It resembles Hashimoto's thyroiditis and to some extent De Quervain's thyroiditis. Silent thyroiditis is a self limited subacute disorder that commonly affects women during the postpartum period. Initially symptoms of hyperthyroidism are seen, then hypothyroidism and then the affected person recovers to an euthyroid (normal functioning thyroid gland) state. During the hyperthyroid phase, drugs belonging to the category of β-blockers can be used. If hypothyroidism is permanent lifelong supplementation with thyroxine would be required.
• Sub-Acute Thyroiditis (De Quervain's Thyroiditis) is less common than Hashimoto's thyroiditis. In this the gland gets rapidly swollen and becomes painful and tender. Also, the gland discharges thyroid hormone into the blood making the patient hyperthyroid. The gland quits iodine uptake and hyperthyroidism resolves after next several weeks.
• Acute Thyroiditis also known as pyrogenic and bacterial thyroiditis is a rare form and results from direct infection in the thyroid due to neck wound or could be due to the spread of bacterial infection into the thyroid that has occurred elsewhere in the body.(3^✔)
• Drug-induced Thyroiditis is caused by drugs like amiodarone, interferon, lithium and cytokines. This type shows symptoms of hyperthyroidism or hypothyroidism and symptoms continue as long as drug is taken.
• Radiation-induced Thyroiditis is a painful acute form of thyroiditis that results from radioactive therapy used to treat hyperthyroidism or from radiation used to treat lymphoma or head and neck cancer.
• Riedel's Thyroiditis is a rare disease involving fibrosis of thyroid gland.(4^✔, 5^✔)

What are the Causes of Thyroiditis?

There can be numerous causes which can lead to thyroiditis, such as:

• Autoimmune disease, making antibodies against thyroid, e.g. juvenile diabetes rheumatoid arthritis
• Infection, like virus or bacteria
• Drugs like interferon, amiodarone causing damage to the thyroid gland.
• Grave's disease
• Pregnancy: Pregnant women who test positive for thyroid antibodies in their 1st trimester have 30%-50% chances of developing thyroiditis post delivery

• Excess intake of iodine(6^✔)

What are the Symptoms & Signs of Thyroiditis?

Thyroiditis refers to group of disorders than just a single disorder, hence symptoms may differ. Also, it can result in slow, long-term damage to thyroid cell and destruction, causing thyroid hormone levels in the blood to fall. In such cases, symptoms of underactive thyroid (hypothyroidism) are:

• Unexpected weight gain
• Constipation
• Fatigue
• Muscle aches
• Dry skin
• Depression

On the contrary, thyroiditis can also cause rapid damage to the cells, due to which thyroid hormone in the gland leaks out raising thyroid hormone levels in the blood, thus giving rise to hyperthyroidism (overactive thyroid), and symptoms include:

• Rapid heart rate
• Difficulty in getting sleep
• Muscle weakness
• Fatigue
• Weight loss
• Shaking of hands or fingers
• Pain in thyroid gland (in front of the neck)(7^✔)

How Do You Diagnose Thyroiditis?

• Physical Examination
• Laboratory Tests are useful in determining elevated thyroglobulin levels, insufficient uptake of radioactive iodine, the amount of hormone produced by the pituitary gland and antibodies present in the body. Tests included are -
• Thyroid function tests (T3, T4, TSH)
• Radioactive iodine uptake
• Antibody tests
• Biopsy is done to find out the cause for thyroid attack.(8^✔)

How Do You Treat Thyroiditis?

Treatment mode depends on type of thyroiditis and clinical presentation

Hyperthyroidism: If there are symptoms of hyperthyroidism, drugs belonging to the category of beta blockers may be prescribed for lowering heart rate and reducing tremors. As symptoms of hyperthyroidism may be temporary, dose may be tapered once symptoms improve.(9^✔)

Hypothyroidism: If the symptoms of hypothyroidism are experienced, replacing with thyroid hormone may be prescribed for restoring hormone levels and shifting metabolism back to normal. This may take some time for your body to adjust to the right dose and as symptoms improve, your doctor will slowly taper this dose.(10^✔)

Surgery: Thyroid gland surgery is well tolerated and has low complication rates, if performed by an experienced thyroid surgeon.

In rare cases, bleeding in the neck region may occur in about 1/300 thyroid operations. Though the amount of bleeding is very small, if left uncontrolled can compress windpipe and cause breathing difficulty. In such cases, an urgent surgery may be performed to drain the blood and relieve the pressure.

Thyroid Pain: Mild anti-inflammatory medicines like aspirin or ibuprofen may be prescribed for mild pain. For severe thyroid pain, treatment with steroid therapy may be required.

Massage: Therapeutic massage may aid in relieving stress and increase sense of well being.

Thyroid in Pregnancy: Thyroid disorders are very common endocrine disorders in pregnant women. Even a slight hormone deficiency can cause problems with fetus. Hence your doctor will closely monitor the levels of thyroid hormones during this period.

Health Tips

Hypothyroid

• Eat healthy foods such as veggies, fruits, lean protein, whole grains and healthy fats. For keeping your energy levels stable, eat small meals throughout the day. As weight gain is a common symptom in hypothyroidism, eating well will help maintain a healthy weight. High fiber foods and supplements like iron and calcium may affect absorption of levothyroxine. Talk to your doctor before taking these foods and supplements.
• Meditation: Get much needed relief from stress by practicing meditation or deep breathing for at least 5 minutes.
• Sleeping early is much needed if you have hypothyroid as you tend to feel tired throughout the day. Hence go to bed early and wake up at the same time every day. Have at least 7-9 hours of sleep.
• Exercise is good and mix it up with your daily routine as it can boost energy, reduce stress and help maintaining a healthy weight (especially for hypothyroidism). Consider doing exercises for strengthening and flexibility. Try out weight lifting and yoga. But, talk to your doctor before starting.

Hyperthyroid

• Get your symptoms under control.
• Modify your lifestyle by eating well and refrain from consuming refined foods and sugars, have 7-8 hours of sleep every day, exercise regularly, minimize exposure to environmental toxins.
• Consider having nutritional supplements and herbs like iodine, magnesium, vitamin D, eleuthero, bugleweed, and motherwort.
• Keep a good positive attitude.(11^✔)

References:

1. Thyroiditis - National Health Services (NHS) - (https://www.nhs.uk/conditions/thyroiditis/)
2. Hashimoto Thyroiditis - (https://ghr.nlm.nih.gov/condition/hashimoto-thyroiditis#genes)
3. Acute Infectious Thyroiditis - (https://en.wikipedia.org/wiki/Acute_infectious_thyroiditis)
4. Thyroiditis - American Thyroid Association - (http://www.thyroid.org/thyroiditis/)
5. Thyroiditis - American Academy of Family Physicians - (https://www.aafp.org/afp/2006/0515/p1769.html)
6. Thyroiditis - (https://www.thyroid.org/wp-content/uploads/patients/brochures/Thyroiditis.pdf)
7. Thyroiditis - Family Doctor Organization - (https://familydoctor.org/condition/thyroiditis/)
8. About Thyroiditis - (https://en.wikipedia.org/wiki/Thyroiditis)
9. Beta Blockers in the Treatment of Hyperthyroidism - (https://www.ncbi.nlm.nih.gov/pubmed/18193813)
10. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409/)
11. Healthy Eating for a Healthy Thyroid - (https://www.health.harvard.edu/staying-healthy/healthy-eating-for-a-healty-thyroid)

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