Subacute thyroiditis
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Subacute thyroiditis
Painless silent, autoimmune subacute thyroiditis PLSAT occurs spontaneously or following pregnancy when it is referred to as postpartum thyroiditis [PPT]. Autoimmune thyroiditis is histologically similar to Hashimoto's thyroiditis and occurs following 3. The combination of thyroid enlargement usually without discomfort and, positive anti-thyroid antibodies, associated with typical thyroid function test abnormalities see figure 1 , over a month course should alert the clinician to the presence of PLSAT.
In both forms, clinical thyroid symptoms result from either the initial release of thyroid hormone from the inflamed tissue during the thyrotoxic phase or the lack of circulating thyroid hormones in the hypothyroid phase See figure 1. Medications associated with SAT outlined in table 4.
Figure 1. Anterior neck pain, preceded by an upper respiratory inflammation, alerts the clinician to the classic PFSAT.
Thyroid function tests see table 3 during the painful initial phase of SAT often reveal a suppressed TSH and elevation of total T4 and T3 levels consistent with the thyrotoxic state.
Ectopic thyroid hormone production in a Struma Ovarii or functional metastatic thyroid cancer can be detected with total body scanning. A recent CT scan will frequently alert the clinician to this artifact. Urine iodine measurement can quantify the degree of iodine contamination present. The presence of thyroid nodules supports the presence of a toxic nodular goiter. Usually the pain, elevated erythrocyte sedimentation rate and leukocytosis, and clinical remission or spread to other parts of the gland make clinical differentiation possible but may require a fine needle aspiration for definitive diagnosis.
The pain may shift from one side of the neck to the other, spread to the jaw and ears, and hurt more when the head is turned or when the person swallows.
Subacute thyroiditis is often mistaken at first for a dental problem or a throat or ear infection. The two halves lobes of the gland are connected Sometimes, it may difficult to differentiate subacute thyroiditis from Graves disease Graves disease Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions.
Graves disease is the most common cause of hyperthyroidism Because of the inflammation, little or no radioactivity is taken up by the thyroid gland in subacute thyroiditis while uptake is increased in Graves disease. Thyroid ultrasonography can also help diagnose subacute thyroiditis. Treatment of Subacute Thyroiditis Sometimes drugs to relieve pain and inflammation Most people recover completely from this type of thyroiditis.
Approximately one-half of the patients present during the first weeks of the illness, with symptoms of thyrotoxicosis. Subsequently patients often experience hypothyroidism before returning to normal see figure 1. This painful condition lasts for a week to a few months, usually demonstrates a very high erythrocyte sedimentation rate ESR , elevated C- reactive protein CRP levels and has a tendency to recur.
Painless silent, autoimmune subacute thyroiditis PLSAT occurs spontaneously or following pregnancy when it is referred to as postpartum thyroiditis [PPT]. Autoimmune thyroiditis is histologically similar to Hashimoto's thyroiditis and occurs following 3. The combination of thyroid enlargement usually without discomfort and, positive anti-thyroid antibodies, associated with typical thyroid function test abnormalities see figure 1 , over a month course should alert the clinician to the presence of PLSAT.
In both forms, clinical thyroid symptoms result from either the initial release of thyroid hormone from the inflamed tissue during the thyrotoxic phase or the lack of circulating thyroid hormones in the hypothyroid phase See figure 1.
Medications associated with SAT outlined in table 4. Therapies that fit this category include: Zinc - Zinc is known to play a role in regulating your immune system 10 and can be used during acute illness to potentially help improve your healing time. Many people in the US are also deficient in this mineral which makes supplementing a no-brainer for many people. Low levels of Vitamin D have been linked to autoimmune disease Fish oil - Fish oil is a potent anti-inflammatory agent 12 which may help to "calm down" the inflammation in your thyroid gland.
Using up to grams per day may help. Ginger - Garlic is known for its ability to fight off both bacterial and viral infections 13 and is used in many at home remedies.
Allicin, found within garlic, may be responsible for these benefits. Oregano - Oregano can be used both as an anti-bacterial and anti-viral remedy 14 and may be as potent as some antibiotics at killing off certain bugs. Oregano contains carvacrol which may help kill off viruses, such as those which trigger thyroiditis. While these treatments have not been proven to work they may be both effective and inexpensive remedies which have the potential to help. During the hypothyroid phase, you can also consider using certain combination supplements such as this , which may help promote thyroid function by providing your body with vitamins and nutrients.
Conclusion Subacute thyroiditis is an inflammatory condition of the thyroid gland which results in both hypothyroid and hyperthyroid symptoms. This condition is thought to be triggered by a viral infection and is usually self-limiting which means your body will heal on its own in a matter of months.
Typically, no treatment is required if you have this condition but you may find relief in using certain natural therapies to expedite the healing process. Subacute thyroiditis can be diagnosed through basic and routine thyroid lab tests as well as a comprehensive medical history by your Doctor. Now I want to hear from you: Are you suffering from subacute thyroiditis?
Do you suspect you have some sort of inflammatory condition of your thyroid gland? Have your symptoms subsided? Leave your comment or questions below! Symptoms include fever and thyroid tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism. Diagnosis is clinical and with thyroid function tests.
Treatment is with high doses of nonsteroidal anti-inflammatory drugs or with corticosteroids. The disease usually resolves spontaneously within months. History of an antecedent viral upper respiratory infection is common in patients with subacute thyroiditis. Histologic studies show less lymphocytic infiltration of the thyroid than in Hashimoto thyroiditis Hashimoto Thyroiditis Hashimoto thyroiditis is chronic autoimmune inflammation of the thyroid with lymphocytic infiltration.
Findings include painless thyroid enlargement and symptoms of hypothyroidism. Symptoms are initially of hyperthyroidism, then hypothyroidism Symptoms and Signs of Subacute Thyroiditis There is pain in the anterior neck and fever.
What is Subacute Thyroiditis
This phase lasts approximately weeks as your body recovers and restores the damage done to your thyroid gland. This is important because all 3 may have some overlap in how they present. Graves' disease is a condition which is progressive meaning it gets worse over time whereas subacute thyroiditis will almost always naturally improve without any therapies. The presence of antibodies to your thyroid gland indicates an autoimmune thyroiditis such as Graves' disease or Hashimoto's. There are actually 3 main types of subacute thyroiditis recognized by medical professions: Subacute granulomatous thyroiditis 6 subacute This condition is almost always the result of a viral infection and tends to go away on its own in a matter of weeks to months. Slow heart rate Dry skin By this point, your fever and chills should have subsided and the pain in your thyroid gland should be reduced.
CLINICAL RECOGNITION
Thyroid antibody Tests - Thyroid antibody tests should be ordered to help differentiate between Hashimoto's Thyroiditis, Graves' disease and subacute thyroiditis. Diagnosis of Subacute Thyroiditis Free thyroxine T4 and thyroid-stimulating hormone TSH levels Erythrocyte sedimentation rate ESR Radioactive iodine uptake Diagnosis is primarily clinical, based on finding an enlarged, tender thyroid in patients with the appropriate clinical history. When symptoms of hyperthyroidism are severe, a beta-blocker may be recommended. Pain may radiate to the jaw or the ears. Symptoms include fever and thyroid tenderness.
Subacute Thyroiditis Guide: Recovery Time, Treatment, Diagnosis & More
This resolved spontaneously within 5 months without levothyroxine replacement. We hope that our case will add to the growing literature of cases of thyroiditis occurring after multiple different types of SARS-CoV-2 vaccination and create awareness of this rare but treatable adverse effect.
We also review the literature on the proposed mechanisms behind this adverse effect. Symptoms are initially of hyperthyroidism, then hypothyroidism Symptoms and Signs of Subacute Thyroiditis There is pain in the anterior neck and fever. Neck pain characteristically shifts from side to side and may settle in one area, frequently radiating to the jaw and ears. It is often confused with dental pain, pharyngitis, or otitis and is aggravated by swallowing or turning of the head.
Symptoms of hyperthyroidism are common early in the disease because of hormone release from the disrupted follicles. There is more lassitude and prostration than in other thyroid disorders. On physical examination, the thyroid is asymmetrically enlarged, firm, and tender. Diagnosis of Subacute Thyroiditis Free thyroxine T4 and thyroid-stimulating hormone TSH levels Erythrocyte sedimentation rate ESR Radioactive iodine uptake Diagnosis is primarily clinical, based on finding an enlarged, tender thyroid in patients with the appropriate clinical history.
Thyroid testing with TSH and at least a free T4 measurement is usually also done. Radioactive iodine uptake should be measured to confirm the diagnosis. In both forms, clinical thyroid symptoms result from either the initial release of thyroid hormone from the inflamed tissue during the thyrotoxic phase or the lack of circulating thyroid hormones in the hypothyroid phase See figure 1.
Medications associated with SAT outlined in table 4. Figure 1. Anterior neck pain, preceded by an upper respiratory inflammation, alerts the clinician to the classic PFSAT. Thyroid function tests see table 3 during the painful initial phase of SAT often reveal a suppressed TSH and elevation of total T4 and T3 levels consistent with the thyrotoxic state. Ectopic thyroid hormone production in a Struma Ovarii or functional metastatic thyroid cancer can be detected with total body scanning.
A recent CT scan will frequently alert the clinician to this artifact. Urine iodine measurement can quantify the degree of iodine contamination present.
This resolved spontaneously within 5 months without levothyroxine replacement. We hope that our case will add to the growing literature of cases of thyroiditis occurring after multiple different types of SARS-CoV-2 vaccination and create awareness of this rare but treatable adverse effect.
We also review the literature on the proposed mechanisms behind this adverse effect. Learning points: Subacute thyroiditis is an inflammatory disorder of the thyroid gland that can occur after a viral illness or vaccination against certain infections.
Subacute thyroiditis is a rare adverse effect that has been reported to occur after different types of SARS-CoV-2 vaccinations.
Ultrasound of the thyroid gland - An ultrasound of the thyroid gland may be helpful. If you have subacute thyroiditis your thyroid gland may be slightly enlarged during the inflammatory phase. Inflammatory Markers - Markers such as ESR and CRP may be elevated during the inflammatory phase and can help identify an inflammatory disorder in the body. Medical History - Your medical history is very important for diagnosis because it can help your Doctor determine the cause of your problem.
Many thyroid inflammatory diseases have overlap in their symptoms but they all have unique characteristics which can your doctor differentiate between them. Types of Subacute Thyroiditis It's very important for your Doctor to identify that you have subacute thyroiditis, and not another form of thyroiditis or thyroid disease because this condition typically does not require any treatment. This has to do with the fact that you may present at different times in the progression of your disease.
Remember: In the beginning you will experience the symptoms of hyperthyroidism, then you will experience the symptoms of hypothyroidism and lastly, you will return to normal thyroid function. When you go to your Doctor will determine how your labs look and whether or not you fit into the "hyperthyroid" or "hypothyroid" category.
There are actually 3 main types of subacute thyroiditis recognized by medical professions: Subacute granulomatous thyroiditis 6 - This condition is almost always the result of a viral infection and tends to go away on its own in a matter of weeks to months. This condition is differentiated from other causes because it is often associated with a thyroid gland which is very painful.
Subacute lymphocytic thyroiditis 7 - This condition is also referred to as "painless thyroiditis" and can be immediately differentiated from granulomatous thyroiditis by this factor alone.
This condition has an overlap between subacute thyroiditis and Hashimoto's thyroiditis and may represent a condition on the autoimmune spectrum of thyroid disease. Subacute postpartum thyroiditis 8 - Subacute postpartum thyroiditis can be differentiated from the other two forms of thyroiditis because it tends to occur in the postpartum period after pregnancy.
This condition, like lymphocytic thyroiditis, may be on the autoimmune spectrum as they share similar findings when evaluated under a microscope. Don't let these types discourage you or scare you because, regardless of which type you have, they almost always go away on their own and without treatment. Subacute Thyroiditis vs Graves' Disease Subacute thyroiditis should be differentiated from the autoimmune condition Graves' disease at the time of diagnosis.
Both of these conditions may present with similar clinical symptoms but they can be differentiated on a few important points. The first is that subacute thyroiditis is usually associated with thyroid pain and Graves' disease is not. The second is that subacute thyroiditis is NOT associated with positive antibodies in the serum while Graves' disease usually is 9.
These points must be checked and evaluated early on in the progression of your symptoms because these two conditions are treated differently. Graves' disease is a condition which is progressive meaning it gets worse over time whereas subacute thyroiditis will almost always naturally improve without any therapies.
Graves' disease also may require treatment such as the use of thyroid blocking medications, thyroid surgery or radioactive iodine ablation of the thyroid gland. Because of the overlap between these two conditions your Doctor should take caution when testing and diagnosing your condition. Natural Treatment Options Is there any way to reduce the amount of time it takes to heal your thyroid if you have subacute thyroiditis? The answer is maybe, but these therapies have not been "proven" through clinical studies.
Even though they are not "proven" there is anecdotal evidence meaning opinions from others who have had the disease that they may provide relief in some cases.
If you want to take a natural approach to treat your condition you should focus on supplements and therapies designed to enhance your immune system and those which may be effective in killing off viruses. Therapies that fit this category include: Zinc - Zinc is known to play a role in regulating your immune system 10 and can be used during acute illness to potentially help improve your healing time.